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Updated guideline for hirsutism in women now available

Dr Joslyn Ngu
16 Mar 2018

A 2008 clinical practice guideline by the Endocrine Society for hirsutism in premenopausal women has been updated and published in the Journal of Clinical Endocrinology & Metabolism. [https://doi.org/10.1210/jc.2018-00241]

“Excess facial or body hair is not only distressing to women, it is often a symptom of an underlying medical problem,” said Dr Kathryn A Martin, of the Massachusetts General Hospital in Boston, Massachusetts, US and chair of the task force that authored the guideline. It is important for patients to refer to their healthcare provider to find out what is causing the excess hair growth and consider treatment options, she continued.

Among the recommendations in the updated guideline is for women with normal or regular menstruation who have unwanted dark, coarse hair growing on the face, chest or back to undergo testing for polycystic ovary syndrome (PCOS) and other underlying health problems. Hirsutism affects 5 to 10 percent of women. The excess hair growth can be caused by PCOS, a common condition that contributes to infertility and metabolic health problems, the authors explained.

The previous guideline recommended testing for the hormones only in moderate-to-severe hirsutism and the updated guideline has broadened the recommendation to improve diagnosis of underlying conditions. The authors suggested to perform blood tests for male sex hormones such as testosterone, for all women with hirsutism. Generally, women have low levels of male sex hormones and the levels will be elevated in women with PCOS and other hirsutism-related conditions.

If left untreated, hirsutism may lead to psychological distress such as anxiety and depression. The guideline suggests treating mild hirsutism with no sign of an underlying condition with medication or direct hair removal. For most women with hirsutism and are not trying to become pregnant, the authors suggest prescribing oral contraceptives as the first-line treatment. They recommended using the combined oestrogen–progestin contraceptives for most patients and to add an antiandrogen after 6 months if the response is suboptimal. 

Another update in the clinical practice guideline is the recommendation to consider lifestyle changes for women with both obesity and hirsutism. The authors noted that weight loss by itself is not a recommended therapy for hirsutism but there are studies that linked weight loss with slight improvement in unwanted hair growth. Additionally, a healthy diet and exercise can be advantageous for women with PCOS, they added.

The guideline also included recommendations for hair removal therapy. For patients with unwanted auburn, brown or black hair, photoepilation is the preferred hair removal method. As for patients with unwanted white or blonde hair, the guideline recommends using electrolysis. In addition to that, the guideline advises healthcare professionals to use a long wavelength and long pulse-duration light source when performing hair removal procedure for women of colour who chose the photoepilation method. This is to avoid complications, the authors explained. Furthermore, healthcare professionals should caution patients of Mediterranean and Middle Eastern descent of the higher risk of side effects such as blistering, skin pigment changes or scarring.

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