Abstract
Answer C. Rule out other causes of hirsutism by measuring serum testosterone and seeking specialist advice if the level is greater than 5 nmol/l.
Mild hirsutism can usually be managed by cosmetic measures alone. For more severe hirsutism, drug treatment may be required in addition to cosmetic measures.
If additional treatment is required, offer a combined oral contraceptive (COC), e.g. co-cyprindiol (Dianette). Hormonal treatments containing the progestogens levonorgestrel or norethisterone may exacerbate hirsutism and should be avoided. Hirsutism may take 6–9 months (or longer) to improve on hormonal treatment.
Topical eflornithine may be offered for facial hirsutism if hormonal treatment is contraindicated, ineffective or inappropriate. Both oral spironolactone and laser treatment can have beneficial effects on hirsutism.