Evaluation of premenopausal women with hirsutism
- Robert L Barbieri, MD
Robert L Barbieri, MD
- Editor-in-Chief — Obstetrics, Gynecology and Women's Health
- Section Editor — General Gynecology and Female Reproductive Endocrinology
- Kate Macy Ladd Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- David A Ehrmann, MD
David A Ehrmann, MD
- Professor of Medicine
- University of Chicago
- Section Editors
- Peter J Snyder, MD
Peter J Snyder, MD
- Editor-in-Chief — Endocrinology
- Section Editor — Pituitary Disease; Male Reproductive Endocrinology
- Professor of Medicine
- University of Pennsylvania School of Medicine
- William F Crowley, Jr, MD
William F Crowley, Jr, MD
- Section Editor — Female Reproductive Endocrinology
- Daniel K Podolsky Professor of Medicine
- Harvard Medical School
Hirsutism, defined as excessive male-pattern hair growth, affects between 5 and 10 percent of women of reproductive age. It may be the initial, and possibly only, sign of an underlying androgen disorder, the cutaneous manifestations of which may also include acne and male-pattern balding (androgenetic alopecia). The most common cause of hirsutism is polycystic ovary syndrome (PCOS). In some cases, hirsutism is mild and requires only reassurance and local (nonsystemic) therapy, while in others it causes significant psychological distress and requires more extensive therapy.
The evaluation and laboratory testing of hirsutism will be discussed here, while its pathophysiology, causes, and treatment are discussed elsewhere (table 1). (See "Pathophysiology and causes of hirsutism" and "Treatment of hirsutism".)
Hirsutism is a clinical diagnosis defined by the presence of excess terminal hair growth (dark, coarse hairs) in androgen-dependent areas (eg, upper lip, chin, midsternum, upper abdomen, back, and buttocks) in which women typically have little or no hair [1,2]. Hair growth can be graded as either normal or excessive based upon the Ferriman-Gallwey score. (See 'Ferriman-Gallwey score' below.)
Hirsutism is an important clinical problem because:
●It affects approximately 5 to 10 percent of women .
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- Ferriman-Gallwey score
- - Limitations
- Other types of excess hair
- APPROACH TO THE PATIENT
- Overview of our approach
- - Age of onset
- - Stable versus progressive hair growth
- - Virilization
- - Emotional distress/depression
- - Other
- Physical examination
- Biochemical testing
- - "Unwanted hair"
- - Hirsutism and normal menstrual cycles
- - Hirsutism with oligomenorrhea/amenorrhea
- - Women already taking pharmacologic therapy
- - Women with features of other endocrine disorders
- - Severe hyperandrogenism
- Additional evaluation for severe hyperandrogenemia
- - Pelvic ultrasonography
- - Adrenal imaging
- - Ovarian and adrenal vein sampling
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS