Hormonal contraception and hyperandrogenias (acne, hirsutism, alopecia)

Abstract

Hyperandrogenism in women is defined as the set
of symptoms resulting from excessive production
of androgens. Clinically, hirsutism, acne, and more
rarely androgenic alopecia are the most common.
The origin of hyperandrogenism may be ovarian,
adrenal, iatrogenic or idiopathic. In 4 out of 5 cases,
a polycystic ovary syndrome is identified. In cases of
mild to moderate hyperandrogenism, combined oral
contraceptives is the first-line treatment in the absence
of contraindication. In cases of severe hyperandrogenism, cyproterone acetate combined with an estrogen
is the treatment of choice, respecting the new precautionary measures related to the risk of meningioma.
As a second line treatment, spironolactone may be
prescribed off-label, with an effective contraception.