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Hum. Reprod. Advance Access published online on December 14, 2007
Human Reproduction, doi:10.1093/humrep/dem379
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© The Author 2007. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Opinion

Cyproterone acetate/ethinyl estradiol for acne and hirsutism: time to revise prescribing policy

Stephen Franks1,4, Alison Layton2 and Anna Glasier3

1 Professor of Reproductive Endocrinology, Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Hospital, London W12 0NN, UK 2 Consultant Dermatologist, Harrogate and District NHS Foundation Trust, Harrogate District Hospital, Lancaster Park Road, Harrogate, North Yorkshire, HG2 7SX, UK 3 Lead Clinician for Sexual Health NHS Lothian and Honorary Professor, Universities of Edinburgh and London, 18 Dean Terrace, Edinburgh EH4 1NL, UK

4 Correspondence address. E-mail: s.franks{at}imperial.ac.uk

Clinical manifestations of androgen excess—hirsutism, acne and alopecia—are very common and distressing symptoms in women of reproductive age. These symptoms are frequently associated with polycystic ovary syndrome, in which condition menstrual disturbances are also common. The combination of the anti-androgen cyproterone acetate (2 mg) and ethinyl estradiol (35 µg) (co-cypridiol) is of proven efficacy in management of symptoms of both hyperandrogenism and menstrual abnormalities but its long-term use has been discouraged because of concern about increased risk of venous thromboembolism. In this article, we review the evidence for efficacy and adverse effects and conclude that its benefits are clear and that the risks of venous thromboembolism are no more common that with the use of third generation combined oral contraceptives.

Key words: anti-androgen/oral contraceptive/venous thromboembolism/polycystic ovary syndrome


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