PCOS-Management of Androgenetic Alopecia

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting women of reproductive age, involving pathways that produce metabolic, reproductive, cardiovascular and dermatologic effects. Around 4–20% of Indian women in the reproductive age group may have problems related to PCOS, in fact the actual problem is much more than what has been reported as per the experience of the clinicians [1]. The complaints that women with PCOS commonly face are irregularities in menstrual periods, oligomenorrhoea, hirsutism, and acne and hair loss. Many women with PCOS have polycystic appearance of ovaries on ultrasonography examination. Hair loss in women can be either telogen effluvium which is diffuse or female pattern hair loss (FPHL), where the loss is seen more on the frontal area. FPHL is specifically reported as a clinical sign of hyperandrogenism associated with PCOS. FPHL is progressive nonscarring type of alopecia. Although the exact incidence of alopecia in PCOS is not clear, approximately 20–30% of women with PCOS have troublesome hair loss [2]. It is generally associated with other symptoms like hirsutism, acanthosis nigricans or acne. Hair loss as a sole complaint is rare in PCOS. Recent guidelines on the diagnosis of polycystic ovary syndrome (PCOS) continue using the more general term “alopecia” and consider the finding diagnostic for the presence of hyperandrogenism [3]. The relationship of hair loss and androgen excess in women is neither consistent nor clear.