Short term effects of spironolactone on blood lipid profile: a 3-month study on a cohort of young women with hirsutism

center dot Spironolactone is known to have antiandrogenic features and agonist activity at progesterone receptors, which are responsible for several of its hormonal side-effects. center dot The potential unfavourable influences of this medication on serum lipoproteins have long been a concern but literature lacks sufficient data on this issue. WHAT THIS STUDY ADDS center dot Spironolactone can adversely affect serum lipids by decreasing high-density lipoprotein and increasing low-density lipoprotein in women treated for hirsutism on a short-term basis. AIMS To investigate the effects of spironolactone on serum lipids in women with hirsutism over a 3-month period. METHODS In a prospective setting, 27 hirsute women (20 with polycystic ovary syndrome and seven with idiopathic hirsutism) with a mean age of 23.0 +/- 5.1 years were studied at baseline and 3 months after receiving a daily dose of 100 mg of spironolactone. Patients did not receive any other medications and did not go through a specific diet during the study. Lipid profile, fasting blood glucose, testosterone, dehydroepiandrosterone sulphate (DHEAS) and prolactin (PRL) were measured at baseline and 3 months after therapy. RESULTS Mean body mass index of patients was 26.1 +/- 5.1 kg m-2 before treatment and 25.9 +/- 5.7 kg m-2 after treatment (NS). The therapy was associated with a significant decline of mean high-density lipoprotein (HDL), 39.5 mg dl-1 [95% confidence interval (CI) 35.6, 43.4] vs. 32.2 mg dl-1 (95% CI 29.2, 35.2), and a significant increase in mean low-density lipoprotein (LDL), 133.1 mg dl-1 (95% CI 120.2, 146) vs. 150.8 mg dl-1 (95% CI 139.1, 162.5), and cholesterol/HDL ratio, 5 (95% CI 4.4, 5.6) vs. 6.4 (95% CI 5.7, 7.1) (P < 0.05). No significant change was noted in total cholesterol, triglyceride or fasting blood glucose levels. Serum values of testosterone, DHEAS and PRL decreased significantly after 3 months of therapy (P < 0.05). CONCLUSIONS Spironolactone might have adverse effects on serum lipoprotein levels by increasing LDL and decreasing HDL over a short course of treatment. While treating hirsutism with spironolactone, special care should be given to women with metabolic disorders such as dyslipidaemia.