What are the treatment options for Hirsutism (Excessive Hair Growth)?

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. For immediate cosmetic management, options include shaving, waxing, plucking, chemical depilatories, or longer-lasting methods like laser hair removal or electrolysis. The first-line medical treatment is typically oral contraceptives containing ethinyl estradiol with a low-androgenic progestin like norgestimate, desogestrel, or drospirenone, taken daily for at least 6-12 months to see significant improvement 1. For women who cannot take or don't respond to oral contraceptives, anti-androgens like spironolactone (50-200 mg daily in divided doses) can be effective, though this requires reliable contraception as it can cause birth defects 1. Finasteride (2.5-5 mg daily) or flutamide may be alternatives in specific cases. For women with polycystic ovary syndrome, metformin (1500-2000 mg daily) may help reduce insulin resistance and subsequently decrease androgen levels. Weight loss of 5-10% in overweight women can significantly improve hirsutism by reducing insulin resistance and androgen production. Some key points to consider when treating hirsutism include:

• The importance of combining medical treatments with cosmetic hair removal methods for optimal results
• The need for reliable contraception when using antiandrogen agents like spironolactone
• The potential benefits of metformin in reducing insulin resistance and androgen levels in women with polycystic ovary syndrome
• The importance of regular follow-up to monitor for side effects and adjust treatment as needed. It's also important to note that medical treatments typically take 6-12 months to show significant results, and combining approaches often yields the best outcomes 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) can be used 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, 4

Pharmacologic Therapies

• Combined oral contraceptives are recommended as a first-line treatment for hirsutism 3, 4
• Finasteride and spironolactone can be used as pharmacologic therapies for hirsutism 2, 4
• Topical eflornithine is a medical therapy that can be used as an adjuvant for hirsutism 3, 4
• Insulin sensitizers may be effective for hirsutism in women with hyperandrogenism and insulin resistance, but not for hirsutism alone 3

Lifestyle and Cosmetic Treatments

• Lifestyle modification counseling is recommended for women with hirsutism 2
• Cosmetic treatments, such as shaving, waxing, and plucking, may be effective but have temporary effects 4
• Photoepilation and electrolysis can be used for long-term hair removal but are expensive 4