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
...Diagnosi...
...e Society (ES) suggests testing for...
...s where serum total testosterone level...
ES suggests screening hyperandrogene...
...rsute patients with a high risk of conge...
...against testing for elevated androgen level...
...Ferriman–Gallwey Hirsutism Scoring Sys...
...ation and Treatment of Hirsutism in Premenopausa...
...ure 2 Notes Local sexual hair growth (i.e.,...
Treatment
...Tre...
...women with patient-important hirsutism despite c...
...en who then desire additional cosmetic b...
...r hirsute women with obesity, including tho...
...Pharmacological Tr...
...Initial Thera...
...or the majority of women with hirsutis...
...st women with hirsutism, ES suggests against a...
...wever, for women who are not sexuall...
...women, ES does not suggest one oral contra...
...or women with hirsutism at higher risk...
...tient-important hirsutism remains d...
...est one antiandrogen over another. (2-L)6...
...wever, we recommend against the use of flutamide b...
...all pharmacologic therapies for hirsu...
...tients with severe hirsutism causing emotional d...
...ever, ES suggests against combination...
...ntraceptives (OCs) and Associated...
...ntiandrogens Used for the Treatment of H...
...Other...
...S suggests against using insulin-lowering drugs f...
...uggests against using gonadotropin-rele...
ES suggests against the use of topical a...
...Direct Hair Re...
...men who choose hair removal therapy, E...
...of color who choose photoepilation treatment, ES s...
...linicians should warn Mediterranean and...
...men who desire more rapid response to photoepi...
...women with known hyperandrogenemia who choose...