New
recommendations on hirsutism advice for testing for elevated androgen levels in
all women with abnormal hirsutism scores as a routine. But if the
hirsutism score is normal there is no need to perform testing for elevated
androgen levels. Hyper-androgenaemic women should also be screened for
non-classical congenital adrenal hyperplasia (NCCAH) due to 21-hydroxylase
deficiency, by measuring early morning 17-hydroxyprogesterone levels in the
follicular phase or on a random day for those with amenorrhoea or infrequent
menses.
·
For most women with patient-important hirsutism despite cosmetic
measures, the recommendation is to start with pharmacological therapy and add
direct hair removal methods such as electrolysis and photoepilation.
·
For women with mild hirsutism and no evidence of an endocrine disorder,
the advice is either direct hair removal methods or oral combined
oestrogen-progestin contraceptives, adding an antiandrogen after six months if
response is suboptimal.
·
For women at higher risk for venous thromboembolism, initial therapy
should be an oral contraceptive containing the lowest effective dose of
ethinylestradiol and low-risk progestin.
The
society advises against using insulin-lowering drugs. For most women who choose
hair removal therapy, laser/photoepilation is recommended.
