Metformin or Antiandrogen in the Treatment of Hirsutism in Polycystic Ovary Syndrome

In a study involving 52 women with polycystic ovary syndrome (PCOS) and hirsutism, the efficacy of metformin (500 mg, three times daily) was compared to the established treatment of combined ethinyl estradiol and cyproterone acetate (Dianette) over a 12-month period. The study used both objective and subjective methods to evaluate hirsutism, including the Ferriman-Gallwey score and patient self-assessment. The results indicated that metformin could be an effective treatment for moderate to severe hirsutism in PCOS patients and, in some aspects, was more efficacious than Dianette. Both treatments moderately reduced hair diameter at multiple anatomical sites. While Dianette significantly suppressed androgen activity, metformin had a negligible effect on androgens but did reduce markers of insulin resistance, suggesting that targeting hyperinsulinemia may be a viable approach to treating hirsutism.