{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T12:58:15Z","timestamp":1791205095875,"version":"4.1.0"},"reference-count":44,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Objective: Polycystic ovary syndrome is frequently associated with hyperandrogenemia-related hirsutism, which creates notable cosmetic concerns for many affected women. Although multiple antiandrogenic treatments exist, many patients remain dissatisfied, and combined oral contraceptives are often contraindicated due to metabolic and cardiovascular risk factors. This study evaluates whether a drospirenone-only pill improves hormonal profiles and hirsutism in PMOS compared to cyclic dydrogesterone. Methods: This retrospective cohort study assessed hyperandrogenemia and hirsutism using the modified Ferriman\u2013Gallwey score in 60 overweight or obese women with PMOS who were treated at the Clinical Division of Gynecologic Endocrinology and Reproductive Medicine of the Medical University of Vienna, Austria. Patients underwent follow-up examinations after three and six months of treatment. Thirty women chose treatment with drospirenone-only and were age-matched with 30 women receiving cyclic dydrogesterone. Results: After 3 months, women in the drospirenone group showed significant improvements, including reductions in LH (p &lt; 0.001), FSH (p &lt; 0.001), testosterone (p = 0.001), FAI (p &lt; 0.001) and AMH (p = 0.005). Ferriman\u2013Gallwey scores were significantly lower after 3 months (p &lt; 0.001) and 6 months (p = 0.001). At follow-up, the drospirenone group exhibited lower LH (5.4 vs. 8.8 mIU\/mL; p = 0.004) and lower FAI (2.9 vs. 4.0; p = 0.045) compared with controls. Among women with baseline hirsutism (FGS \u2265 8), scores decreased from 14 to 12 (p &lt; 0.001) after 3 months and to 10 (p = 0.002) after 6 months in the drospirenone group. Conclusions: Drospirenone-only treatment resulted in a modest reduction in Ferriman\u2013Gallwey score, with more pronounced improvements observed in women with baseline hirsutism. This was accompanied by hormonal changes, suggesting a potentially beneficial option for women with hyperandrogenic PMOS for whom combined oral contraceptives are not suitable.<\/jats:p>","DOI":"10.3390\/jcm15197701","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T12:31:31Z","timestamp":1791203491000},"page":"7701","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Use of the Drospirenone 4 mg-Only Pill in Overweight and Obese Women with Polyendocrine Metabolic Ovarian Syndrome: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Klara","family":"Hofer","sequence":"first","affiliation":[{"name":"Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8712-6636","authenticated-orcid":false,"given":"Selina","family":"Ebner","sequence":"additional","affiliation":[{"name":"Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1772-6695","authenticated-orcid":false,"given":"Rodrig","family":"Marculescu","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Medical University of Vienna, A-1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"given":"Magdalena","family":"Boegl","sequence":"additional","affiliation":[{"name":"Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"}]},{"given":"Peter","family":"Frigo","sequence":"additional","affiliation":[{"name":"Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"conceptualization","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5454-2620","authenticated-orcid":false,"given":"Robert","family":"Krysiak","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Clinical Pharmacology, Medical University of Silesia, 40-055 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2761-5262","authenticated-orcid":false,"given":"Johannes","family":"Ott","sequence":"additional","affiliation":[{"name":"Clinical Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2841","DOI":"10.1093\/humrep\/dew218","article-title":"The prevalence and phenotypic features of polycystic ovary syndrome: A systematic review and meta-analysis","volume":"31","author":"Bozdag","year":"2016","journal-title":"Hum. Reprod."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2447","DOI":"10.1210\/clinem\/dgad463","article-title":"Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome","volume":"108","author":"Teede","year":"2023","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1089\/jwh.2022.0497","article-title":"Unmet Clinical Needs in Women with Aesthetic Manifestations of Polycystic Ovary Syndrome: A Cross-Sectional Study","volume":"32","author":"Estermann","year":"2023","journal-title":"J. Womens Health"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1097\/AOG.0000000000002698","article-title":"Polycystic Ovary Syndrome","volume":"132","author":"Azziz","year":"2018","journal-title":"Obstet. Gynecol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.bpobgyn.2016.05.003","article-title":"Androgen excess: Investigations and management","volume":"37","author":"Lizneva","year":"2016","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"5603","DOI":"10.2174\/1381612822666160720151243","article-title":"Hirsutism in Polycystic Ovary Syndrome: Pathophysiology and Management","volume":"22","author":"Spritzer","year":"2016","journal-title":"Curr. Pharm. Des."