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Evaluation and treatment of hirsutism in premenopausal women: an endocrine society clinical practice guideline.
J Clin Endocrinol Metab. 2008 Apr; 93(4):1105-20.JC

Abstract

OBJECTIVE

Our objective was to develop clinical practice guidelines for the evaluation and treatment of hirsutism in premenopausal women.

PARTICIPANTS

The Task Force was composed of a chair, selected by the Clinical Guidelines Subcommittee (CGS) of The Endocrine Society, six additional experts, two methodologists, and a medical writer. The Task Force received no corporate funding or remuneration.

EVIDENCE

Systematic reviews of available evidence were used to formulate the key treatment and prevention recommendations. We used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) group criteria to describe both the quality of evidence and the strength of recommendations. We used "recommend" for strong recommendations, and "suggest" for weak recommendations.

CONSENSUS PROCESS

Consensus was guided by systematic reviews of evidence and discussions during one group meeting, several conference calls, and e-mail communications. The drafts prepared by the Task Force with the help of a medical writer were reviewed successively by The Endocrine Society's CGS, Clinical Affairs Core Committee (CACC), and Council. The version approved by the CGS and CACC was placed on The Endocrine Society's Web site for comments by members. At each stage of review, the Task Force received written comments and incorporated needed changes.

CONCLUSIONS

We suggest testing for elevated androgen levels in women with moderate or severe hirsutism or hirsutism of any degree when it is sudden in onset, rapidly progressive, or associated with other abnormalities such as menstrual dysfunction, obesity, or clitoromegaly. For women with patient-important hirsutism despite cosmetic measures, we suggest either pharmacological therapy or direct hair removal methods. For pharmacological therapy, we suggest oral contraceptives for the majority of women, adding an antiandrogen after 6 months if the response is suboptimal. We recommend against antiandrogen monotherapy unless adequate contraception is used. We suggest against using insulin-lowering drugs. For women who choose hair removal therapy, we suggest laser/photoepilation.

Authors+Show Affiliations

Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Practice Guideline
Review

Language

eng

PubMed ID

18252793

Citation

Martin, Kathryn A., et al. "Evaluation and Treatment of Hirsutism in Premenopausal Women: an Endocrine Society Clinical Practice Guideline." The Journal of Clinical Endocrinology and Metabolism, vol. 93, no. 4, 2008, pp. 1105-20.
Martin KA, Chang RJ, Ehrmann DA, et al. Evaluation and treatment of hirsutism in premenopausal women: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2008;93(4):1105-20.
Martin, K. A., Chang, R. J., Ehrmann, D. A., Ibanez, L., Lobo, R. A., Rosenfield, R. L., Shapiro, J., Montori, V. M., & Swiglo, B. A. (2008). Evaluation and treatment of hirsutism in premenopausal women: an endocrine society clinical practice guideline. The Journal of Clinical Endocrinology and Metabolism, 93(4), 1105-20. https://doi.org/10.1210/jc.2007-2437
Martin KA, et al. Evaluation and Treatment of Hirsutism in Premenopausal Women: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2008;93(4):1105-20. PubMed PMID: 18252793.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluation and treatment of hirsutism in premenopausal women: an endocrine society clinical practice guideline. AU - Martin,Kathryn A, AU - Chang,R Jeffrey, AU - Ehrmann,David A, AU - Ibanez,Lourdes, AU - Lobo,Rogerio A, AU - Rosenfield,Robert L, AU - Shapiro,Jerry, AU - Montori,Victor M, AU - Swiglo,Brian A, Y1 - 2008/02/05/ PY - 2008/2/7/pubmed PY - 2008/5/28/medline PY - 2008/2/7/entrez SP - 1105 EP - 20 JF - The Journal of clinical endocrinology and metabolism JO - J Clin Endocrinol Metab VL - 93 IS - 4 N2 - OBJECTIVE: Our objective was to develop clinical practice guidelines for the evaluation and treatment of hirsutism in premenopausal women. PARTICIPANTS: The Task Force was composed of a chair, selected by the Clinical Guidelines Subcommittee (CGS) of The Endocrine Society, six additional experts, two methodologists, and a medical writer. The Task Force received no corporate funding or remuneration. EVIDENCE: Systematic reviews of available evidence were used to formulate the key treatment and prevention recommendations. We used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) group criteria to describe both the quality of evidence and the strength of recommendations. We used "recommend" for strong recommendations, and "suggest" for weak recommendations. CONSENSUS PROCESS: Consensus was guided by systematic reviews of evidence and discussions during one group meeting, several conference calls, and e-mail communications. The drafts prepared by the Task Force with the help of a medical writer were reviewed successively by The Endocrine Society's CGS, Clinical Affairs Core Committee (CACC), and Council. The version approved by the CGS and CACC was placed on The Endocrine Society's Web site for comments by members. At each stage of review, the Task Force received written comments and incorporated needed changes. CONCLUSIONS: We suggest testing for elevated androgen levels in women with moderate or severe hirsutism or hirsutism of any degree when it is sudden in onset, rapidly progressive, or associated with other abnormalities such as menstrual dysfunction, obesity, or clitoromegaly. For women with patient-important hirsutism despite cosmetic measures, we suggest either pharmacological therapy or direct hair removal methods. For pharmacological therapy, we suggest oral contraceptives for the majority of women, adding an antiandrogen after 6 months if the response is suboptimal. We recommend against antiandrogen monotherapy unless adequate contraception is used. We suggest against using insulin-lowering drugs. For women who choose hair removal therapy, we suggest laser/photoepilation. SN - 0021-972X UR - https://www.unboundmedicine.com/medline/citation/18252793/Evaluation_and_treatment_of_hirsutism_in_premenopausal_women:_an_endocrine_society_clinical_practice_guideline_ L2 - https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2007-2437 DB - PRIME DP - Unbound Medicine ER -