Cochrane · systematic review · CD010334
Interventions for hirsutism (excluding laser and photoepilation therapy alone)
van Zuuren, EJ, Fedorowicz, Z, Carter, B, et al. · Cochrane Database of Systematic Reviews · 2015 · Cochrane Library
SkinAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
63
current version
GRADE rated
42
No studies
21
Included studies
NR
No studies 21 · 33.3%Ungraded 0 · 0%Very low 15 · 23.8%Low 15 · 23.8%Moderate 10 · 15.9%High 2 · 3.2%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Ethinyl estradiol 35 μg + cyproterone acetate 2 mg compared to ethinyl estradiol 30 μg + desogestrel 0.15 mg for hirsutism
Population: patients with hirsutism
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Participant‐reported improvement of hirsutism ‐ not measured Ethinyl estradiol 35 μg + cyproterone acetate 2 mg vs ethinyl estradiol 30 μg + desogestrel 0.15 mg | no estimate extracted | NR | No studies |
Change in health‐related quality of life (HRQOL) ‐ not measured Ethinyl estradiol 35 μg + cyproterone acetate 2 mg vs ethinyl estradiol 30 μg + desogestrel 0.15 mg | no estimate extracted | NR | No studies |
Proportion of participants who reported an adverse event Ethinyl estradiol 35 μg + cyproterone acetate 2 mg vs ethinyl estradiol 30 μg + desogestrel 0.15 mg | RR 0.41 [0.08, 2.05] | 1 study · 100 participants | Moderate Downgraded: imprecision |
Clinician's assessment of improvement of hirsutism Ferriman‐Gallwey score Scale from: 0 to 36 Ethinyl estradiol 35 μg + cyproterone acetate 2 mg vs ethinyl estradiol 30 μg + desogestrel 0.15 mg | no estimate extracted | 3 studies · 164 participants | Low Downgraded: risk of bias, imprecision |
Change in serum androgen levels Ethinyl estradiol 35 μg + cyproterone acetate 2 mg vs ethinyl estradiol 30 μg + desogestrel 0.15 mg | no estimate extracted | 4 studies · 184 participants | High |
Change in BMI kg/m² Ethinyl estradiol 35 μg + cyproterone acetate 2 mg vs ethinyl estradiol 30 μg + desogestrel 0.15 mg | no estimate extracted | 2 studies · 136 participants | Moderate Downgraded: imprecision |
Improvement of other clinical signs of hyperandrogenism Acne score ‐ grade 1 to 4 (higher is worse) Ethinyl estradiol 35 μg + cyproterone acetate 2 mg vs ethinyl estradiol 30 μg + desogestrel 0.15 mg | no estimate extracted | 1 study · 100 participants | Moderate Downgraded: imprecision |
Flutamide 250 mg b.i.d. compared to placebo for hirsutism
Population: women with hirsutism
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Participant‐reported improvement of hirsutism 4‐point Likert scale Flutamide 250 mg b.i.d. vs placebo | RR 17 [1.11, 259.87] | 1 study · 20 participants | Low Downgraded: imprecision |
Change in health‐related quality of life (HRQOL) ‐ not measured Flutamide 250 mg b.i.d. vs placebo | no estimate extracted | NR | No studies |
Proportion of participants who reported an adverse event Flutamide 250 mg b.i.d. vs placebo | no estimate extracted | 2 studies · 60 participants | Very low Downgraded: risk of bias, imprecision |
Clinician's assessment of improvement of hirsutism Ferriman‐Gallwey score Scale from: 0 to 36 Flutamide 250 mg b.i.d. vs placebo | no estimate extracted | 2 studies · 60 participants | Very low Downgraded: risk of bias, imprecision |
Change in serum androgen levels Flutamide 250 mg b.i.d. vs placebo | no estimate extracted | 2 studies · 60 participants | Low Downgraded: imprecision |
Change in BMI kg/m² Flutamide 250 mg b.i.d. vs placebo | no estimate extracted | 1 study · 40 participants | Very low Downgraded: risk of bias, imprecision |
Improvement of other clinical signs of hyperandrogenism Mean number of menses in previous 6 months Scale from: 0 to 6 Flutamide 250 mg b.i.d. vs placebo | no estimate extracted | 1 study · 40 participants | Very low Downgraded: risk of bias, imprecision |
Flutamide 250 mg once to b.i.d. compared to spironolactone 100 mg for hirsutism
Population: women with hirsutism
