Hirsutism: a guide for the obstetrician and gynaecologist

Key content Hirsutism is the presence of excess terminal hairs in androgen‐dependent areas in women. The Ferriman–Gallwey score is a pictorial tool used to quantify hirsutism. Polycystic ovary syndrome is the most common cause of hirsutism. In patients with an abnormal Ferriman–Gallwey score or local sexual hair growth, with clinical evidence of a hyperandrogenic endocrine disorder, it is important to measure the total testosterone levels using a reliable specialty assay. Methods of hair reduction and removal remain an important part of management. For most patients who do not seek fertility, combined oral contraceptives are considered as first line pharmacological treatment. Learning objectives To be able to undertake an appropriate evaluation of a patient with hirsutism and understand the rationale behind it. To be able to provide guidance on a structured approach in pharmacological management of hirsutism. To understand how to counsel patients on various management options available for the treatment of hirsutism. Ethical issues Given that hirsutism is only rarely due to a life‐threatening condition, should its treatment be available on the NHS free of cost? Can methods of hair removal and reduction used for the treatment of hirsutism be labelled as cosmetic rather than medical treatment?