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Hirsutism - Management
How should I manage hirsutism in premenopausal women?

For premenopausal women (with or without polycystic ovary syndrome):

  • Encourage weight loss in women who are overweight or obese (see the CKS topic on Obesity for more information).
  • Discuss cosmetic methods of hair reduction and removal, as these will remain an important part of management.
  • If hirsutism is mild and does not significantly impact on the woman's quality of life, consider no additional treatment.
  • If additional treatment is required, offer co-cyprindiol (Dianette®) or a combined oral contraceptive (COC) containing drospirenone (for example Yasmin®).
    • Co-cyprindiol (Dianette®; a combination of ethinylestradiol and the anti-androgen cyproterone acetate) is licensed for the treatment of moderately-severe hirsutism but should be stopped three or four menstrual cycles after the woman's hirsutism has completely resolved because of an increased risk of venous thromboembolism.
    • Yasmin® (a combination of ethinylestradiol and drospirenone) is not licensed specifically for hirsutism but is an alternative to co-cyprindiol for women who require long-term treatment. Yasmin® is more expensive than co-cyprindiol.
    • See the CKS topic on Contraception for a full discussion of the risks of COCs.
  • Advise the woman that treatment may take at least 6 months to work.
  • If relapse occurs when co-cyprindiol is stopped, consider:
    • Intermittent use of co-cyprindiol — stopping treatment after resolution occurs, and starting again if symptoms reappear (licensed use).
    • Switching to a COC containing drospirenone (Yasmin®).
    • Some experts recommend continuing treatment with co-cyprindiol if the above measures fail.
  • If COCs are contraindicated or have not worked, offer women with facial hirsutism topical eflornithine.
    • Benefit should be noticed in 6–8 weeks, and eflornithine should be discontinued if no benefit is seen within 4 months of starting treatment.
    • If improvement is seen, continued treatment is necessary to maintain the benefits. Once the cream is discontinued, hair growth returns to pretreatment levels within about 8 weeks.
    • Eflornithine is contraindicated during pregnancy and breastfeeding.

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