Evaluation and Treatment of Hirsutism in Premenopausal Women.

Guideline Title: Evaluation and Treatment of Hirsutism in Premenopausal Women

Developer: Endocrine Society, Androgen Excess and Polycystic Ovary Syndrome Society, European Society of Endocrinology

Release Date: March 2018

Prior Version: February 5, 2008

Funding Source: Endocrine Society

Target Population: Premenopausal women with excess hair growth

Major Recommendations: DIAGNOSIS: Obtain a random serum total testosterone measurement to assess for androgen excess in all women with an abnormal hirsutism score (weak recommendation, low-quality evidence). Obtain an early-morning 17-hydroxyprogesterone measurement in all women with elevated testosterone and in women with hirsutism who are at high risk of congenital adrenal hyperplasia (weak recommendation; low-quality evidence). Do not measure androgen levels in women with normal menses and a normal hirsutism score (weak recommendation; low-quality evidence). PHARMACOLOGIC TREATMENT: Start with pharmacologic therapy and add direct hair removal methods for women with a normal hirsutism score but patient-important hirsutism despite shaving or plucking (weak recommendation; very low-quality evidence). In women who are not seeking pregnancy, oral contraceptive pills (OCPs) are recommended as initial therapy (weak recommendation; low-quality evidence). Either OCPs or antiandrogens are acceptable initial therapies in women who are not sexually active, have undergone permanent sterilization, or are using long-acting reversible contraception (weak recommendation; very low-quality evidence). Combination therapy with an antiandrogen is recommended if patient-important hirsutism persists despite 6 months of monotherapy with an OCP (weak recommendation; low-quality evidence).