CCI |
|
-
Monotherapy for mild cases of facial hirsutism or as adjunct to other therapies (complements antiandrogen, laser, or IPL therapy) -
Considered first-line in postmenopausal women -
Well tolerated: might cause rash, burning, or tingling
|
-
Improvement noted at ≥ 8 wk; effect reverses 8 wk after discontinuation12–14 -
Used alone, treatment is successful about 30% of the time (slows rate of hair growth); variable cosmetic significance14 -
Improves time to effect with laser therapy (up to 95% successful)12
| Topical; apply twice daily, at least 8 h apart ($64 per 30-g tube; lasts about 3–5 mo for upper lip and 4–6 wk for lower face) |
OCPs |
-
EE with drospirenone (Yasmin, Yaz) -
EE with desogestrel (Marvelon, Ortho-Cept, Linessa) -
EE with norgestimate (Tri-Cyclen, Tri-Cyclen LO, Cyclen) -
See full RxFiles chart15 for other low-androgen OCP options
|
-
Generalized hirsutism, for women not seeking fertility -
All OCPs can help owing to estrogen’s effect on SHBG -
Risk of VTE, although small, increases with age (especially > 39 y) and possibly choice of OCP
-
-baseline risk: about 5/10 000 -
-with OCPs: 8–9/10 000 (up to 14/10 000) -
-possible increased risk with Yasmin, Yaz16,17
|
-
Improvement noted at 3 mo; maximum effect at 9–12 mo -
Yasmin: FGS 65%–70% lower at 6 mo and 80% lower at 12 mo18,19 -
Marvelon: FGS 40% lower at 6 mo and 35% lower at 12 mo18 -
Tri-Cyclen: no specific evidence
| 1 tablet, orally, once daily ($17–$23) |
|
-
Mild hirsutism, severe acne -
Risk of VTE, though small, might be higher compared with some other OCPs17
|
| EE 35 μg with CPA 2 mg ($29) |
Antiandrogens† |
|
|
-
Superior to metformin, flutamide20 -
Combination of spironolactone with OCPs superior to OCPs alone or flutamide21,22
| 25 mg orally, twice daily, for the first 1 wk; check potassium level in 3–7 d; then 50–100 mg orally, twice daily ($17–$25 for 100-mg tablet; $54–$100 for 25-mg tablet) |
|
|
-
No difference in efficacy between 2-mg and 100-mg doses23 -
Subjectively improves hirsutism and provides a “good clinical response” in 60%–80% of patients23 -
Similar efficacy to spironolactone, finasteride, GnRH analogues; less effective than flutamide23
| 25–100 mg/d, orally, at days 1–10 or 5–15 of cycle ($9–$33 for 50-mg tablet) |
|
|
| 5 mg/d orally $35 (5-mg tablet) |
|
|
| 250 mg/d orally $52 (250-mg tablet) |