Oral contraceptives are the standard first-line pharmacological treatment for hirsutism. When a patient has used combined oral estrogen–progestin contraceptives as monotherapy for approximately 6 months and the Ferriman–Gallwey hirsutism score has not meaningfully improved, a protocol change is warranted.
The previous step — combined oral estrogen–progestin contraceptives (oral contraceptives) as sole pharmacological therapy — did not achieve a clinically detectable reduction in the Ferriman–Gallwey hirsutism score by approximately 6 months. Direct hair removal methods may have been used adjunctively.
Improvement of hirsutism, detectable as a reduction in the Ferriman–Gallwey hirsutism score.
The next step involves adding an antiandrogen to the ongoing oral contraceptive — a combination approach that evidence shows is associated with incremental reductions in hirsutism scores beyond what oral contraceptive therapy alone achieves. The full protocol specifies which antiandrogens are considered and which are not recommended.
DOI: 10.1210/jc.2018-00241