Hirsutism is one of the most common clinical features encountered in women attending endocrine clinics. It can also be extraordinarily difficult and challenging to manage well. In this brief presentation I will discuss management of hirsutism, using three major challenges as a scaffold:
Challenge 1: diagnosing the underlying cause: Hirsutism, the presence of terminal hairs distributed in a male-like pattern in women, affects between 5 and 10% of women. Polycystic ovary syndrome (PCOS) is the commonest cause of hirsutism, but many endocrine conditions manifest clinically with hirsutism (including Cushings syndrome, CAH, and androgen-secreting ovarian and adrenal tumors). Diagnostically therefore, hirsutism is inherently challenging and it is important for the healthcare professional to invest time and effort at the onset of hirsutism, to diagnose correctly the underlying cause, particularly to exclude a neoplastic origin.
Challenge 2: being sensitive to the patients needs: Unfortunately, hirsurtism is considered as a cosmetic issue by NHS funders, and as such many treatments such as laser therapy are not widely available currently under the NHS. Hirsutism however has been termed as the thief of womanhood and as such can be associated with substantial psychological distress which should not be under-estimated. Such distress can have far-reaching deleterious consequences. Dealing sympathetically with such distress in an empathic way forms an essential component of effective management.
Challenge 3: choosing an effective treatment (with a limited evidence-base): One of the biggest challenges to management of hirsutism is choosing an effective therapy. Whilst there are plenty to choose from, including laser therapy, electrolysis, anti-androgens and eflornithine cream, there are substantial hurdles which include the need for self-funding for some of these, and general lack of clear evidence of efficacy from the literature. There is a clear need for a robust evidence-base for hirsutism management, preferably a long-term prospective study, to inform future guidelines.
02 Nov 2015 - 04 Nov 2015