Hirsutism in premenopausal women - new treatment guidelines

The Endocrine Society has released new clinical practice guidelines for the treatment of hirsutism in premenopausal women. The guidelines appear in the April issue of the Journal of Clinical Endocrinology & Metabolism (JCEM), a publication of The Endocrine Society.

Hirsutism is defined medically as excessive terminal hair that appears in a male pattern in women. Terminal hair refers to the stiff, pigmented hairs normally seen in men on the face, chest, abdomen, and back, and which are not normal in women. The cause of hirsutism can be either an increased level of androgens in women or an oversensitivity of hair follicles to natural levels of androgens in women.

"Hirsutism is a potential indication of an underlying medical disorder that may require specific treatment, and such a disorder may have implications for menstrual function, fertility, and metabolic risks," said Kathryn Martin, MD, of the Reproductive Endocrine Unit at Massachusetts General Hospital in Boston, Massachusetts, and member of the Society's task force that developed the guidelines. "These evidence-based guidelines give healthcare professionals an approach to treating hirsutism based upon a comprehensive review of clinical trials of drug therapy and hair removal techniques such as laser and electrolysis."

The guidelines suggest testing for elevated androgen levels in women with moderate or severe hirsutism, or hirsutism of any degree when it is sudden in onset, rapidly progressive, or associated with other abnormalities such as menstrual dysfunction or obesity.

For pharmacological therapy, the guidelines suggest oral contraceptives for the majority of women, adding an antiandrogen after six months if the response in suboptimal. An antiandrogen is a substance that prevents or inhibits the effects of male sex hormones. The guidelines recommend against using antiandrogens alone unless adequate contraception is used, because antiadrogens pose a potential risk to the normal sexual development of a male fetus.

Almost all women with hirsutism use temporary methods of hair removal such as shaving, plucking, and waxing. For those considering more "permanent" methods of hair removal the guidelines suggest photoepilation (laser and intense pulsed light) as first line therapy. Photoepilation methods, when compared to electrolysis, are more expensive per treatment session, but are more efficient, less painful, and may be associated with less scarring.

The guidelines were developed by a task force chaired by Dr. Martin. Other members of the task force included R. Jeffrey Chang of the University of California School of Medicine-San Diego in La Jolla, California; David Ehrmann of the University of Chicago General Clinical Research Center in Chicago, Illinois; Lourdes Ibanez of the University of Barcelona in Barcelona, Spain; Rogerio Lobo of Columbia University Medical Center in New York, New York; Robert Rosenfeld of the University of Chicago Comer Children's Hospital in Chicago, Illinois; Jerry Shapiro of the University of British Columbia in Vancouver, Canada; and Victor Montori and Brian Swiglo of Mayo Clinic in Rochester, Minnesota.