Hair Loss/female 40 with aga pt 2
QUESTION: Hi Dr,
Had a couple other questions for you, sorry, but it's nice to find someone with so much knowledge on this subject.
When I was 17 I started to gradually thin, I also had acne that I have to this day and it's on my back as well, not cystic. I was on Diane for a few years in my thirties and that was the only time I was completely clear.
I have also had a few black course hairs around nipples and navel area and chin that I needed electrolysis for a few years ago but I wouldn't call it excessive hair growth.
My dr did send me for an ultrasound of my ovaries in my early thirties and found 1 small cyst. I am a normal weight and have normal regular menses.
What are your opinions on these being pcos symptoms?
Also if a woman has regular aga and another has thinning due to pcos are the regrowth treatments roughly the same?
Also below are 3 dermatology case studies I have found with pictures documenting regrowth at 200 mg day of spironolactone
for the adult women.
And regrowth at 100 mg day for a 9 yr old girl. Not sure if you've seen these but they are encouraging and interesting.
My question is that these women were only given spironolactone,or spiro with rogaine in the 1 case study. But no birth control pills and still there was regrowth.
If I wanted to just take the spiro without bcp's for a while would I be losing anything?
Or is it just more effective with the addition of bcp's? I already have a copper iud in so I am not needing the bcp for birth control unless you think they would enhance growth.
Thank you for all you do, I am attaching a picture this time so you can see what I'm dealing with.
ANSWER: If you have hair which needs electrolysis I would consider that excess hair. When a dermatologist sees the triad of increased facial, AGA and acne the first thing that comes to mind is PCOS even if a cyst is not found by ultrasound.
The treatment I think most doctors would suggest in this case is both Diane and Spironolacotne 100 mg . Diane shuts off production of Testosterone from the ovary and spironolactone blocks what DHT is produced at the androgen receptor sites on the hair follicles.
With an IUD you may do well with just the spironolactone.
---------- FOLLOW-UP ----------
Thank you so much for all you do. You have really helped me shed some light on what's going on with my body and are literally a godsend.
I have seen 2 dermatologists in the past for the acne problem and the thinning hair. 1 quite recently, but I never even thought to ask about pcos. Nor was I asked about it.
Makes sense though. My mother also has thinning hair and course hair on her body.
Would you recommend I see a different dermatologist and inquire about pcos or would a gp be good enough?
In the meantime I will ask my doctor to switch me back to diane (my iud is copper/non hormonal so I guess that wouldn't be of any help) and I will continue with the spiro.
And I see a lot of women with pcos need metformin. Is that a possibility too? I apologize for asking you all these questions but you have been so much of a help to me and I really appreciate it.
Have a wonderful day Dr.
If your IUD is non hormonal then Diane would be of benefit. If your dermatologist is not helping you out with this then perhaps and endocrinologist or Gynecologist could. Metformin is used frequently in the treatment of PCOS and that too should be addressed by your Gyn doctor.
Some doctors believe all PCOS patients should be on Metformin and others use it only with those who have signs of diabetes or are overweight.
From wikipedia: http://en.wikipedia.org/wiki/Polycystic_ovary_syndrome
Reducing insulin resistance by improving insulin sensitivity through medications such as metformin, and the newer thiazolidinedione (glitazones), have been an obvious approach and initial studies seemed to show effectiveness. Although metformin is not licensed for use in PCOS, the United Kingdom's National Institute for Health and Clinical Excellence recommended in 2004 that women with PCOS and a body mass index above 25 be given metformin when other therapy has failed to produce results. However subsequent reviews in 2008 and 2009 have noted that randomised control trials have in general not shown the promise suggested by the early observational studies.