CLINICAL REVIEW Management of hirsutism

Hirsutism is the presence of excess hair growth in women, and the term usually refers to excessive growth of terminal hair in an androgen dependent distribution. Although it is often thought to be a cosmetic problem, unwanted hair growth adversely affects psychological wellbeing. It can have a similar effect on quality of life scores to that of asthma, epilepsy, and diabetes, and effective treatments reverse these adverse scores. Several new treatments have emerged in recent years, including the wider availability of laser depilation, topical suppressors of hair growth (eflornithene), and a progestogenwith antiandrogenic properties (drospirenone). In this review, we assess the evidence base for new treatments in the context of established treatments, although the worldwide availability of these preparations varies greatly. The overall quality of primary evidence of the relative efficacyof treatments for hirsutism isweak and is based on small studies of short duration that lack quality of life outcomes. Recently, however, systematic reviews have amalgamated this evidence and new guidelines are now available.