Hirsutism is a common problem that can have profound implications for quality of life and psychological wellbeing. Various nonpharmacologic and pharmacologic strategies are available to manage excess hair. In this Practice Point commentary, I discuss the results of a systematic review, which assessed the relative efficacy of several commonly used pharmacologic agents for the treatment of hirsutism. Koulouri and Conway identified 28 randomized controlled trials of 6 months' duration that assessed four interventions: modulators of metabolism, oral contraceptive pills, antiandrogens, and combination therapy. All treatment options significantly improved the main outcome measure (FerrimanGallwey score). Obesity was found to negatively affect treatment efficacy, suggesting that lifestyle modification could represent an important component of the treatment strategy. The study design had several weaknesses, such as the relatively small number of women in each treatment group. Nonetheless, the results add to the evidence base supporting the use of these agents in the treatment of hirsutism.
Keywords antiandrogen, hirsutism, metformin, oral contraceptive, polycystic ovary syndrome
Hirsutism is characterized by a clinical diagnosis of excessive terminal hair growth in a malepattern distribution (specifically, a Ferriman-Gallway score [greater than or equal to] 8). (1) This condition occurs as a result of increased androgen levels and/or the increased androgen sensitivity of the hair follicle, (2) and is present in 5% of all premenopausal women. Hirsutism is not only a cosmetic problem--it also affects a woman's psychological sense of wellbeing. In addition, hirsutism might reflect a more-serious underlying disorder, such as polycystic ovary syndrome (PCOS).
Treatment options for hirsutism include nonpharmacologic approaches, such as bleaching, shaving, waxing, electrolysis, and laser hair removal. Pharmacologic treatments are also available, with oral contraceptive pills and/or androgen-receptor antagonists as the most commonly prescribed agents. The choice of therapy is determined by the extent and location of excessive hair growth and by the patient's own personal preference. The beneficial effects of hormonal therapies often take 6 months for detection (because of the long life-cycle of the hair follicle) and...