Search

Objective To evaluate idiopathic hirsutism etiology via molecular studies testing peripheral and local aromatase and 5α-reductase expression. Design Assessment of the expression of messenger RNA (mRNA) for type 1 and 2,5α-reductase isoenzyme gene ( SDR5A1, SDR5A2 ) and aromatase ( CYP19A ) in dermal papillae cells and peripheral blood mononuclear cells. Setting University hospital. Patient(s) 28 untreated idiopathic hirsute patients and 20 healthy women (controls). Intervention(s) Human skin biopsies and peripheral venous blood. Main Outcome Measure(s) SDR5A1, SDR5A2, CYP19A gene expression in skin biopsies and peripheral blood. Result(s) A statistically significant reduction of SRD5A1, SRD5A2 , and CYP19A gene expression was found in the dermal papillae cells and peripheral blood mononuclear cell between the study and control group. Conclusion(s) Further study, including protein expression and enzyme activity assays, are warranted to characterize the paradoxically low gene expression levels of local 5α-reductase and aromatase in women with idiopathic hirsutism.

Objective To compare the effectiveness of oral and vaginal misoprostol for preoperative cervical ripening in premenopausal women before hysteroscopic surgery. Design Placebo-controlled, double blind, randomized trial. Setting University hospital. Patient(s) Eighty-six premenopausal women eligible for operative hysteroscopy were recruited. Nine women were excluded from the study. Intervention(s) Patients were randomly assigned to receive 400 μg of misoprostol orally (n = 39) or vaginally (n = 38), 10–12 hours before operative hysteroscopy. Main Outcome Measure(s) Extent of initial cervical width, percentage of patients requiring cervical dilatation, duration of cervical dilatation and surgical procedure, complications during procedure, and associated side effects. Result(s) Mean cervical widths in the vaginal and oral misoprostol groups after treatment were 7.3 ± 1.6 mm and 6.0 ± 1.5 mm, respectively, which was a statistically significant difference. Time required for cervical dilatation (98.6 ± 88.7 s vs. 49.1 ± 34.9 s) and duration of surgery (14.5 ± 6 vs. 7.7 ± 4.0 min) was statistically significantly shorter in the vaginal misoprostol group. The percentage of women with an initial cervical width of 9 mm was statistically significantly higher in the vaginal misoprostol group (36.8% vs. 5.1%). Uterine perforation occurred in two patients in the oral misoprostol group and in none in the vaginal misoprostol group. Side effects were comparable between the two treatment groups. Conclusion(s) Vaginal administration of misoprostol is more effective than the oral route for preoperative cervical ripening in premenopausal women.

Objective This study represents long term clinical and biochemical results and the response of different body parts to medical therapy with oral ethinyl estradiol/drospirenone combination in hirsute patients with or without polycystic ovary syndrom (PCOS). Design Prospective, open, controlled clinical study. Setting Outpatients at Erciyes University Medical School. Patient(s) Fifty women with moderate to severe hirsutism were recruited. Two women were lost to follow-up. Intervention(s) Women were treated with 3 mg of drospirenone and 30 μg of ethinyl estradiol for 12 cycles. Main Outcome Measure(s) Hirsutism was assessed at 6-month intervals using the Ferriman-Gallwey (F-G) scoring system. Serum FSH, LH, total and free testosterone (T), androstenedione (A), dehydroepiandrosterone sulfate (DHEAS), estradiol (E 2 ), and sex-hormone binding globulin (SHBG) levels at 6 and 12 months of therapy were compared with baseline values. Result(s) Total mean FG score declined by 67% and 78% after 6 and 12 months, respectively. Improvement was most prominent on the chest and abdomen, followed by the upper lip and chin. The lowest effect was observed on the back and arms. Serum levels of total and free T and A decreased, whereas SHBG levels increased significantly after 6 and 12 months when compared with baseline levels. Conclusion(s) Drospirenone/ethinyl estradiol combination exerts significant antiandrogenic activity and is effective in improving facial hirsutism. The beneficial effect is most obvious after six cycles and continues thereafter at a slower rate.