JAMA · 2018
Evaluation and Treatment of Hirsutism in Premenopausal Women.
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Mimoto Mizuho S, Oyler Julie L, Davis Andrew M
Аннотация
GUIDELINE TITLE: Evaluation and Treatment of Hirsutism in Premenopausal Women
DEVELOPER: Endocrine Society, Androgen Excess and Polycystic Ovary Syndrome Society, European Society of Endocrinology
RELEASE DATE: March 2018
PRIOR VERSION: February 5, 2008
FUNDING SOURCE: Endocrine Society
TARGET POPULATION: Premenopausal women with excess hair growth
MAJOR RECOMMENDATIONS: DIAGNOSIS: Obtain a random serum total testosterone measurement to assess for androgen excess in all women with an abnormal hirsutism score (weak recommendation, low-quality evidence). Obtain an early-morning 17-hydroxyprogesterone measurement in all women with elevated testosterone and in women with hirsutism who are at high risk of congenital adrenal hyperplasia (weak recommendation; low-quality evidence). Do not measure androgen levels in women with normal menses and a normal hirsutism score (weak recommendation; low-quality evidence). PHARMACOLOGIC TREATMENT: Start with pharmacologic therapy and add direct hair removal methods for women with a normal hirsutism score but patient-important hirsutism despite shaving or plucking (weak recommendation; very low-quality evidence). In women who are not seeking pregnancy, oral contraceptive pills (OCPs) are recommended as initial therapy (weak recommendation; low-quality evidence). Either OCPs or antiandrogens are acceptable initial therapies in women who are not sexually active, have undergone permanent sterilization, or are using long-acting reversible contraception (weak recommendation; very low-quality evidence). Combination therapy with an antiandrogen is recommended if patient-important hirsutism persists despite 6 months of monotherapy with an OCP (weak recommendation; low-quality evidence).
DEVELOPER: Endocrine Society, Androgen Excess and Polycystic Ovary Syndrome Society, European Society of Endocrinology
RELEASE DATE: March 2018
PRIOR VERSION: February 5, 2008
FUNDING SOURCE: Endocrine Society
TARGET POPULATION: Premenopausal women with excess hair growth
MAJOR RECOMMENDATIONS: DIAGNOSIS: Obtain a random serum total testosterone measurement to assess for androgen excess in all women with an abnormal hirsutism score (weak recommendation, low-quality evidence). Obtain an early-morning 17-hydroxyprogesterone measurement in all women with elevated testosterone and in women with hirsutism who are at high risk of congenital adrenal hyperplasia (weak recommendation; low-quality evidence). Do not measure androgen levels in women with normal menses and a normal hirsutism score (weak recommendation; low-quality evidence). PHARMACOLOGIC TREATMENT: Start with pharmacologic therapy and add direct hair removal methods for women with a normal hirsutism score but patient-important hirsutism despite shaving or plucking (weak recommendation; very low-quality evidence). In women who are not seeking pregnancy, oral contraceptive pills (OCPs) are recommended as initial therapy (weak recommendation; low-quality evidence). Either OCPs or antiandrogens are acceptable initial therapies in women who are not sexually active, have undergone permanent sterilization, or are using long-acting reversible contraception (weak recommendation; very low-quality evidence). Combination therapy with an antiandrogen is recommended if patient-important hirsutism persists despite 6 months of monotherapy with an OCP (weak recommendation; low-quality evidence).