Use of GnRH agonists in the treatment of hyperandrogenism and hirsutism
- Jeffrey Chang, MD
Jeffrey Chang, MD
- University of California, San Diego
- Section Editors
- Robert L Barbieri, MD
Robert L Barbieri, MD
- Editor-in-Chief — Obstetrics, Gynecology and Women's Health
- Section Editor — General Gynecology and Female Reproductive Endocrinology
- Kate Macy Ladd Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- William F Crowley, Jr, MD
William F Crowley, Jr, MD
- Section Editor — Female Reproductive Endocrinology
- Daniel K Podolsky Professor of Medicine
- Harvard Medical School
Hyperandrogenism and hirsutism in women are most commonly due to idiopathic hirsutism and the polycystic ovary syndrome (PCOS). The options for drug therapy for these women are oral contraceptives, antiandrogens, and gonadotropin-releasing hormone (GnRH) agonists. Consideration of GnRH agonist therapy is based upon the assumption that the hyperandrogenism is at least in part gonadotropin-dependent, because the action of chronic GnRH agonist therapy (as opposed to physiologic endogenous pulsatile GnRH secretion) is to inhibit luteinizing hormone (LH) and to a lesser extent follicle-stimulating hormone (FSH) secretion, thereby leading to a decline in ovarian function and consequently ovarian androgen production (figure 1). (See "Physiology of gonadotropin-releasing hormone".)
The role of GnRH agonist therapy in women with hyperandrogenism and hirsutism will be reviewed here. Any therapy that decreases androgen production, such as the administration of a GnRH agonist, must be continued for at least six months before its efficacy can be judged. Decreasing androgen secretion slows the growth of new hair follicles, but has little effect on existing ones, which must complete their life span before the hair is lost. Other therapies for hirsutism are reviewed separately. (See "Treatment of hirsutism".)
Gonadotropin-releasing hormone (GnRH) agonist therapy should be considered for those women with ovarian hyperandrogenism who do not respond adequately to oral contraceptive therapy with or without an antiandrogen such as spironolactone (see "Treatment of hirsutism", section on 'Treatments not recommended'). This situation is most likely to occur in women who have marked menstrual disturbances and signs of virilization in addition to hirsutism. Unlike women with hirsutism alone, these women usually have unequivocal increases in serum testosterone concentrations and polycystic ovary syndrome (PCOS) or ovarian hyperthecosis. (See "Pathophysiology and causes of hirsutism".)
The reasons for not using a GnRH agonist as primary therapy include:
●GnRH agonist therapy alone causes severe hypoestrogenism, and therefore estrogen-progestin supplementation must be given if therapy is continued for more than a few months, as is necessary in women with hyperandrogenism.
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