Treatment of hirsutism

The underlying cause should always be treated if possible. (1,2)

Physical methods of hair removal - waxing removes a large part of the hair shaft underlying the skin surface; other methods include shaving, bleaching, plucking, depilation, and electrolysis. There is evidence for the effectiveness of treatment with the ruby laser in hirsutism .

Women who are overweight or obese should be advised on losing weight

Medical treatments include:

• anti-androgens e.g. cyproterone acetate - competitively inhibits androgens at peripheral receptors and may also reduce androgen synthesis. Often cyproterone acetate is used in a combined preparation (2mg cyproterone and 35 mcg ethinyloestradiol) Dianette (R) which is useful in women who also wish to receive oral contraception
  
  
• oestrogen such as ethinlyoestradiol, or a combined oral contraceptive pill (without an androgenic progesterone) - these suppress ovarian androgen production in patients in whom the androgen is of ovarian origin)
  
  
• spironolactone occupies androgen binding sites on target tissues and has direct anti-androgenic properties. Some women develop polymenorrhoea and should receive oral contraceptives. It is not considered as a first line treatment in UK
  
  
• flutamide and finasteride are occasionally used in hospital practice
• GnRH analogs: two to three months of treatment may be required to achieve maximum effect, usually combined with estrogen-progestin replacement or an OC, and an androgen blocker
• Glucocorticoids – used for the treatment of both classic and non classic forms of congenital adrenal hyperplasia.
• Metformin can be used in women with polycystic ovarian disease
• topical eflornithine cream
  • used in UK to treat facial hirsutism
  • 11.5% eflornithine cream used in treatment of hirsutism; irreversibly inhibits ornithine decarboxylase
  • marketed as a treatment modality to reduce the frequency of the woman's usual method of hair removal. It is not being marketed as a replacement
  • the overall response may be modest, with marked improvement being seen in 32% of women

References:

1. Liu K, Motan T, Claman P. No. 350-Hirsutism: evaluation and treatment. J Obstet Gynaecol Can. 2017 Nov;39(11):1054-68.
2. Koulouri O, Conway GS. Management of hirsutism. BMJ. 2009 Mar 27;338:b84