Antiandrogen cyproterone acetate as an alternative treatment for polycystic ovary syndrome, acne and hirsutis in adolescence

Period of adolescence has been identified as age group of otherwise healthy population, but at risk. During maturational processes of hypothalamo-pituitary-ovarian axis menstrual dysfunction and anovulatory cycles are common and often short lived; yet in some cases they may lead into persistent hyperandrogenism like PCOS, acne and hirsutism. In the Adolescent Clinics in National University Hospital and School Health Services long follow-up of cases with menstrual disorders has been conducted, also relating to 150 adolescents with PCOS, 52% of them had acne and hirsutism. Uniform investigations of patients included clinical features, hormonal investigations, ultrasound findings and psychological screening. Typical features for the group, treatment options and prognosis for future reproductive abilities are discussed in detail. The majority of patients (82.6%) were treated with anti-androgen cyproterone acetate in a preparation containing 2 mg + 35 ug ethinyl Estradiol in three weeks course per month. Following treatment acne resolved completely or showed visible improvement in 93.7%. Varying degree of improvement in hirsutism were noted in 60.8% of girls. Importantly cyclic function either was normalised or improved in 62.7% of girls. However the situation remained unchanged in 11.3% and in 26% worsened. In our opinion complete management of adolescent PCOS should include medical correction of hormonal disbalance, body weight correction and psychological intervention to ensure healthy adulthood and normal reproductive function. Implications of hyperandrogenism in adolescence are multifaceted. Immediate concerns are menstrual irregularities, hirsutism and acne associated with PCOS, but long standing possible hazards in adult life are impaired fertility, oestrogen dependent maJignancies and insulin resistance related conditions. In addition to mentioned health hazards it has become clear that adolescent girls with PCOS show low self-esteem and high degrees of psychological distress.