Cyproterone acetate/ethinyl estradiol for acne and hirsutism: time to revise prescribing policy

Clinical manifestations of androgen excess-hirsutism, acne and alopecia-are very common and distressing symptoms in women of reproductive age. These symptoms are frequently associated with polycystic ovary syndrome, in which condition menstrual disturbances are also common. The combination of the anti-androgen cyproterone acetate (2 mg) and ethinyl estradiol (35 microg) (co-cypridiol) is of proven efficacy in management of symptoms of both hyperandrogenism and menstrual abnormalities but its long-term use has been discouraged because of concern about increased risk of venous thromboembolism. In this article, we review the evidence for efficacy and adverse effects and conclude that its benefits are clear and that the risks of venous thromboembolism are no more common that with the use of third generation combined oral contraceptives.