From the Guidelines
For facial hair treatment with PCOS, a combination approach typically works best, starting with prescription medications like spironolactone or combined oral contraceptives, and considering methods like laser hair removal or electrolysis for immediate hair removal. The primary goal of treatment is to reduce androgen levels, which can be achieved through medications such as spironolactone (50-200mg daily) or combined oral contraceptives containing ethinyl estradiol with anti-androgenic progestins like drospirenone 1. These medications usually take 3-6 months to show noticeable results and should be continued long-term for maintenance.
For immediate hair removal, consider methods like:
- Laser hair removal (requiring 6-8 sessions spaced 4-6 weeks apart)
- Electrolysis for permanent reduction Temporary methods include:
- Waxing
- Threading
- Depilatory creams Avoid shaving as it can cause stubble. Weight management through diet and exercise can also help reduce insulin resistance, which contributes to hormone imbalances in PCOS, as supported by the international evidence-based guideline for the assessment and management of PCOS 1. Medications like metformin may be prescribed to improve insulin sensitivity, indirectly helping with hirsutism 1.
The treatment approach should prioritize a combination of medical interventions, including antiandrogen and ovarian suppression agents, as well as lifestyle modifications, such as weight management and exercise, to address the underlying hormonal imbalance that causes excess facial hair in PCOS 1. By taking a comprehensive approach, patients with PCOS can effectively manage their symptoms and improve their quality of life.
From the FDA Drug Label
Two randomized double-blind studies involving 594 female patients (393 treated with VANIQA, 201 with vehicle) treated twice daily for up to 24 weeks evaluated the efficacy of VANIQA in the reduction of unwanted facial hair in women. Women in the trial had a customary frequency of removal of facial hair two or more times per week Women with facial conditions such as severe inflammatory acne, women who were pregnant, and nursing mothers were excluded from the studies. Approximately 32% of patients showed marked improvement or greater (protocol definition of clinical success) after 24 weeks of treatment with VANIQA (eflornithine hydrochloride) Cream, 13. 9%, compared to 8% with the vehicle.
The use of eflornithine (VANIQA) for the treatment of unwanted facial hair in women with PCOS is not directly addressed in the provided drug labels. However, the studies do show that VANIQA is effective in reducing unwanted facial hair in women.
- The drug labels do not provide information on the specific use of VANIQA in patients with PCOS.
- It is essential to consult a healthcare professional to determine if VANIQA is suitable for treating unwanted facial hair in women with PCOS 2.
- As with any medication, it is crucial to follow the prescribed treatment plan and report any side effects or concerns to a healthcare professional 2.
From the Research
Treatment Options for Facial Hair in PCOS
- Facial hair treatment in PCOS can be managed through various treatment options, including hormonal therapies and anti-androgen medications 3, 4.
- Cyproterone acetate (CPA) combined with ethinylestradiol (EE) is a commonly used treatment for hyperandrogenic skin symptoms, including hirsutism, in women with PCOS 4, 5, 6.
- This combination has been shown to effectively reduce facial hair growth and improve menstrual irregularities, while also decreasing the risk of endometrial cancer 4.
Mechanism of Action
- The mechanism of action of CPA/EE involves the reduction of androgen levels, which contributes to the development of hyperandrogenic skin symptoms in PCOS 4, 5, 6.
- CPA/EE has also been shown to improve endothelial function in young, non-obese women with PCOS, which may help reduce the risk of cardiovascular disease 5.
Alternative Treatment Options
- Other treatment options for facial hair in PCOS include spironolactone-norgestimate-estrogen, which has been shown to be effective in reducing hirsutism and improving lipid profiles 7.
- Lifestyle modifications, such as weight loss and exercise, may also help improve hormonal imbalances and reduce facial hair growth in women with PCOS 3.
Potential Side Effects
- CPA/EE may increase the risk of venous thromboembolic complications, and its long-term effects on metabolic and cardiovascular health are still being investigated 4, 6.
- Spironolactone-norgestimate-estrogen may have a more favorable influence on lipids and indices of low-grade inflammation compared to CPA/EE 7.