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Managing Hirsutism (Excessive facial and body hair) - What really works.

This page reviews the research evidence on the treatment options for hirsutism in PCOS. On a general note, treating hirsutism can be challenging in PCOS. However, where carefully managed it can lead to a significant rise in self esteem, confidence and psychological wellbeing. In clinical practice an objective measure of the degree of hirsutism such as the Ferriman-Gallwey score should be performed to determine the severity of hirsutism so that the efficacy of any treatment can be determined. Baseline tests to determine the source of excessive androgen (male hormones such as testosterone) are also imperative before treatment as hirsutism may have other (occasionally sinister) causes. Finally it is also important to note that, treatment must ideally be continued for a minimum of six months for any significant benefit to be observed.

The currently available treatment options include
· Mechanical Methods
o Plucking, Bleaching, Depilatory Cream Or Wax And Shaving May All Help
o Electrolysis
o Laser Treatment
· Drugs
o Cyproterone Acetate ethinylestradiol (Dianette),
o Combined Oral Contraceptive Pill
o Spironolactone
o Ketoconazole
o Finasteride
o Flutamide.
o Metformin
o Vaniqa (Eflornithine) - Recently Licensed for The UK Market.

The effectiveness of treatment options for PCOS were recently reviewed in “clinical evidence” ( with the following findings

Cyproterone acetate ethinylestradiol (Dianette)
Of the clinical trials discussed, four showed that cyproterone acetate alone or in combination with finasteride reduced hirsutism at 6 months. Interestingly, one other study showed that dianette was less effective than Metformin at 6 months and in another, less effective than ketoconazole. However, cyproterone acetate ethinylestradiol (dianette) is associated with an increased risk of venous thromboembolism (clots in the veins) and must be used with caution.

Three studies were discussed (two clinical trials and one systematic review). The systematic review and one trial showed that spironolactone resulted in a benefit in the treatment of hirsutism. However, one other clinical trial showed that spironolactone was less effective in reducing hirsuitism at 6 months than ketoconazole.

Five clinical trials reviewed showed some benefit with finasteride after 6 months treatment compared with placebo or compared with the baseline hirsutism score. However, when the relative effectiveness of finasteride, flutamide, and spironolactone were compared, there was either no significant difference in hirsutism among treatments or finasteride was less effective than flutamide in reducing hirsutism at 12 months. As stated previously, adding finasteride to cyproterone acetate ethinylestradiol reduced hirsutism at 6 months compared with cyproterone acetate ethinylestradiol alone.

Four clinical trials showed that flutamide improved hirsuitism when compared with placebo or with baseline hair quantity. Although one trial found that flutamide was more effective than finasteride in reducing hirsutism at 12 months. from baseline, two found no significant difference in hirsutism when flutamide was compared to other treatments.

One study was found, and it showed limited evidence that ketoconazole reduced hirsutism at 6 months compared with low dose cyproterone acetate ethinylestradiol or spironolactone.

One trial found that metformin was more effective in reducing hirsutism at 12 months than cyproterone acetate ethinylestradiol.

Mechanical Hair Removal
No studies were reviewed.

Vaniqa (eflornithine) is marketed by Shire Pharmaceuticals for facial hirsutism and has recently been licensed in the UK. However, as far as I know, there are currently no large UK clinical trials of its effectiveness.

In conclusion, mechanical and pharmacological (drugs) options exist for the management of women with hirsutism and PCOS. Apart from mechanical methods and Vaniqa where UK based clinical trials are currently awaited, it would appear that one clinical trial or the other has shown that the other drugs currently used to treat hirsutism in PCOS are effective. Care of women with PCOS and hirsutism is therefore best individualized, with treatment perhaps commenced with mechanical methods and Vaniqa used in conjunction with cyproterone acetate or the combined pill in the first instance. Where these fail, Finasteride, Metformin, Ketoconazole or Flutamide may be introduced.

Copyright William Atiomo 2005