(225) Unveiling the Impact of Spironolactone in Women with PCOS: Beyond Its Anti-androgen Properties - Insights from a Systematic Review and Meta-analysis

Background: The use of Spironolactone as a treatment for hirsutism and various dermatological conditions in individuals with polycystic ovary syndrome (PCOS) and idiopathic hirsutism has yielded diverse outcomes.

Objectives: This study aims to comprehensively summarize the collective evidence to provide a clearer definition of its influence on the Ferriman-Gallwey (FG) score, along with other associated disturbances linked to PCOS.

Methods: Searches were conducted in PubMed, Embase, Scopus, and pertinent article references. This included the inclusion of randomized controlled trials (RCTs) examining the efficacy & safety of spironolactone in treating PCOS and idiopathic hirsutism. A random effects model was utilized to compute the pooled mean difference (MD), and relevant subgroup analysis was performed. Evaluation of potential heterogeneity and publication bias was undertaken.

Results: Out of 1,041 studies identified, 24 RCTs met the inclusion criteria. Spironolactone (at a daily dosage of 100 mg) demonstrated a significant reduction in the Ferriman-Gallwey (FG) score among individuals with idiopathic hirsutism when compared to finasteride (MD: -2.43; 95% C.I: -3.29, -1.57) and cyproterone acetate (MD: -1.18; 95% C.I: -2.10, -0.26). However, no substantial variance was observed among PCOS subjects in comparison to flutamide and finasteride. In contrast, a lower dose of spironolactone (50 mg/day) showed no significant difference when compared to metformin regarding FG Score (MD: -0.61; 95% C.I: -1.76, 0.54, I2 = 57%), serum total testosterone (MD: -0.61; 95% C.I: -1.76, 0.54, I2 = 57%), and HOMA-IR (MD: 1.03; 95% C.I: -1.22, 3.29, I2 = 60%) among women with PCOS. The primary reported side effects across the studies encompassed menstrual irregularities, mild nausea, vomiting, and diarrhea.

Conclusions: Spironolactone demonstrates good tolerability in women with idiopathic hirsutism and PCOS. The medication notably enhanced hirsutism in those with idiopathic hirsutism and displayed a favorable trend in women with PCOS. However, it exhibited no impact on FSH, LH, menstrual regularity, BMI, or HOMA-IR in women with PCOS.