Pharmacologic management of premenopausal hirsutism

This algorithm shows the pharmacologic management of premenopausal females with hirsutism of any degree that causes personal distress. For further details, refer to UpToDate content on management of hirsutism in premenopausal females. Most patients have underlying PCOS.

Direct hair removal methods may be used simultaneously with pharmacologic treatment.

BMI: body mass index; COC: combined oral contraceptives; VTE: venous thromboembolism; EE: ethinyl estradiol; K+: potassium; PCOS: polycystic ovary syndrome.

* Patient-important hirsutism: unwanted androgen-dependent hair growth of any degree that causes patient distress.

¶ The modified Ferriman-Gallwey score is used to monitor response to therapy (although it has limitations).

Δ Refer to UpToDate content on COCs and patient selection for contraindications.

◊ Neutral progestin: low or neutral androgenicity and a favorable VTE profile. Refer to UpToDate content on progestins in COCs.

§ Not all patients are candidates for laser hair removal. Refer to UpToDate content on treatment of hirsutism.

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Pharmacologic management of premenopausal hirsutism