Background: Hirsutism is defined as the presence of terminal hair with male
distribution in women, and polycystic ovary syndrome (PCOS) is the most common etiology
Methods: The aim of this study is to review aspects of hair growth that are relevant for the
understanding of hirsutism in PCOS, along with current treatment alternatives.
Results: The prevalence of hirsutism in PCOS ranges from 70 to 80%, vs. 4% to 11% in
women in the general population. Hirsutism in PCOS is associated with both ovarianderived
androgen excess and individual sensitivity of the pilosebaceous unit to androgens.
Interventions to decrease hirsutism in PCOS include the suppression of androgen excess by
combined oral contraceptives (OCPs). If OCPs are contraindicated, mainly in the presence
of insulin-resistance related comorbidities, a second-line option for reducing androgen secretion
may be metformin associated with lifestyle changes. Other interventions should be
guided by hirsutism severity, determined by the modified Ferriman-Gallwey score, and by the amount of distress
hirsutism causes to the patient, and should be maintained for at least 6-12 months. Mild hirsutism is usually
treated with a combination of non-pharmacological methods and OCPs, whereas moderate and severe hirsutism
may require a combination of antiandrogens and OCPs, or, if OCPs cannot be used, antiandrogens plus a safe
contraceptive method. In all cases, strong clinical support is crucial to ensure treatment adherence and success.
Conclusion: The understanding of the pathophysiology of hirsutism in PCOS, as well as classifying its severity
and the distress it causes to each patient is essential to choose the proper treatment. The presence of metabolic
comorbidities and menstrual disturbances will also guide the individualized management of hirsutism in women