What medical treatments are available for my hirsutism?-checksum="42180" ends

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There are medical treatments that:-

• inhibit gonadotrophins (sex hormones).

Combined oral contraceptive pills, and in particular one containing the anti-androgen cyproterone acetate (Dianette - Schering) are the most popular treatments for hirsutism (Q8.14):

• inhibit overproduction of androgens.

Steroids such as dexamethasone may be used if there is evidence of congenital adrenal hyperplasia. There is some evidence that a small dose of steroids can be an effective treatment when no obvious cause can be found. Suppression of ovarian hormone production with GnRH analogues (gonadotrophins) is expensive and they can only be used by themselves for short spells. Combinations of GnRH and add-back hormone replacement therapy (HRT-Add-Back) may have an occasional place.

• increase SHBG (SHBG).

Combined oral contraceptive pill.

• block androgen receptor sites. 

Cyproterone acetate (Q8.15)

• increase sensitivity to insulin.

There is accumulating evidence that the clinical manifestations, including hirsutism, associated with PCOS can be related to insulin resistance (PCOS cause). Metformin is a drug that increases insulin sensitivity and it has been used from the 1950s in the management of diabetes. Recent studies have demonstrated that metformin may be of value in the treatment of hirsutism associated with PCOS.

Patients often present with a combination of hirsutism and infertility. Investigation to establish the cause is required. Several medical treatments for hirsutism, such as the combined oral contraceptive, would clearly be inappropriate when pregnancy is being contemplated. Metformin may have a place in the treatment of PCOS associated hirsutism and anovulatory infertility. Currently we recommend that the drug should be discontinued as soon as pregnancy is confirmed.

Related Medical Abstracts - Click on the paper title:-

 

• Treatment with flutamide, metformin, and their combination added to a hypocaloric diet in overweight-obese women with polycystic ovary syndrome: a randomized, 12-month, placebo-controlled study. (2006-01)
• Spironolactone for hirsutism in polycystic ovary syndrome. (2005-01)
• Comparison of the clinical efficacy of flutamide and spironolactone plus Diane 35 in the treatment of idiopathic hirsutism: a randomized controlled study. (2005-02)
• Comparison of efficacy of spironolactone with metformin in the management of polycystic ovary syndrome: an open-labeled study. (2004-01)
• A comparison between spironolactone and spironolactone plus finasteride in the treatment of hirsutism. (2004-02)
• Finasteride versus cyproterone acetate-estrogen regimens in the treatment of hirsutism. (2004-03)
• Intermittent low-dose finasteride is as effective as daily administration for the treatment of hirsute women. (2004-04)
• Relative safety and efficacy of finasteride for treatment of hirsutism. (2004-05)
• Venous thromboembolism associated with cyproterone acetate in combination with ethinyloestradiol (Dianette): observational studies using the UK General Practice Research Database. (2004-06)
• Finasteride versus cyproterone acetate-estrogen regimens in the treatment of hirsutism. (2004-07)
• Spironolactone versus placebo or in combination with steroids for hirsutism and/or acne (2003-01)
• Comparison of the efficiency of anti-androgenic regimens consisting of spironolactone, Diane 35, and cyproterone acetate in hirsutism. (2003-02)
• Metformin or antiandrogen in the treatment of hirsutism in polycystic ovary syndrome. (2003-03)
• Low-dose (2.5 mg/day) finasteride treatment in hirsutism. (2003-04)
• Cyproterone acetate for hirsutism. (2003-05)
• The risk of liver disorders in women prescribed cyproterone acetate in combination with ethinyloestradiol (Dianette): a nested case-control study using the GPRD. (2003-06)
• The effect of metformin on hirsutism in polycystic ovary syndrome. (2002-01)
• Efficacy of the combination ethinyl oestradiol and cyproterone acetate on endocrine, clinical and ultrasonographic profile in polycystic ovarian syndrome. (2001-01)
• Sensitization to insulin in adolescent girls to normalize hirsutism, hyperandrogenism, oligomenorrhea, dyslipidemia, and hyperinsulinism after precocious pubarche. (2000-01)
• Comparison of finasteride and flutamide in the treatment of idiopathic hirsutism. (1999-01)
• A prospective randomized trial comparing low dose flutamide, finasteride, ketoconazole, and cyproterone acetate-estrogen regimens in the treatment of hirsutism. (1999-02) 
• Treatment of hirsutism: Comparisons between different antiandrogens with central and peripheral effects. (1999-03)
• A prospective randomized trial comparing low dose flutamide, finasteride, ketoconazole, and cyproterone acetate-estrogen regimens in the treatment of hirsutism. (1999-04)
• The addition of dexamethasone to antiandrogen therapy for hirsutism prolongs the duration of remission. (1998-01)
• Effects of two antiandrogen treatments on hirsutism and insulin sensitivity in women with polycystic ovary syndrome. (1998-02)
• Comparison of Diane 35 and Diane 35 plus finasteride in the treatment of hirsutism (1998-03)
• The efficacy of 250 mg/day flutamide in the treatment of patients with hirsutism (1996-01)
• Comparison of spironolactone-oral contraceptive versus cyproterone acetate-estrogen regimens in the treatment of hirsutism (1996-02)?
• Flutamide in the treatment of hirsutism: Long-term clinical effects, endocrine changes, and androgen receptor behavior (1995-01)?
• Treatment of hirsutism with a gonadotropin-releasing hormone agonist and estrogen replacement therapy (1994-01)
• Treatment of hirsutism with flutamide and a low-dosage oral contraceptive in polycystic ovarian disease patients (1994-02)
  

  
  

  

  
  
  
  

  

  
  

  See Also:
  

  Hirsutism

  Alopecia

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  Answers to FAQs on women's health, patient information and medical advice by David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist (Gynecologist - OBGYN), Department of Obstetrics and Gynaecology, Whipps Cross Hospital, London