Hirsutism medical therapy
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Hirsutism Microchapters |
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Diagnosis |
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Treatment |
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Medical Therapy |
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Case Studies |
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Hirsutism medical therapy On the Web |
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Risk calculators and risk factors for Hirsutism medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2],Rasam Hajiannasab M.D.[3]
Overview
Pharmacologic medical therapies for hirsituism include oral contraceptives, androgen receptor blockers, 5-alpha reductase inhibitors, gonadotrophin-releasing hormone (GnRH agonist), adrenal suppressive glucocorticoids, insulin-sensitising agents, and biological modifiers of hair follicular growth. Treatment options are systemic therapy and topical therapy.
Medical Therapy
- Pharmacologic medical therapies for hirsituism include:[1]
- Oral contraceptives
- Androgen receptor blockers
- 5-alpha reductase inhibitors
- Gonadotrophin-releasing hormone (GnRH agonist)
- Adrenal suppressive glucocorticoids
- Insulin-sensitising agents
- Biological modifiers of hair follicular growth
Hirsutism
- 1. Adult
- 1.1 Systemic therapy
- Preferred regimen (1): Ethinyl estradiol 30 μg PLUS norethindrone l mg PO daily over a 9-month period[2]
- Preferred regimen (2): Mestranol 100 μg PLUS norethindrone 2 mg PO daily for about 2 weeks[3]
- Preferred regimen (3): Ethinyl estradiol 30 μg PLUS desogesterol 150 mcg PO daily for 4-7 months[4]
- Preferred regimen (4): Spironolactone starting dose of 50 mg PO q12h; may be increased to 200 mg PO daily.[5]
- Alternative regimen (1): Cyproterone Acetate 50-100 mg PO daily[6]
- Alternative regimen (2): Cyproterone Acetate 2 mg PLUS ethinyl estradiol 35 μg PO daily[7]
- Alternative regimen (3): Finasteride 1-5 mg PO daily[8]
- Alternative regimen (4): Flutamide 125-250 mg PO q12h
- Alternative regimen (5): Bicalutamide 25 mg PO daily[9]
- Alternative regimen (6): Metformin 500-1000 mg PO q12h[10]
- Alternative regimen (7): Rosiglitazone 4-8 mg PO daily
- Alternative regimen (8): Pioglitazone 10-30 mg PO daily[11]
- Alternative regimen (9): Leuprolide 7.5 mg IM PLUS estradiol 25-50 µg transdermal monthly[12]
- Alternative regimen (10): Prednisone 5-10 mg PO daily[13]
- 1.2 Topical Therapy
- Preferred regimen (1): Eflornithine hydrochloride 13.9% cream topical q12h[14]
- Preferred regimen (2): Finasteride 0.25% or 0.5% cream topical daily[15]
- 1.1 Systemic therapy
| Type of amenorrhea | Medicine | Dosage | Treatment duration | Bone mineral density (BMD) site | Outcome | |
|---|---|---|---|---|---|---|
| Exercise-associated
functional amenorrhea |
Ethinyl estradiol | 0.035 mg | 12 months | Lumbar spine and femoral neck | Increased BMD in all sites[16] | |
| Norethindrone | 0.5-1.0 mg
10 mg | |||||
| Ethinyl estradiol | 0.03 or 0.02 mg | 12 months | Lumbar spine | Increased BMD in all sites[17] | ||
| Desogestrel | 0.15 mg | |||||
| Ethinyl estradiol | 0.030 mg | 10 months | Lumbar spine and legs | Increase BMD in lumbar spine not in legs[18] | ||
| Levonorgestrel | 0.150 mg | |||||
| Ethinyl estradiol | 0.05 mg | 8 months | Lumbar spine and radius | Increase BMD in lumbar spine not in radius[19] | ||
| Cyproterone acetate | 2 mg | |||||
| Conjugated estrogen | 0.0625 mg | 24 months | Lumbar spine and femoral neck | Increased BMD in all sites[20] | ||
| Transdermal estradiol | 0.05 mg | |||||
| 12 days | Estriol | 1 mg | 9.3 months | Lumbar spine, femoral neck, and trochanter | No change BMD in any sites[21] | |
| Estradiol | 2 mg | |||||
| 10 days | Estriol | 1 mg | ||||
| Estradiol | 2 mg | |||||
| Norethisterone | 1 mg | |||||
| 6 days | Estriol | 0.5 mg | ||||
| Estradiol | 1 mg | |||||
| Premarin | 0.625 mg | 24 months | Lumbar spine, wrist, and foot | Increase BMD in lumbar spine, neither in wrist nor in foot[22] | ||
