Q. Kindly suggest an alternative for Yasmin to control PCOS.

Answered by
Dr. Sameer Kumar
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Apr 01, 2016 and last reviewed on: Jan 04, 2020

Hi doctor,

I have PCOS, hypothyroidism and pituitary Cushing's disease. I am taking Yasmin, Glucophage 850 mg and T4 150 mg. As I have to take Metyrapone for Cushing's my doctor recommended stopping Yasmin. But if I stop it, I do not have period for months and I get acne all over my body. What can I use instead of Yasmin in order to control PCOS? Can I get it cured by removing ovaries?

#

Hello,

Welcome to icliniq.com.

Metyrapone (Metopirone) is an orphan medication that holds the FDA approval (Food and Drug Administration) for the diagnosis of Cushing’s syndrome and is occasionally used off-label for short-term treatment of Cushing’s syndrome prior to surgery.

Metyrapone prevents cortisol synthesis by inhibiting 11 β-hydroxylase, the enzyme responsible for the conversion of deoxycortisol to cortisol.

The restricted access and adverse reactions of Metyrapone are associated with increased androgen and mineralocorticoid production, which limits the use of this medication for the treatment of Cushing’s syndrome.

It can cause a negative feedback increase of ACTH (adrenocorticotropic hormone) leading to acne, hirsutism excessive male pattern hair growth, hyperkalemia.

However, Yasmin (Drospirenone and Ethinyl Estradiol) is a low dose sequential pill which has been given to regularize your cycles.

They really do not actually affect the cortisol levels due to Cushing's and not really interact with Metyrapone either.

It is often associated with weight gain. So, for that you may opt for Ginette 35 (combination of Ethinyl Estradiol and Cyproterone acetate) tablet monthly for next 6 months to regularize cycles and balance hormones.

There is no need at all for oophorectomy for PCOS (polycystic ovarian syndrome). It is never indicated. It can be controlled by medication as advised and revised now.

For further information consult an obstetrician and gynaecologist online --> https://www.icliniq.com/ask-a-doctor-online/obstetrician-and-gynaecologist

Hello doctor,

In the brain MRI and pituitary MRI, the tumor is not visible. So, they cannot remove it and they suggested to take Metyrapone forever. Your suggestion is to stop Yasmin and get Ginette 35. Will I have period every month with this? Is it possible to stay acne free with that?

#

Hello,

Welcome back to icliniq.com.

  • Yes, I suggest Ginette 35. It is a nonsteroidal oral contraceptive pill and can be safely used.
  • It will regulate your cyclical menstrual bleeding and will control on the androgen as well as will keep your acne and hirsutism low.
  • Metyrapone as I mentioned is advised for long as a treatment but again there have to be break cycles to disallow a negative feedback after prolonged usage for Cushing's.

So, evaluation has to be made every six months ideally in your case with regards to ACTH (adrenocorticotropic hormone) and other hormone levels.

Revert back for further information to an obstetrician and gynaecologist online --> https://www.icliniq.com/ask-a-doctor-online/obstetrician-and-gynaecologist


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