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
...agnosi...
...ne Society (ES) suggests testing for elevated andr...
...those cases where serum total testosteron...
...s screening hyperandrogenemic wome...
...hirsute patients with a high risk...
...S suggests against testing for elevated androgen...
.... Ferriman–Gallwey Hirsutism Scoring...
...valuation and Treatment of Hirsutism...
...e 2 Notes Local sexual hair growth (i.e...
Treatment
...eatment...
...t women with patient-important hirsutism...
...women who then desire additional cosmeti...
...hirsute women with obesity, includ...
...acological Treatmen...
...itial Therapie...
...or the majority of women with hirsutism wh...
...n with hirsutism, ES suggests against anti...
...for women who are not sexually active, have u...
...ES does not suggest one oral contracepti...
...h hirsutism at higher risk for venous thromb...
...ortant hirsutism remains despite 6 mon...
...est one antiandrogen over another. (2-L)699...
...r, we recommend against the use of fluta...
...pharmacologic therapies for hirsutism, ES sugg...
...patients with severe hirsutism causing emot...
...uggests against combination therapy as...
...le 2. Oral Contraceptives (OCs) an...
...androgens Used for the Treatment of...
...Drug Therapies...
...uggests against using insulin-lowering drugs fo...
...nst using gonadotropin-releasing hormone...
...nst the use of topical antiandrogen therapy for h...
...rect Hair Removal Method...
...r women who choose hair removal therapy, E...
...or who choose photoepilation treatment, ES sugg...
...should warn Mediterranean and Middle Eastern wome...
...esire more rapid response to photoepilat...
...th known hyperandrogenemia who choos...