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1080\/13625187.2022.2164186","article-title":"The drospirenone (DRSP)-only pill: Clinical implications in the daily use","volume":"28","author":"Kubba","year":"2023","journal-title":"Eur. J. Contracept. Reprod. Health Care"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1016\/j.contraception.2015.07.014","article-title":"Drospirenone-only oral contraceptive: Results from a multicenter noncomparative trial of efficacy, safety and tolerability","volume":"92","author":"Archer","year":"2015","journal-title":"Contraception"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1549","DOI":"10.1111\/aogs.13688","article-title":"Multicenter, phase III trials on the contraceptive efficacy, tolerability and safety of a new drospirenone-only pill","volume":"98","author":"Palacios","year":"2019","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1007\/s40618-019-01133-3","article-title":"Clinical, hormonal and metabolic parameters in women with PCOS with different combined oral contraceptives (containing chlormadinone acetate versus drospirenone)","volume":"43","author":"Podfigurna","year":"2020","journal-title":"J. Endocrinol. Investig."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1016\/j.maturitas.2009.09.002","article-title":"Dydrogesterone\u2014A unique progestogen","volume":"65","author":"Schindler","year":"2009","journal-title":"Maturitas"},{"key":"ref_12","first-page":"167","article-title":"Dydrogesterone has no peripheral (anti)-androgenic properties","volume":"1","author":"Vermorken","year":"1987","journal-title":"In Vivo"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1080\/09513590.2021.1908252","article-title":"Dydrogesterone indications beyond menopausal hormone therapy: An evidence review and woman\u2019s journey","volume":"37","author":"Stute","year":"2021","journal-title":"Gynecol. Endocrinol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"The Rotterdam ESHRE\/ASRM-Sponsored PCOS Consensus Workshop Group (2004). Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum. Reprod., 19, 41\u201347.","DOI":"10.1093\/humrep\/deh098"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2329","DOI":"10.1016\/S0140-6736(26)00717-8","article-title":"Polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome: A multistep global consensus process","volume":"407","author":"Teede","year":"2026","journal-title":"Lancet"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1440","DOI":"10.1210\/jcem-21-11-1440","article-title":"Clinical assessment of body hair growth in women","volume":"21","author":"Ferriman","year":"1961","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1093\/humupd\/dmt061","article-title":"Definition and significance of polycystic ovarian morphology: A task force report from the Androgen Excess and Polycystic Ovary Syndrome Society","volume":"20","author":"Dewailly","year":"2014","journal-title":"Hum. Reprod. Update"},{"key":"ref_18","unstructured":"(2022). Medical laboratories\u2014Requirements for quality and competence (Standard No. ISO 15189: 2022). Available online: https:\/\/www.iso.org\/standard\/76677.html."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Ghobrial, S., Krysiak, R., Goldstein, T., Patsch, A., Paternostro, C., Heinzl, F., Marculescu, R., and Ott, J. (2025). Distribution of prolactin and its correlation with insulin resistance in women with polycystic ovary syndrome. Front. Endocrinol., 16.","DOI":"10.3389\/fendo.2025.1674795"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1186\/s13048-019-0564-7","article-title":"Changes in serum markers of patients with PCOS during consecutive clomiphene stimulation cycles: A retrospective study","volume":"12","author":"Hager","year":"2019","journal-title":"J. Ovarian Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1016\/j.fertnstert.2008.06.035","article-title":"The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: The complete task force report","volume":"91","author":"Azziz","year":"2009","journal-title":"Fertil. Steril."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2504","DOI":"10.1007\/s43032-021-00535-0","article-title":"Evaluation of the Efficacy of Sex Hormone-Binding Globulin in Insulin Resistance Assessment Based on HOMA-IR in Patients with PCOS","volume":"28","author":"Chen","year":"2021","journal-title":"Reprod. Sci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1210\/jc.2014-2523","article-title":"Testosterone to dihydrotestosterone ratio as a new biomarker for an adverse metabolic phenotype in the polycystic ovary syndrome","volume":"100","author":"Hofer","year":"2015","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1210\/er.2015-1104","article-title":"The Pathogenesis of Polycystic Ovary Syndrome (PCOS): The Hypothesis of PCOS as Functional Ovarian Hyperandrogenism Revisited","volume":"37","author":"Rosenfield","year":"2016","journal-title":"Endocr. Rev."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e3503","DOI":"10.1210\/clinem\/dgaf226","article-title":"Approach to the Patient: Hirsutism","volume":"110","author":"Azziz","year":"2025","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1080\/09513590801948309","article-title":"Treatment of hirsutism with combined pill containing drospirenone","volume":"24","author":"Gregoriou","year":"2008","journal-title":"Gynecol. Endocrinol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1016\/j.fertnstert.2005.07.1311","article-title":"Efficacy of a new oral contraceptive containing drospirenone and ethinyl estradiol in the long-term treatment of hirsutism","volume":"85","author":"Batukan","year":"2006","journal-title":"Fertil. Steril."