Hirsutism: an evidence-based treatment update

Area of Science:

• Endocrinology
• Dermatology
• Women's Health

Background:

• Hirsutism affects many women, causing psychosocial distress and potentially indicating underlying disorders.
• It requires thorough evaluation to manage associated etiologies and sequelae.
• Treatment often involves a multidisciplinary approach with varied physical or pharmacologic modalities.

Purpose of the Study:

• To review and summarize current evidence on the efficacy of hirsutism treatment modalities in premenopausal women.
• To consolidate findings from recent randomized controlled trials, systematic reviews, and meta-analyses.

Main Methods:

• Systematic search of online databases for relevant systematic reviews, meta-analyses, and randomized controlled trials (RCTs) published from 2012 to the present.
• Inclusion of four recent RCTs, one meta-analysis, and one systematic review/treatment guideline.

Main Results:

• Oral contraceptive pills (OCPs) and physical modalities are first-line treatments.
• Electrolysis and lasers (alexandrite, diode) offer permanent hair removal/reduction.
• Topical eflornithine is effective for mild hirsutism or as an adjunct therapy.
• Antiandrogens like spironolactone are indicated for moderate to severe hirsutism.
• Insulin sensitizers are not recommended for hirsutism as the sole indication.

Conclusions:

• Most hirsutism therapies have weak recommendations due to balanced or uncertain risk-benefit estimates and low-to-moderate quality evidence.
• Treatment requires careful discussion of risks, benefits, and realistic efficacy expectations.
• Pharmacotherapy benefits may take at least 6 months to appear, often requiring lifelong treatment.