What are the management options for female patients with hirsutism (excessive hair growth)?

From the Guidelines

Management Options for Female Patients with Hirsutism

The primary approach to managing hirsutism in female patients involves a combination of pharmacological and cosmetic therapies, with anti-androgen medications and oral contraceptives being key components of treatment, as suggested by guidelines 1.

• Pharmacological Treatment: Anti-androgen medications such as spironolactone and flutamide can be used to reduce androgen levels and alleviate hirsutism symptoms 1. Spironolactone can be initiated at a dose of 50-100 mg per day, while flutamide can be used at a dose of 250-500 mg per day. It is essential to monitor liver function tests regularly when using these medications.
• Oral Contraceptives: For patients with polycystic ovary syndrome (PCOS) or those who desire contraception, combined oral contraceptives (COCs) containing ethinyl estradiol and a progestin can be used to regulate menstrual cycles, reduce androgen levels, and improve hirsutism symptoms 1.
• Cosmetic Therapies: In addition to medical treatment, cosmetic therapies such as waxing, tweezing, or depilatory creams can be used to manage excessive hair growth. Electrolysis or laser hair removal can also be considered for more permanent hair reduction, although multiple treatments may be needed 1.
• Individualized Treatment: It is crucial to individualize treatment based on the patient's specific needs, medical history, and preferences. Regular follow-up appointments are necessary to monitor treatment efficacy, adjust medications as needed, and address any potential side effects.

The combination of an anti-androgen and an ovarian suppression agent, such as an oral contraceptive, appears to be an effective treatment approach for hirsutism, especially in women with PCOS 1.

From the FDA Drug Label

The following adverse reactions have been reported in users of oral contraceptives and the association has been neither confirmed nor refuted: ... Hirsutism There is no information in the provided drug label that directly supports management options for female patients with hirsutism. The FDA drug label does not answer the question.

From the Research

Management Options for Hirsutism

The management options for female patients with hirsutism include:

• Pharmacological treatments such as suppressing ovarian or adrenal androgen secretion, or blocking androgen actions in the skin 2
• Gonadotropin-releasing hormone (GnRH) agonists, combined oral contraceptives (COCs), and steroidal or nonsteroidal antiandrogens 2
• Estrogen-progestin oral contraceptives pills (OCPs), antiandrogens, and insulin sensitizers, which have been shown to be superior to placebo in reducing hirsutism 3

Medical Treatment Regimens

Medical treatment regimens for hirsutism include:

• Monotherapy with oral contraceptives that have antiandrogenic activity as a first-line treatment 4
• Combining an oral contraceptive pill with an antiandrogen if clinical improvement of hirsutism is insufficient after 6-9 months' monotherapy 4
• Antiandrogen monotherapy with flutamide, finasteride, and spironolactone, which have been shown to be effective in reducing hirsutism 3
• Insulin sensitizers, which are effective in treating hirsutism, hyperinsulinemia, and hyperandrogenism in women with polycystic ovary syndrome 4, 5

Combination Therapies

Combination therapies for hirsutism include:

• The combination of OCPs and antiandrogen, which has been shown to be superior to OCPs alone 3
• The combination of OCPs and insulin sensitizer, which has been shown to be effective in reducing hirsutism 3
• Cyproterone acetate plus ethyniloestradiol and spironolactone, cyproterone acetate plus ethyniloestradiol and finasteride, and spironolactone and finasteride combinations, which have been used successfully in decreasing the hirsutism score 5

Important Considerations

Important considerations in the treatment of hirsutism include:

• The need for adequate contraception if antiandrogens are used 2, 6
• The potential risk of abnormal development of a male fetus if pregnancy occurs during therapy with antiandrogens 2
• The importance of considering the patient's hormonal profile, expectations, and preferences when guiding the therapeutic approach 6