How effective are pharmacologic treatments for women with hirsutism?

Abstract

Hirsutism is a common problem that can have profound implications for quality of life and psychological wellbeing. Various nonpharmacologic and pharmacologic strategies are available to manage excess hair. In this Practice Point commentary, I discuss the results of a systematic review, which assessed the relative efficacy of several commonly used pharmacologic agents for the treatment of hirsutism. Koulouri and Conway identified 28 randomized controlled trials of 6 months' duration that assessed four interventions: modulators of metabolism, oral contraceptive pills, antiandrogens, and combination therapy. All treatment options significantly improved the main outcome measure (Ferriman–Gallwey score). Obesity was found to negatively affect treatment efficacy, suggesting that lifestyle modification could represent an important component of the treatment strategy. The study design had several weaknesses, such as the relatively small number of women in each treatment group. Nonetheless, the results add to the evidence base supporting the use of these agents in the treatment of hirsutism.