There are medical treatments that:-

Combined oral contraceptive pills, and in particular one containing the anti-androgen cyproterone acetate (Dianette - Schering) are the most popular treatments for hirsutism (Q8.14):

  • inhibit overproduction of androgens.

Steroids such as dexamethasone may be used if there is evidence of congenital adrenal hyperplasia. There is some evidence that a small dose of steroids can be an effective treatment when no obvious cause can be found. Suppression of ovarian hormone production with GnRH analogues (gonadotrophins) is expensive and they can only be used by themselves for short spells. Combinations of GnRH and add-back hormone replacement therapy (HRT-Add-Back) may have an occasional place.

  • increase SHBG (SHBG).

Combined oral contraceptive pill.

  • block androgen receptor sites. 

Cyproterone acetate (Q8.15)

  • increase sensitivity to insulin.

There is accumulating evidence that the clinical manifestations, including hirsutism, associated with PCOS can be related to insulin resistance (PCOS cause). Metformin is a drug that increases insulin sensitivity and it has been used from the 1950s in the management of diabetes. Recent studies have demonstrated that metformin may be of value in the treatment of hirsutism associated with PCOS.

Patients often present with a combination of hirsutism and infertility. Investigation to establish the cause is required. Several medical treatments for hirsutism, such as the combined oral contraceptive, would clearly be inappropriate when pregnancy is being contemplated. Metformin may have a place in the treatment of PCOS associated hirsutism and anovulatory infertility. Currently we recommend that the drug should be discontinued as soon as pregnancy is confirmed.

Related Medical Abstracts - Click on the paper title:-