Help for hirsutism
TANYA WOOD, MD, of Boiestown, NB, queries: "A 40-year-old woman with polycystic ovary syndrome (PCOS) had a hysterectomy with bilateral oophorectomy but still notes hirsutism and obesity. Does oophorectomy cure the disorder? Should she be given hormone therapy to clear up the hormonal imbalance causing the hirsutism? What other good options can you suggest?"
The association between polycystic ovary syndrome and hyperandrogenic signs like hirsutism, male pattern hair loss and acne is well known. Less commonly recognized is the fact that PCOS can be either a primary or a secondary process. It may occur as a result of insulin resistance. For example, the obesity may be due more to the high insulin levels than to the ovarian hormones. A check of serum insulin levels is useful and metformin or the thiazolinediones will help correct the imbalance.
Although removal of the ovaries might reduce the production of androgenic steroids, it may not eliminate all the stigmata of hyperandrogenism. I find that hormone replacement therapy has no benefit on these signs. Hirsutism is a very slow process to correct. It could take up to one year for the coarseness and volume of hair to decrease. Patients with a balanced hormonal state and excessive hair may benefit from hair removal through a variety of methods. GS