| Provera | 10 mg | |||||
| Ethinyl estradiol | 0.035 mg | 10 months | Lumbar spine and femoral neck | Increase BMD in lumbar spine not in femoral neck[23] | ||
| Norgestimate | 0.180–0.250 mg | |||||
| Anorexia-associated
functional amenorrhea |
Ethinyl estradiol | 0.020–0.035 mg | 12 months | Lumbar spine and femoral neck | No change BMD in any sites[24] | |
| Norgestimate | 0.180–0.250 mg
0.5 mg 0.5-1.0 mg - | |||||
| Ethinyl estradiol | 0.05 mg | 12 months | Lumbar spine | No change BMD[25] | ||
| Norgestrel | 0.5 mg | |||||
| Premarin | 0.625 mg | 18 months | Lumbar spine | No change BMD[26] | ||
| Provera | 5 mg | |||||
| Ethinyl estradiol | 0.035 mg | |||||
| Premarin | 0.3–0.625 mg daily | 4.3 years | Lumbar spine and femoral neck | Increased BMD in all sites[27] | ||
| Ethinyl estradiol | 0.020 mg | 12 months | Lumbar spine and femoral neck | No change BMD in any sites[28] | ||
| Levonorgestrel | 0.1 mg | |||||
| Dihydroepiandrostendion (DHEA) | 50 mg daily | |||||
| Recombinant IGF-1 | 30 mg/kg twice daily | 9 months | Lumbar spine, femoral neck, and radius | No change BMD in any sites[29] | ||
| Ethinyl estradiol | 0.035 mg | |||||
| Norethindrone | 0.4 mg | |||||
| Ethinyl estradiol | 0.035 mg | 13 cycles | Lumbar spine and femoral neck | No significant change BMD in any sites[30] | ||
| Norgestimate | 0.180–0.250 mg | |||||
Medical Therapy
Pharmacologic Treatment
Hormonal Therapy
- Oral contraceptives : Suppresses free testosterone level eg Yasmin which contains 30 microgram of estradiol and 3mg of drospirenone or Yaz (20microgram of estradiol and 3mg of drospirenone).
- Gonadotropin-releasing hormone agonists :An alternative to oral contraceptives[31]
If a tumor of ovaries or adrenal glands is the underlying cause of hirsutism, surgery may be the treatment option.
- Parenteral long acting gonadotropin-releasing hormone analogues [32] combined with OCPs containing estrogen and progestin for severe hirsutism not respinding to OCPs and antiandrogen e.g Leuprolide.
Adrenal Suppression
- Oral glucocorticoids : In patients with CAH eg Prednisone or Dexamethasone.
- Metformin for infertile women with PCOS.
Antiandrogens
- Finasteride: A 5α-reductase inhibitor, 2.5mg daily. (this is rarely used because it causes fatal hepatitis with a high risk of being teratogenic.
- Eflornithine hydrochloride cream (Vaniqa): Applied twice daily to the face.
Non-Pharmacologic Treatment
- Cosmetic therapy : Bleaching, shaving, depilating agents, plucking, waxing treatments.
- Electrosurgical methods include electrosurgical epilation and Laser therapy which can remove unwanted hair for some women specially for women with dark hair and light skin.[33]
Light-source-assisted hair reduction (photoepilation) is a common method in the treatment of unwanted hair and is more effective than shaving, waxing and electrolysis.[34]
| Skin/hair color | Choice of photoepilation device |
|---|---|
| Light skin/dark hair | Relatively short wavelength |
| Dark skin/dark hair | Relatively long wavelength or IPL(intense pulsed light) |
| Light/white hair | IPL + radiofrequency |
References
- ↑ Sachdeva S (2010). "Hirsutism: evaluation and treatment". Indian J Dermatol. 55 (1): 3–7. doi:10.4103/0019-5154.60342. PMC 2856356. PMID 20418968.
- ↑ Murphy A, Cropp CS, Smith BS, Burkman RT, Zacur HA (1990). "Effect of low-dose oral contraceptive on gonadotropins, androgens, and sex hormone binding globulin in nonhirsute women". Fertil. Steril. 53 (1): 35–9. PMID 2136834.
- ↑ Givens, James R.; Andersen, Richard N.; Wiser, Winfred L.; Fish, Stewart A. (1974). "Dynamics of Suppression and Recovery of Plasma FSH, LH, Androstenedione and Testosterone in Polycystic Ovarian Disease Using an Oral Contraceptive". The Journal of Clinical Endocrinology & Metabolism. 38 (5): 727–735. doi:10.1210/jcem-38-5-727. ISSN 0021-972X.
- ↑ Dewis P, Petsos P, Newman M, Anderson DC (1985). "The treatment of hirsutism with a combination of desogestrel and ethinyl oestradiol". Clin. Endocrinol. (Oxf). 22 (1): 29–36. PMID 3156694.
