Treating Hirsutism
Topical eflornithine is the only FDA-approved treatment for hirsutism; it has a 60% improvement rate after 6 months. Some nonrandomized studies have shown improvement with hormonal contraceptives, especially when they are combined with spironolactone (an androgen receptor antagonist). Antiandrogens have been used empirically and are often combined with oral contraceptives because of their teratogenic effects. There is no evidence that metformin improves hirsutism. Mechanical hair removal (by shaving, waxing, plucking, electrolysis, or laser) is often the treatment of choice.
Bottom Line
PCOS is characterized by a combination of hyperandrogenism, insulin resistance, menstrual dysfunction, polycystic ovaries, infertility, hirsutism, acne, androgenic alopecia, and metabolic syndrome. The most effective intervention for PCOS appears to be lifestyle management, with a goal of exercise and weight loss. Further treatment is geared toward symptom relief and reduction of long-term cardiovascular risk. (Reference: ACOG Practice Bulletin No. 108: Polycystic Ovary Syndrome. Obstet. Gynecol. 2009;114:936-49.)
This column, "Clinical Guidelines for Family Physicians," regularly appears in Family Practice News, an Elsevier publication. Dr. Skolnik is an associate director of the family medicine residency program at Abington (Pa.) Memorial Hospital. Dr. Myers is a chief resident in the family medicine residency program at Abington Memorial Hospital.