by Shady Mahmoud Ibrahim, MD

The PCOS, which is the most common cause of hirsutism, is characterized by the combination of hirsutism and/or biochemical hyperandrogenism with anovulatory cycles and/or polycystic ovarian morphology (PCOm).¹ It is a distressing disorder with a major impact on the quality of life which can lead to low self-image, depression, low self-esteem, and social difficulties.

Many patients have hirsutism with PCOS achieve disappointing results from laser hair reduction, such as resistance, poor response, many sessions will be needed, and short hair free interval. Although the results of laser hair reduction can be successful sometimes, they will need to continue laser treatment sessions to maintain a reduction in hair growth because of the presence of the current medical condition like PCOS that affects the body’s hair growth.

Systemic treatments aim to suppress ovarian androgen secretion or reduce the action of testosterone on the androgen receptor, it can add valuable support to laser hair reduction as a long-term effect. In the study by Dorgham, there was an expected superior effect of oral contraceptives pills compared to other groups, which are the most clinically meaningful results. So, there is no surprise regarding the outcome of the three groups.

In a systematic review of 28 randomized trials of systemic treatments for hirsutism that included 1227 women, they found that the following drugs were effective: metformin (19.1% suppression of hirsutism over baseline over six months compared with placebo), and oral contraceptive pills (27%).² In a prospective randomized controlled trial, adding metformin to IPL in women with PCOS results in a significant improvement in insulin sensitivity and hirsutism compared to IPL treatment alone.³

Regarding previous studies and the study by Dorgham, all hirsute patients will benefit from the laser treatment, but laser treatment is associated with a poorer than expected reduction in hair reduction. To achieve better results and to maintain long-term effects in those patients with PCO, laser treatment should be given alongside the treatment of the underlying cause. So, hirsute patients should have all investigations that confirm PCOS at first.  Modification of lifestyle (diet and exercise) should be advised to all women with PCOS before starting treatment.

Oral contraceptives (OCP) are first-line treatment for hirsutism, and the most popular treatment for hirsutism, which suppress circulating luteinizing hormone (LH) and follicle-stimulating hormone (FSH), leading to a decrease in ovarian androgen production.^4,5 Adding OCPs during laser hair reduction treatment might maintain long term hair reduction results and it will be most meaningful to patients.

 

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References

1. Pasquali R, Gambineri A. Therapy in Endocrine Disease: Treatment of Hirsutism in the Polycystic Ovary Syndrome. Eur J Endocrinol 2013 Dec 21;170(2): R75-90.
2. Koulouri O, Conway GS. A systematic review of commonly used medical treatments for hirsutism in women. Clin Endocrinol 2008; 68:800-5.
3. Rezvanian H, Adibi N, Siavash M, Kachuei A, Shojaee-Moradie F, Asilian A. Increased Insulin Sensitivity by Metformin Enhances Intense-Pulsed-Light-Assisted Hair Removal in Patients with Polycystic Ovary Syndrome. Dermatology. 2009;218(3):231-6. 
4. Sachdeva S. Hirsutism: evaluation and treatment. Indian J Dermatol. 2010;55(1):3-7.
5. Agrawal NK. Management of hirsutism. Indian J Endocrinol Metab. 2013;17(Suppl 1): S77-S82.