- ↑ Shaw JC (1991). "Spironolactone in dermatologic therapy". J. Am. Acad. Dermatol. 24 (2 Pt 1): 236–43. PMID 1826112.
- ↑ Lumachi F, Rondinone R (2003). "Use of cyproterone acetate, finasteride, and spironolactone to treat idiopathic hirsutism". Fertil. Steril. 79 (4): 942–6. PMID 12749435.
- ↑ Van der Spuy ZM, le Roux PA (2003). "Cyproterone acetate for hirsutism". Cochrane Database Syst Rev (4): CD001125. doi:10.1002/14651858.CD001125. PMID 14583927.
- ↑ Faloia E, Filipponi S, Mancini V, Di Marco S, Mantero F (1998). "Effect of finasteride in idiopathic hirsutism". J. Endocrinol. Invest. 21 (10): 694–8. doi:10.1007/BF03350800. PMID 9854686.
- ↑ Castelo-Branco C, Cancelo MJ (2010). "Comprehensive clinical management of hirsutism". Gynecol. Endocrinol. 26 (7): 484–93. doi:10.3109/09513591003686353. PMID 20218823.
- ↑ Paparodis R, Dunaif A (2011). "The Hirsute woman: challenges in evaluation and management". Endocr Pract. 17 (5): 807–18. doi:10.4158/EP11117.RA. PMID 21856600.
- ↑ Blume-Peytavi U (2013). "How to diagnose and treat medically women with excessive hair". Dermatol Clin. 31 (1): 57–65. doi:10.1016/j.det.2012.08.009. PMID 23159176.
- ↑ Bode D, Seehusen DA, Baird D (2012). "Hirsutism in women". Am Fam Physician. 85 (4): 373–80. PMID 22335316.
- ↑ Escobar-Morreale HF, Carmina E, Dewailly D, Gambineri A, Kelestimur F, Moghetti P, Pugeat M, Qiao J, Wijeyaratne CN, Witchel SF, Norman RJ (2012). "Epidemiology, diagnosis and management of hirsutism: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society". Hum. Reprod. Update. 18 (2): 146–70. doi:10.1093/humupd/dmr042. PMID 22064667.
- ↑ Martin KA, Chang RJ, Ehrmann DA, Ibanez L, Lobo RA, Rosenfield RL, Shapiro J, Montori VM, Swiglo BA (2008). "Evaluation and treatment of hirsutism in premenopausal women: an endocrine society clinical practice guideline". J. Clin. Endocrinol. Metab. 93 (4): 1105–20. doi:10.1210/jc.2007-2437. PMID 18252793.
- ↑ Farshi S, Mansouri P, Rafie F (2012). "A randomized double blind, vehicle controlled bilateral comparison study of the efficacy and safety of finasteride 0.5% solution in combination with intense pulsed light in the treatment of facial hirsutism". J Cosmet Laser Ther. 14 (4): 193–9. doi:10.3109/14764172.2012.699680. PMID 22658123.
- ↑ Hergenroeder AC, Smith EO, Shypailo R, Jones LA, Klish WJ, Ellis K (1997). "Bone mineral changes in young women with hypothalamic amenorrhea treated with oral contraceptives, medroxyprogesterone, or placebo over 12 months". Am. J. Obstet. Gynecol. 176 (5): 1017–25. PMID 9166162.
- ↑ Castelo-Branco C, Vicente JJ, Pons F, Martínez de Osaba MJ, Casals E, Vanrell JA (2001). "Bone mineral density in young, hypothalamic oligoamenorrheic women treated with oral contraceptives". J Reprod Med. 46 (10): 875–9. PMID 11725730.
- ↑ Rickenlund A, Carlström K, Ekblom B, Brismar TB, Von Schoultz B, Hirschberg AL (2004). "Effects of oral contraceptives on body composition and physical performance in female athletes". J. Clin. Endocrinol. Metab. 89 (9): 4364–70. doi:10.1210/jc.2003-031334. PMID 15328063.
- ↑ De Crée C, Lewin R, Ostyn M (1988). "Suitability of cyproterone acetate in the treatment of osteoporosis associated with athletic amenorrhea". Int J Sports Med. 9 (3): 187–92. PMID 2970444.
- ↑ Cumming DC (1996). "Exercise-associated amenorrhea, low bone density, and estrogen replacement therapy". Arch. Intern. Med. 156 (19): 2193–5. PMID 8885817.
- ↑ Gibson JH, Mitchell A, Reeve J, Harries MG (1999). "Treatment of reduced bone mineral density in athletic amenorrhea: a pilot study". Osteoporos Int. 10 (4): 284–9. doi:10.1007/s001980050228. PMID 10692976.
