Hirsutism in Premenopausal Women
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
| 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
...agnosis...
...ne Society (ES) suggests testing for...
...cases where serum total testosterone le...
...gests screening hyperandrogenemic wome...
...e patients with a high risk of congenital...
...S suggests against testing for elevated and...
...Ferriman–Gallwey Hirsutism Scoring SystemFe...
...tion and Treatment of Hirsutism in Premenopa...
...Local sexual hair growth (i.e., in the abse...
Treatment
...reatmen...
...men with patient-important hirsutis...
For women who then desire additional cosmetic ben...
...hirsute women with obesity, including those...
...acological Treatme...
...tial Therapies
...majority of women with hirsutism wh...
...women with hirsutism, ES suggests against antiand...
...er, for women who are not sexually acti...
...t women, ES does not suggest one o...
...omen with hirsutism at higher risk for veno...
...-important hirsutism remains despite 6 mont...
ES does not suggest one antiandrogen over...
...ever, we recommend against the use of flutamide be...
...macologic therapies for hirsutism, ES suggests...
...severe hirsutism causing emotional distres...
...ggests against combination therapy as a standard f...
...Oral Contraceptives (OCs) and Associated Ve...
...ble 3. Antiandrogens Used for the Treatmen...
...er Drug Therapie...
...ests against using insulin-lowering drugs...
...against using gonadotropin-releasing hormone...
...inst the use of topical antiandrogen therapy for...
...irect Hair Removal Method...
For women who choose hair removal...
...olor who choose photoepilation treatme...
...cians should warn Mediterranean and Midd...
...who desire more rapid response to...
...women with known hyperandrogenemia who...