Hirsutism in Premenopausal Women
Key Points
Key Points
- Hirsutism is common, occurring in 5 to 10 percent of all women.
- Hirsutism is usually a sign of an underlying endocrine disorder (most commonly polycystic ovary syndrome [PCOS]). Women who present with hirsutism should therefore be offered an endocrine evaluation followed by appropriate therapy.
- Hirsutism is associated with personal distress, anxiety and depression. It is important for clinicians to take their patients’ cosmetic concerns seriously.
- Treatment options include pharmacologic therapy (starting with combination oral estrogen-progestin contraceptives for most), direct hair removal methods such as photoepilation/laser, or both.
- Photoepilation (hair removal using laser and intense pulsed light) is most effective for women with light skin and dark hair. It is less effective and sometimes associated with complications in women with darker skin, especially those with Middle Eastern and Mediterranean ancestry.
Table 1. Definitions of Terms Used in This Guideline
| Term | Definition | ||
|---|---|---|---|
| Hirsutism | Hirsutism is excessive terminal hair that appears in a male pattern (excessive hair in androgen-dependent areas; i.e., sexual hair) in women. | ||
| Ferriman–Gallwey score | The modified Ferriman–Gallwey score is the gold standard for evaluating hirsutism. Nine body areas most sensitive to androgen are assigned a score from 0 (no hair) to 4 (frankly virile), and these separate scores are summed to provide a hormonal hirsutism score (Fig. 1). | ||
| Local hair growth | This is unwanted localized hair growth in the absence of an abnormal hirsutism score. | ||
| Patient-important hirsutism | Unwanted sexual hair growth of any degree that causes sufficient distress for women to seek additional treatment. | ||
| Hyperandrogenism | Hyperandrogenism (for the purposes of this guideline) is defined as clinical features that result from increased androgen production and/or action. | ||
| Idiopathic hirsutism | This is hirsutism without hyperandrogenemia or other signs or symptoms indicative of a hyperandrogenic endocrine disorder. | ||
Diagnosis
...gnosis...
...docrine Society (ES) suggests testing for elevate...
...es where serum total testosterone levels are norma...
...screening hyperandrogenemic women for non...
...ents with a high risk of congenital adrenal...
...nst testing for elevated androgen levels...
...rriman–Gallwey Hirsutism Scoring Sy...
...Evaluation and Treatment of Hirsutism in Preme...
...otes Local sexual hair growth (i....
Treatment
...atment...
...with patient-important hirsutism despite cosm...
...omen who then desire additional cosmetic ben...
...or hirsute women with obesity, including thos...
...logical Treatments...
...tial Therapies
...the majority of women with hirsutism who are n...
...women with hirsutism, ES suggests against antia...
...women who are not sexually active, have u...
For most women, ES does not suggest o...
...en with hirsutism at higher risk fo...
...-important hirsutism remains despite 6...
ES does not suggest one antiandrogen over a...
...er, we recommend against the use of fl...
For all pharmacologic therapies for hirsutism...
...with severe hirsutism causing emo...
...ever, ES suggests against combination the...
...le 2. Oral Contraceptives (OCs) and Associated...
.... Antiandrogens Used for the Treatment o...
...Drug Therapies...
ES suggests against using insulin-lowering d...
...s against using gonadotropin-releas...
ES suggests against the use of topical antiand...
...Hair Removal Method...
...en who choose hair removal therapy, ES suggests...
...en of color who choose photoepilation treatm...
...ans should warn Mediterranean and Midd...
...desire more rapid response to photoepilation,...
...ith known hyperandrogenemia who choose hai...