- ↑ Warren MP, Brooks-Gunn J, Fox RP, Holderness CC, Hyle EP, Hamilton WG, Hamilton L (2003). "Persistent osteopenia in ballet dancers with amenorrhea and delayed menarche despite hormone therapy: a longitudinal study". Fertil. Steril. 80 (2): 398–404. PMID 12909505.
- ↑ Warren MP, Miller KK, Olson WH, Grinspoon SK, Friedman AJ (2005). "Effects of an oral contraceptive (norgestimate/ethinyl estradiol) on bone mineral density in women with hypothalamic amenorrhea and osteopenia: an open-label extension of a double-blind, placebo-controlled study". Contraception. 72 (3): 206–11. doi:10.1016/j.contraception.2005.03.007. PMID 16102557.
- ↑ Golden NH, Lanzkowsky L, Schebendach J, Palestro CJ, Jacobson MS, Shenker IR (2002). "The effect of estrogen-progestin treatment on bone mineral density in anorexia nervosa". J Pediatr Adolesc Gynecol. 15 (3): 135–43. PMID 12106749.
- ↑ Muñoz MT, Morandé G, García-Centenera JA, Hervás F, Pozo J, Argente J (2002). "The effects of estrogen administration on bone mineral density in adolescents with anorexia nervosa". Eur. J. Endocrinol. 146 (1): 45–50. PMID 11751066.
- ↑ Klibanski A, Biller BM, Schoenfeld DA, Herzog DB, Saxe VC (1995). "The effects of estrogen administration on trabecular bone loss in young women with anorexia nervosa". J. Clin. Endocrinol. Metab. 80 (3): 898–904. doi:10.1210/jcem.80.3.7883849. PMID 7883849.
- ↑ Karlsson MK, Weigall SJ, Duan Y, Seeman E (2000). "Bone size and volumetric density in women with anorexia nervosa receiving estrogen replacement therapy and in women recovered from anorexia nervosa". J. Clin. Endocrinol. Metab. 85 (9): 3177–82. doi:10.1210/jcem.85.9.6796. PMID 10999805.
- ↑ Gordon CM, Grace E, Emans SJ, Feldman HA, Goodman E, Becker KA, Rosen CJ, Gundberg CM, LeBoff MS (2002). "Effects of oral dehydroepiandrosterone on bone density in young women with anorexia nervosa: a randomized trial". J. Clin. Endocrinol. Metab. 87 (11): 4935–41. doi:10.1210/jc.2002-020545. PMID 12414853.
- ↑ Grinspoon S, Thomas L, Miller K, Herzog D, Klibanski A (2002). "Effects of recombinant human IGF-I and oral contraceptive administration on bone density in anorexia nervosa". J. Clin. Endocrinol. Metab. 87 (6): 2883–91. doi:10.1210/jcem.87.6.8574. PMID 12050268.
- ↑ Strokosch GR, Friedman AJ, Wu SC, Kamin M (2006). "Effects of an oral contraceptive (norgestimate/ethinyl estradiol) on bone mineral density in adolescent females with anorexia nervosa: a double-blind, placebo-controlled study". J Adolesc Health. 39 (6): 819–27. doi:10.1016/j.jadohealth.2006.09.010. PMID 17116511.
- ↑ Rosenfield, Robert L. (2005). "Hirsutism". New England Journal of Medicine. 353 (24): 2578–2588. doi:10.1056/NEJMcp033496. ISSN 0028-4793.
- ↑ Klotz RK, Müller-Holzner E, Fessler S, Reimer DU, Zervomanolakis I, Seeber B; et al. (2010). "Leydig-cell-tumor of the ovary that responded to GnRH-analogue administration - case report and review of the literature". Exp Clin Endocrinol Diabetes. 118 (5): 291–7. doi:10.1055/s-0029-1225351. PMID 20198556.
- ↑ Franks, Stephen (2012). "The investigation and management of hirsutism". Journal of Family Planning and Reproductive Health Care. 38 (3): 182–186. doi:10.1136/jfprhc-2011-100175. ISSN 1471-1893.
- ↑ Dierickx CC, Grossman MC, Farinelli WA, Anderson RR (1998). "Permanent hair removal by normal-mode ruby laser". Arch Dermatol. 134 (7): 837–42. PMID 9681347.
- ↑ Goh CL (2003). "Comparative study on a single treatment response to long pulse Nd:YAG lasers and intense pulse light therapy for hair removal on skin type IV to VI--is longer wavelengths lasers preferred over shorter wavelengths lights for assisted hair removal". J Dermatolog Treat. 14 (4): 243–7. doi:10.1080/09546630310004171. PMID 14660273.