Hirsutism. Practical therapeutic guidelines

Hirsutism is the transformation of fine vellus hair to visible, thickened terminal hair under androgenic stimulus. The most common causes of hirsutism are familial, idiopathic or polycystic ovarian disease. Patient distress is the prime indication for therapy. Drug treatment should be continued for 12 months before assessing response. Spironolactone is generally the drug tried first. Ovarian hormones, e.g. medroxyprogesterone acetate plus ethinylestradiol, or cyproterone acetate plus ethinylestradiol may be added if response is inadequate.