Hirsutism

Question 1

What is hirsutism?

Answer 1

• Male pattern hair growth
• Hirsutism (HUR-soot-iz-um) is a condition of unwanted, male-pattern hair growth in women.
• Hirsutism results in excessive amounts of dark, course hair on body areas where men typically grow hair — face, chest and back.
• It is common in 10% of women and is benign

Question 2

What causes hirsutism?

Answer 2

• Familial
• Idiopathic
• Increased androgen secretion by the ovary
  
  • Polycystic ovarian syndrome
    
    • This causes hirsutism, secondary oligo- or amenohorroea, infertility, obesity and acne
  • Ovarian cancer
• Increased androgen secretion by the adrenal gland
  
  • Late onset congenital adrenal hyperplasia
  • Cushings syndrome
  • Adrenal cancer
• Drugs
  
  • Steroids

Question 3

How would you investigate Hirsutism?

Answer 3

• Ultrasound of ovaries for PCOS
• Blood tests
  
  • Raised testosterone levels
  • Decreased sex hormone binding globulin
  • Raised LH:FSH ratio
  • TSH
  • Lipids

Question 4

How is Hirsutism managed?

Answer 4

1. Addres any feelings of lack of conformity to society’s feminine beauty norms
2. Lifestyle changes
   
   1. Healthy eat
   2. Optimise weight
   3. Shaving/laser/epitalation/wax/creams/bleach
3. Oestrogens
   
   1. COCP
      
      1. Yasmin - its progestegen is an antimineralocorticoid
      2. Cocyprindiol - as long as there are no contraindications
4. Metformin - for insulin resistance
5. Spironolactone
6. Clomifene - for infertility

Question 5

What are the contraindications and risks of Cocyprindiol?

Answer 5

• CI = Uncontrolled hypertension & current breast cancer
• Risk = VTE risk therefore must be stopped 3-4 months after hirsutism has completely resolved