Insulin Sensitizers for the Treatment of Hirsutism: A Systematic Review and Meta-Analyses of Randomized Controlled Trials

The systematic review and meta-analyses from 2008 evaluated the effectiveness of insulin sensitizers, such as metformin and thiazolidinediones, in treating hirsutism. The review included 16 trials with 22 comparisons, but these trials were of low methodological quality. The results showed a small decrease in hirsutism severity with insulin sensitizers compared to placebo, but no significant difference when compared with oral contraceptives or antiandrogens. Specifically, the pooled weighted mean difference (WMD) for insulin sensitizers versus placebo was -1.5, indicating a small benefit. However, metformin was less effective than spironolactone and flutamide. The evidence was characterized as imprecise and inconsistent, and the review suggested that insulin sensitizers provide limited or no significant benefit for women with hirsutism. The review also noted the need for future clinical trials with patient-reported outcomes and highlighted the limitations of the studies, including small sample sizes and potential publication bias.