Management of Hirsutism

The document from 2000 reviews the management of hirsutism, with a focus on pharmacological treatments for women with PCOS and idiopathic hirsutism. It evaluates the effectiveness of GnRH agonists, COCs, and antiandrogens such as flutamide, CPA, spironolactone, and finasteride. The review highlights that antiandrogens, especially flutamide and CPA, are the most effective, with flutamide showing a Ferriman-Gallwey score reduction of up to 56.7% in PCOS and 50.9% in idiopathic hirsutism at 12 months. COCs are beneficial over the long term, particularly for mild to moderate hirsutism. The document also emphasizes the importance of managing obesity, insulin resistance, and hyperinsulinemia in hirsutism treatment. Adverse effects of these treatments are noted, including hepatotoxicity and teratogenicity. The authors' experience with 310 hirsute women shows the necessity of long-term and continuous use of antiandrogens and COCs for treating mild to moderate hirsutism, with electrolysis recommended for severe cases. The preferred management approach at the time was using CPA and flutamide in specific dosages and regimens, often in combination with COCs.