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2817","DOI":"10.1210\/jc.2003-031158","article-title":"Drospirenone for the treatment of hirsute women with polycystic ovary syndrome: A clinical, endocrinological, metabolic pilot study","volume":"89","author":"Guido","year":"2004","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/S0015-0282(16)53212-9","article-title":"Effect of low-dose oral contraceptive on gonadotropins, androgens, and sex hormone binding globulin in nonhirsute women","volume":"53","author":"Murphy","year":"1990","journal-title":"Fertil. Steril."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1773","DOI":"10.1007\/s00404-025-08083-7","article-title":"Use of progestin-only drospirenone-based pills in hyperandrogenic women with polycystic ovary syndrome","volume":"312","author":"Diterlizzi","year":"2025","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1080\/13625187.2017.1317339","article-title":"The use of cyproterone acetate\/ethinyl estradiol in hyperandrogenic skin symptoms\u2014A review","volume":"22","author":"Bitzer","year":"2017","journal-title":"Eur. J. Contracept. Reprod. Health Care"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"103594","DOI":"10.1016\/j.eclinm.2025.103594","article-title":"Oral prolonged-release dienogest 2 mg and ethinylestradiol 0.02 mg in a 24\/4-day regimen for polycystic ovary syndrome-associated hirsutism: A double-blind, randomised, placebo-controlled trial","volume":"90","author":"Lobo","year":"2025","journal-title":"EClinicalMedicine"},{"key":"ref_33","first-page":"49","article-title":"Drospirenone: A new cardiovascular-active progestin with antialdosterone and antiandrogenic properties","volume":"6","year":"2003","journal-title":"Climacteric"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1080\/14656566.2016.1215430","article-title":"Spironolactone in the treatment of polycystic ovary syndrome","volume":"17","author":"Armanini","year":"2016","journal-title":"Expert Opin. Pharmacother."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"25","DOI":"10.2147\/IJWH.S11304","article-title":"Treatment options for polycystic ovary syndrome","volume":"3","author":"Badawy","year":"2011","journal-title":"Int. J. Womens Health"},{"key":"ref_36","first-page":"89","article-title":"Comparison of spironolactone, flutamide, and finasteride efficacy in the treatment of hirsutism: A randomized, double blind, placebo-controlled trial","volume":"85","author":"Moghetti","year":"2000","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_37","first-page":"CD000194","article-title":"Spironolactone versus placebo or in combination with steroids for hirsutism and\/or acne","volume":"2","author":"Brown","year":"2009","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"102162","DOI":"10.1016\/j.eclinm.2023.102162","article-title":"Efficacy and safety of anti-androgens in the management of polycystic ovary syndrome: A systematic review and meta-analysis of randomised controlled trials","volume":"63","author":"Alesi","year":"2023","journal-title":"EClinicalMedicine"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/S0010-7824(00)00133-5","article-title":"Drospirenone: Pharmacology and pharmacokinetics of a unique progestogen","volume":"62","author":"Krattenmacher","year":"2000","journal-title":"Contraception"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"515.e1","DOI":"10.1016\/j.ajog.2021.06.052","article-title":"Anti-M\u00fcllerian hormone levels among contraceptive users: Evidence from a cross-sectional cohort of 27,125 individuals","volume":"225","author":"Hariton","year":"2021","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"3332","DOI":"10.1210\/jc.2013-1393","article-title":"Can anti-Mullerian hormone predict the diagnosis of polycystic ovary syndrome? A systematic review and meta-analysis of extracted data","volume":"98","author":"Iliodromiti","year":"2013","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.ejogrb.2022.10.020","article-title":"Prevalence of polycystic ovary syndrome in European countries and USA: A systematic review and meta-analysis","volume":"279","author":"Chiaffarino","year":"2022","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1097\/00001648-199001000-00010","article-title":"No adjustments are needed for multiple comparisons","volume":"1","author":"Rothman","year":"1990","journal-title":"Epidemiology"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1644","DOI":"10.1016\/j.athoracsur.2015.11.024","article-title":"Adjust for Multiple Comparisons? It\u2019s Not That Simple","volume":"101","author":"Althouse","year":"2016","journal-title":"Ann. Thorac. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7701\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T12:46:34Z","timestamp":1791204394000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7701"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,5]]},"references-count":44,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["jcm15197701"],"URL":"https:\/\/doi.org\/10.3390\/jcm15197701","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,5]]}}}