Hirsutism in Premenopausal Women

Publication Date: March 7, 2018

Key Points

Key Points

  • Hirsutism is common, occurring in 5 to 10 percent of all women.
  • Hirsutism is usually a sign of an underlying endocrine disorder (most commonly polycystic ovary syndrome [PCOS]). Women who present with hirsutism should therefore be offered an endocrine evaluation followed by appropriate therapy.
  • Hirsutism is associated with personal distress, anxiety and depression. It is important for clinicians to take their patients’ cosmetic concerns seriously.
  • Treatment options include pharmacologic therapy (starting with combination oral estrogen-progestin contraceptives for most), direct hair removal methods such as photoepilation/laser, or both.
  • Photoepilation (hair removal using laser and intense pulsed light) is most effective for women with light skin and dark hair. It is less effective and sometimes associated with complications in women with darker skin, especially those with Middle Eastern and Mediterranean ancestry.

Table 1. Definitions of Terms Used in This Guideline

Having trouble viewing table?
Term Definition
Hirsutism Hirsutism is excessive terminal hair that appears in a male pattern (excessive hair in androgen-dependent areas; i.e., sexual hair) in women.
Ferriman–Gallwey score The modified Ferriman–Gallwey score is the gold standard for evaluating hirsutism. Nine body areas most sensitive to androgen are assigned a score from 0 (no hair) to 4 (frankly virile), and these separate scores are summed to provide a hormonal hirsutism score (Fig. 1).
Local hair growth This is unwanted localized hair growth in the absence of an abnormal hirsutism score.
Patient-important hirsutism Unwanted sexual hair growth of any degree that causes sufficient distress for women to seek additional treatment.
Hyperandrogenism Hyperandrogenism (for the purposes of this guideline) is defined as clinical features that result from increased androgen production and/or action.
Idiopathic hirsutism This is hirsutism without hyperandrogenemia or other signs or symptoms indicative of a hyperandrogenic endocrine disorder.

Diagnosis

...gnosis

...ne Society (ES) suggests testing for elevated a...


...those cases where serum total testo...


...ening hyperandrogenemic women for nonclassi...

In hirsute patients with a high risk of con...


...inst testing for elevated androgen lev...


...1. Ferriman–Gallwey Hirsutism Sc...


...2. Evaluation and Treatment of Hirsutism...

...tes Local sexual hair growth (i.e., in...


Treatment

...eatmen...

...with patient-important hirsutism d...

...ho then desire additional cosmetic benefit, ES...

...omen with obesity, including those w...


...macological Treatme...

Initial Therapi...

...e majority of women with hirsutism who are not s...

...with hirsutism, ES suggests against antiand...

...for women who are not sexually active, have...

...omen, ES does not suggest one oral co...

...en with hirsutism at higher risk for venous t...

...portant hirsutism remains despite 6 months...

...s not suggest one antiandrogen over...

...commend against the use of flutamide...

...logic therapies for hirsutism, ES suggests a tria...

...ith severe hirsutism causing emotional distre...

...ES suggests against combination therapy as a s...

...2. Oral Contraceptives (OCs) and Associate...

.... Antiandrogens Used for the Treatment of Hi...

...her Drug Therapie...

...s against using insulin-lowering drugs for...

...ests against using gonadotropin-releasing...

...uggests against the use of topical ant...


...rect Hair Removal Method

...en who choose hair removal therapy, ES suggests ph...

...color who choose photoepilation treatment, ES...

...cians should warn Mediterranean and Middle E...

...who desire more rapid response to...

...n with known hyperandrogenemia who choos...