From the Guidelines
The most effective treatment approach for hirsutism is a combination of medical interventions, including oral contraceptives and antiandrogen agents, along with cosmetic hair removal methods. When considering treatment options, it's essential to prioritize a combination of therapies that address both the hormonal imbalance and cosmetic concerns. For immediate cosmetic management, options include:
- Shaving
- Waxing
- Plucking
- Chemical depilatories
- Longer-lasting methods like laser hair removal or electrolysis, as mentioned in 1. The primary medical treatment is oral contraceptives containing ethinyl estradiol with anti-androgenic progestins, typically taken daily for at least 6-12 months to see significant improvement, as supported by 1. For more severe cases, anti-androgen medications like spironolactone (starting at 50-100mg daily, potentially increasing to 200mg daily) can be added, as noted in 1. Finasteride (2.5-5mg daily) or flutamide may be considered in resistant cases. Weight loss of 5-10% in overweight patients can significantly improve symptoms by reducing insulin resistance and androgen production. Metformin (500mg three times daily) may help patients with insulin resistance or polycystic ovary syndrome, as mentioned in 1. Treatment should continue for at least 6 months before assessing effectiveness, and maintenance therapy is often needed long-term to prevent recurrence. These medications work by either blocking androgen receptors, reducing androgen production, or increasing sex hormone binding globulin, which reduces free testosterone levels in the bloodstream, as explained in 1.
From the Research
Treatment Options for Hirsutism
- Physical modalities and oral contraceptive pills (OCPs) remain first-line treatments for hirsutism, as supported by studies 2, 3
- Electrolysis and lasers (particularly alexandrite and diode lasers) are effective for permanent hair removal or reduction 2
- Topical eflornithine can be used as monotherapy for mild hirsutism or as an adjunct therapy with lasers or pharmacotherapy in more severe cases 2, 3
- Combined OCPs are superior to placebo, with antiandrogenic and low-dose neutral OCPs being slightly more efficacious in improving hirsutism 2
- Antiandrogens, such as spironolactone, finasteride, and cyproterone acetate, are indicated for moderate to severe hirsutism 2, 3
Lifestyle Modifications and Other Therapies
- Lifestyle modification counseling is recommended for patients with hirsutism 2
- Insulin sensitizers may be effective in improving hirsutism in women with polycystic ovary syndrome, but not as monotherapy for hirsutism alone 2, 3
- Gonadotropin-releasing hormone analogs and glucocorticoids are only recommended in specific circumstances 2
- Mechanical methods of hair removal, such as shaving, waxing, and depilatory creams, can be used in combination with medical therapies 4
Important Considerations
- Treatment of hirsutism should be based on the degree of excess hair growth and the underlying cause of the condition 5, 6
- Women with hirsutism should be warned not to expect improvement for at least 3-6 months after therapy is begun, and lifelong therapy may be needed to prevent recurrence 2, 6
- The choice of treatment for hirsutism depends on the severity of symptoms, the patient's reproductive goals, and the underlying cause 4