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Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline.
J Clin Endocrinol Metab. 2018 04 01; 103(4):1233-1257.JC

Abstract

Objective

To update the "Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline," published by the Endocrine Society in 2008.

Participants

The participants include an Endocrine Society-appointed task force of seven medical experts and a methodologist.

Evidence

This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation system to describe the strength of recommendations and the quality of evidence. The task force commissioned two systematic reviews and used the best available evidence from other published systematic reviews and individual studies.

Consensus Process

Group meetings, conference calls, and e-mail communications facilitated consensus development. Endocrine Society committees, members, and cosponsoring organizations reviewed and commented on preliminary drafts of the guidelines.

Conclusion

We suggest testing for elevated androgen levels in all women with an abnormal hirsutism score. We suggest against testing for elevated androgen levels in eumenorrheic women with unwanted local hair growth (i.e., in the absence of an abnormal hirsutism score). For most women with patient-important hirsutism despite cosmetic measures (shaving, plucking, waxing), we suggest starting with pharmacological therapy and adding direct hair removal methods (electrolysis, photoepilation) for those who desire additional cosmetic benefit. For women with mild hirsutism and no evidence of an endocrine disorder, we suggest either pharmacological therapy or direct hair removal methods. For pharmacological therapy, we suggest oral combined estrogen-progestin 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 most women who choose hair removal therapy, we suggest laser/photoepilation.

Authors+Show Affiliations

Massachusetts General Hospital, Boston, Massachusetts.Massachusetts General Hospital, Boston, Massachusetts.University of California, San Diego, La Jolla, California.University of Chicago, Chicago, Illinois.Columbia University, New York, New York.Mayo Clinic Evidence-Based Practice Center, Rochester, Minnesota.Hospices Civils de Lyon, Bron, France.University of Chicago, Chicago, Illinois.

Pub Type(s)

Journal Article
Practice Guideline
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29522147

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. 103, no. 4, 2018, pp. 1233-1257.
Martin KA, Anderson RR, Chang RJ, et al. Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(4):1233-1257.
Martin, K. A., Anderson, R. R., Chang, R. J., Ehrmann, D. A., Lobo, R. A., Murad, M. H., Pugeat, M. M., & Rosenfield, R. L. (2018). Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology and Metabolism, 103(4), 1233-1257. https://doi.org/10.1210/jc.2018-00241
Martin KA, et al. Evaluation and Treatment of Hirsutism in Premenopausal Women: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018 04 1;103(4):1233-1257. PubMed PMID: 29522147.
* 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 - Anderson,R Rox, AU - Chang,R Jeffrey, AU - Ehrmann,David A, AU - Lobo,Rogerio A, AU - Murad,M Hassan, AU - Pugeat,Michel M, AU - Rosenfield,Robert L, PY - 2018/01/29/received PY - 2018/01/29/accepted PY - 2018/3/10/pubmed PY - 2018/10/10/medline PY - 2018/3/10/entrez SP - 1233 EP - 1257 JF - The Journal of clinical endocrinology and metabolism JO - J Clin Endocrinol Metab VL - 103 IS - 4 N2 - Objective: To update the "Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline," published by the Endocrine Society in 2008. Participants: The participants include an Endocrine Society-appointed task force of seven medical experts and a methodologist. Evidence: This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation system to describe the strength of recommendations and the quality of evidence. The task force commissioned two systematic reviews and used the best available evidence from other published systematic reviews and individual studies. Consensus Process: Group meetings, conference calls, and e-mail communications facilitated consensus development. Endocrine Society committees, members, and cosponsoring organizations reviewed and commented on preliminary drafts of the guidelines. Conclusion: We suggest testing for elevated androgen levels in all women with an abnormal hirsutism score. We suggest against testing for elevated androgen levels in eumenorrheic women with unwanted local hair growth (i.e., in the absence of an abnormal hirsutism score). For most women with patient-important hirsutism despite cosmetic measures (shaving, plucking, waxing), we suggest starting with pharmacological therapy and adding direct hair removal methods (electrolysis, photoepilation) for those who desire additional cosmetic benefit. For women with mild hirsutism and no evidence of an endocrine disorder, we suggest either pharmacological therapy or direct hair removal methods. For pharmacological therapy, we suggest oral combined estrogen-progestin 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 most women who choose hair removal therapy, we suggest laser/photoepilation. SN - 1945-7197 UR - https://www.unboundmedicine.com/medline/citation/29522147/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.2018-00241 DB - PRIME DP - Unbound Medicine ER -