A Cochrane review [Abstract] 1 included 44 trials involving a total of 2253 women. Metformin was less effective in improving hirsutism compared to combined oral contraceptives (COC) in the subgroup BMI 25 kg/m² to 30 kg/m² (MD 1.92, 95% CI 1.21 to 2.64, 5 RCTs, n = 254), but there were no clear difference in the subgroup BMI under 25. Either metformin alone or COC alone may be less effective in improving hirsutism compared to metformin combined with COC. Metformin resulted in a higher incidence of gastrointestinal and a lower incidence of non-gastrointestinal severe adverse effects requiring stopping of medication.
A comparative study 2 divided women with polycystic ovary syndrome (PCOS) either to receive COC containing 3 mg drospirenone/30 mcg EE (ethinylestradiol) (DRSP group, n=60) or 2 mg chlormadinone acetate/30 mcg EE (CMA group, n=60). After 6 months of continuous treatment, a significant improvement was observed in hirsutism in both groups, the drop in Ferriman-Gallwey score was around 8 units (scale 0 to 36). also in acne lesions (scale 0-3) the imrovement was significant: with DRSP from2.32 ± 0.89to 0.31 ± 0.78 and with CMA 2.32 ± 0.89 to0.45 ± 0.98. Among glucose, insulin levels and HOMA-IR, there were statistically significant higher levels and the hormonal parameters (LH, FSH, prolactin, testosterone and DHEA-S) were statistically significant lower in both groups.
Comment: The quality of evidence is downgraded by study quality (lack of blinding, inadequate intention-to-treat) and by imprecise results (few patients and wide confidence intervals).
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