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
Diagnos...
...ndocrine Society (ES) suggests test...
...hose cases where serum total testosterone level...
...eening hyperandrogenemic women for nonc...
...ents with a high risk of congenital adrenal...
...s against testing for elevated androgen levels in...
.... Ferriman–Gallwey Hirsutism Scoring System...
...igure 2. Evaluation and Treatment of Hirsuti...
...ure 2 Notes Local sexual hair growth...
Treatment
...eatment...
...r most women with patient-important hi...
...or women who then desire additional cosmetic ben...
...e women with obesity, including those with polycys...
...acological Treatments...
...tial Therapies...
...the majority of women with hirsutism who ar...
...ost women with hirsutism, ES suggests ag...
...omen who are not sexually active, have undergo...
...most women, ES does not suggest one ora...
...h hirsutism at higher risk for ven...
...rtant hirsutism remains despite 6 months...
...suggest one antiandrogen over another. (...
...r, we recommend against the use of fl...
...r all pharmacologic therapies for hirsutism, ES s...
...tients with severe hirsutism causing emotional di...
...suggests against combination therapy as a stand...
Table 2. Oral Contraceptives (OCs) and Asso...
...able 3. Antiandrogens Used for the Treatment...
...Drug Therapies...
...gests against using insulin-lowering drugs f...
ES suggests against using gonadotropin-re...
...ainst the use of topical antiandrogen...
...irect Hair Removal Method...
...choose hair removal therapy, ES suggests photoep...
...women of color who choose photoepilation t...
...s should warn Mediterranean and Middle Easte...
...who desire more rapid response to ph...
...women with known hyperandrogenemia w...