Sandbox:SMMM
S.Mojdeh Mirmomen
Treatment
Shown below is an algorithm summarizing the treatment of hirsutism according the Endocrine Society Clinical Practice guidelines.
| Initial therapy for patient with hirsutism | |||||||||||||||||||||||||||||||||||||||
| Mild hirsutism and no evidence of an endocrine disorder | Moderate or patient-important hirsutism | Severe hirsutism | |||||||||||||||||||||||||||||||||||||
| Direct hair removal methods | Pharmacological therapy | Pharmacological therapy (add direct hair removal if needed) | Combined pharmacological therapy | ||||||||||||||||||||||||||||||||||||
| • Photoepilation for women with auburn, brown, or black unwanted hair • Electrolysis for women with white or blonde hair | • Start oral contraceptives in women who are not seeking fertility ** Use oral contraceptives containing the lowest effective dose of ethinyl estradiol and a low-risk progestin for women at higher risk for venous thromboembolism (e.g., obese or >39 years old) • Start either oral contraceptives or anti-androgens in women who are not sexually active, have undergone permanent sterilization, or who are using long-acting reversible contraception | Oral contraceptives and antiandrogens | |||||||||||||||||||||||||||||||||||||
| Add an antiandrogen if hirsutism remains despite 6 months of monotherapy with an oral contraceptive | |||||||||||||||||||||||||||||||||||||||