Treatment of 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
- Jeffrey Chang, MD
Jeffrey Chang, MD
- University of California, San Diego
- 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 in a woman, affects between 5 and 10 percent of women of reproductive age. In some cases, hirsutism is mild and requires only reassurance and perhaps cosmetic therapy, while in others, it causes significant distress and requires more extensive intervention.
The treatment of hirsutism will be reviewed here. The pathogenesis, causes, and evaluation of hirsutism are discussed separately. Direct methods of hair removal are reviewed briefly here and in greater detail elsewhere. (See "Pathophysiology and causes of hirsutism" and "Evaluation of premenopausal women with hirsutism" and "Removal of unwanted hair".)
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) [1,2]. Hair growth can be graded as either normal or excessive based upon the Ferriman-Gallwey score. There are several conditions characterized by generalized or "excess" hair growth that do not represent hirsutism and do not require biochemical evaluation with serum androgens, including hypertrichosis and "unwanted hair" (any hair growth [usually light, unpigmented facial hair] that the patient finds bothersome). This type of hair is not a sign of androgen excess. (See "Evaluation of premenopausal women with hirsutism", section on 'Other types of excess hair'.)
Hirsutism is an important clinical problem that affects approximately 5 to 10 percent of women . It is important to evaluate and treat because:
●It is associated with significant emotional distress and depression [4-6]. (See "Evaluation of premenopausal women with hirsutism", section on 'Emotional distress/depression'.)
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- GENERAL PRINCIPLES
- OVERVIEW OF APPROACH
- Drug therapy or hair removal?
- Pharmacologic therapy
- - Oral contraceptives
- Mechanisms of action in hyperandrogenism/hirsutism
- - Choice of pill
- - Monitoring
- Good cosmetic response
- Suboptimal response
- - Add antiandrogen to OC
- Severe symptoms causing distress
- - Antiandrogen therapy
- Choice of antiandrogen
- Duration of drug therapy
- - Direct hair removal methods
- - Treatments not recommended
- - Special populations
- Coexisting depression
- Women with NCCAH
- Postmenopausal women
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS