The Use of the Drospirenone 4 mg-Only Pill in Overweight and Obese Women with Polyendocrine Metabolic Ovarian Syndrome: A Retrospective Cohort Study

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–Gallwey 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 < 0.001), FSH (p < 0.001), testosterone (p = 0.001), FAI (p < 0.001) and AMH (p = 0.005). Ferriman–Gallwey scores were significantly lower after 3 months (p < 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 ≥ 8), scores decreased from 14 to 12 (p < 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–Gallwey 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.