4. Treatment

Finasteride is a 5α-reductase inhibitor and may decrease DHT levels by 50–60%. Significant anti-androgenic effects were shown after 6 months of treatment at 5 mg/day dose [20, 21]. The use of 5α-reductase inhibition therapy should be considered when the previous therapy with oral contraceptive and spironolactone is relatively ineffective [22]. Dutasteride, another antiandrogen molecule which has limited data, reduces plasma DHT more significantly than finasteride and inhibits the conversion of testosterone to dihydrotestosterone by the inhibition

Metformin is an alternative therapy for hirsutism in women with PCOS who have other indications for the use of metformin. This oral antidiabetic drug is useful for metabolic and glycemic anomalies and for the treatment of menstrual irregularities, but less effective than

It should be remembered that hirsutism treatment is a continuing treatment that the medical treatment response does not occur 6 months before the hair cycle and individualization of the

PCOS commonly presents in the adolescence; underestimation may be more in this period because of some confounding factors such as acne, menstrual irregularities, and hirsutism [25]. These factors may also be observed in normal puberty thus misdiagnosis may be common. Anovulatory cycles and menstrual irregularities with variable cycle length are common during first years following menarche due to the immaturity of the hypothalamic-pituitary-ovarian axis. Additionally, large, multicystic ovaries in adolescents may also be considered normal as a result of natural ovarian development. It may be acceptable to clinically follow the patient for

Hyperandrogenism leading to acne and hirsutism may be associated with normal puberty rather than underlying PCOS, and hyperinsulinemia is a characteristic of normal puberty. Furthermore, ranges of laboratory values for the hyperandrogenemia and Ferriman-Gallwey scoring system are established for adults and may not be of similar clinical importance in

On the other hand, symptoms in adolescents are heterogeneous and may change over time,

In conclusion, clinical findings for PCOS in adolescents can be confusing and laboratory measurements are important. Lower and upper bounds of testosterone are not clear in young

A relationship between PCOS and malignancy has been reported in the literature, but this relationship is not strong. The altered metabolic and hormonal environment among women

antiandrogens for the treatment of both hirsutism and acne [22, 24].

2–3 years in terms of defining the over dysfunction in adolescents [26].

of 5α-reductase isoenzymes [23].

16 Debatable Topics in PCOS Patients

treatment are necessary.

adolescence.

girls [25, 27].

PCOS diagnosis may be overlooked.

with PCOS may increase the risk of some types of cancer.

2.4. PCOS and malignancy

2.3. PCOS in the adolescent

Lifestyle changes, local treatment approaches, and pharmacological treatment will review under the heading of treatment.

In cases with PCOS, lifestyle modification resulting from medical nutrition therapy and exercise is effective in improving clinical signs and symptoms of hyperandrogenemia. With lifestyle changes, SHBG levels increase as serum androgen levels decrease as a result of weight loss. Stop smoking is also important to reduce the complications of oral contraceptive use [33].

Local treatment; hair removal methods such as hair bleaching, tearing, shaving, waxing, electrolysis, laser hair removal, and local drug application such as eflornithine are used. It can be applied as a single treatment in the case of localized small incisions. Medical treatment is applied when waiting for the response. It has been shown that shaving does not increase the formation of new hair, and it should be explained that the illness should not underestimate this concern. It has been shown that laser epilation can treat up to 2 years hirsutism in randomized controlled trials. Since hair follicle stimulation continues in hyperandrogenic women, hair growth after laser epilation repeats. About 13.9% eflornithine topical cream inhibits DNA synthesis by inhibiting ornithine decarboxylase enzyme and suppresses the mitotic activity of the hair follicle. Terminal hair growth begins again when the drug is stopped.

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[4] Dewailly D et al. Definition and significance of polycystic ovarian morphology: A task force report from the androgen excess and polycystic ovary syndrome society. Human

[5] The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic

[6] Goodman NF, Cobin RH, Futterweit W, Glueck JS, Legro RS, Carmina E. American Association of Clinical Endocrinologists, American College of Endocrinology, and androgen excess and PCOS society disease state clinical review: Guide to the best practices in the evaluation and treatment of polycystic ovary syndrome-part 1. Endocrine Practice.

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Patients with polycystic ovarian syndrome are referred to clinics of dermatology with cutaneous androgenesis findings such as hirsutism, acne, and alopecia. For this reason, pharmacological treatment is often required to treat hyperandrogenemia. It should be remembered that hirsutism treatment is a continuing treatment, which the medical treatment response does not occur 6 months before the hair cycle and individualization of the treatment is necessary. Treatment may not be necessary for the patients who do not worry about hirsutism, planning to be pregnant, and regular menstrual cycles. OCSs are used as the only medication in mild hirsutism cases, while OCSs are used in combination with other antiandrogen drugs in severe and moderate hirsutism. Hirsutism adolescent girls respond perfectly to medical treatment. The combination of spironolactone and an oral contraceptive provides effective medical treatment. This combination also improves spironolactone-related menstrual irregularities. If there is no response after 6 months of treatment, the treatment should be changed. The combination of mechanical and medical treatment provides a rapid and effective remedy. The average duration of treatment is 2–3 years. Because the underlying cause is persistent, local or drug treatment does not completely cease, and the complaints start again after the treatment is discontinued.

Insulin-sensitizing drugs (metformin and pioglitazone) are used in the treatment of hyperandrogenemic patients with severe insulin resistance syndrome. It should not be used as a primary treatment in incontinent cases. Metformin is preferred for patients with PCOS with glucose intolerance. In these cases, metformin may contribute to other treatments on hirsutism. Glitazones are not recommended for treatment of hirsutism due to possible cardiovascular side effects. It is the first choice in the treatment of menstrual and ovulatory dysfunction, especially in obese cases of lifestyle change and weight loss.