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Participant‐reported improvement of hirsutism 4‐point Likert scale Flutamide 250 mg once to b.i.d. vs spironolactone 100 mg | RR 2 [0.88, 4.54] | 1 study · 20 participants | Low Downgraded: imprecision |
Change in health‐related quality of life (HRQOL) ‐ not measured Flutamide 250 mg once to b.i.d. vs spironolactone 100 mg | no estimate extracted | NR | No studies |
Proportion of participants who reported an adverse event Flutamide 250 mg once to b.i.d. vs spironolactone 100 mg | no estimate extracted | 2 studies · 40 participants | Low Downgraded: risk of bias, imprecision |
Clinician's assessment of improvement of hirsutism Ferriman‐Gallwey score Scale from: 0 to 36 Flutamide 250 mg once to b.i.d. vs spironolactone 100 mg | no estimate extracted | 2 studies · 40 participants | Very low Downgraded: risk of bias, imprecision |
Change in serum androgen levels Flutamide 250 mg once to b.i.d. vs spironolactone 100 mg | no estimate extracted | 2 studies · 40 participants | Moderate Downgraded: imprecision |
Change in BMI ‐ not measured Flutamide 250 mg once to b.i.d. vs spironolactone 100 mg | no estimate extracted | NR | No studies |
Improvement of other clinical signs of hyperandrogenism ‐ not measured Flutamide 250 mg once to b.i.d. vs spironolactone 100 mg | no estimate extracted | NR | No studies |
Spironolactone 100 mg compared to placebo for hirsutism
Population: women with hirsutism
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Participant‐reported improvement of hirsutism 4‐point Likert scale Spironolactone 100 mg vs placebo | RR 9 [0.55, 147.95] | 1 study · 20 participants | Low Downgraded: imprecision |
Change in health‐related quality of life (HRQOL) ‐ not measured Spironolactone 100 mg vs placebo | no estimate extracted | NR | No studies |
Proportion of participants who reported an adverse event Spironolactone 100 mg vs placebo | RR 5 [0.7, 35.5] | 1 study · 20 participants | Low Downgraded: imprecision |
Clinician's assessment of improvement of hirsutism Ferriman‐Gallwey score Scale from: 0 to 36 Spironolactone 100 mg vs placebo | no estimate extracted | 1 study · 20 participants | Low Downgraded: imprecision |
Change in serum androgen levels Spironolactone 100 mg vs placebo | no estimate extracted | 1 study · 20 participants | Low Downgraded: imprecision |
Change in BMI ‐ not measured Spironolactone 100 mg vs placebo | no estimate extracted | NR | No studies |
Improvement of other clinical signs of hyperandrogenism ‐ not measured Spironolactone 100 mg vs placebo | no estimate extracted | NR | No studies |
Finasteride 5 mg to 7.5 mg compared to placebo for hirsutism
Population: women with hirsutism
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Participant‐reported improvement of hirsutism 3‐point (Lakryc 2003) and 4‐point (Moghetti 2000) Likert scale Finasteride 5 mg to 7.5 mg vs placebo | no estimate extracted | 2 studies · 54 participants | Very low Downgraded: risk of bias, imprecision |
Change in health‐related quality of life (HRQOL) ‐ not measured Finasteride 5 mg to 7.5 mg vs placebo | no estimate extracted | NR | No studies |
Proportion of participants who reported an adverse event Finasteride 5 mg to 7.5 mg vs placebo | RR 1.13 [0.48, 2.67] | 3 studies · 67 participants | Very low Downgraded: risk of bias, imprecision |
Clinician's assessment of improvement of hirsutism Ferriman‐Gallwey score Scale from: 0 to 36 Finasteride 5 mg to 7.5 mg vs placebo | no estimate extracted | 3 studies · 62 participants | Very low Downgraded: risk of bias, imprecision |
Change in serum androgen levels Finasteride 5 mg to 7.5 mg vs placebo | no estimate extracted | 3 studies · 52 participants | Low Downgraded: imprecision |
Change in BMI kg/m2 Finasteride 5 mg to 7.5 mg vs placebo | no estimate extracted | 1 study · 24 participants | Very low Downgraded: risk of bias, imprecision |
Improvement of other clinical signs of hyperandrogenism ‐ not measured Finasteride 5 mg to 7.5 mg vs placebo | no estimate extracted | NR | No studies |
Metformin 500 mg to 2550 mg per day compared to placebo for hirsutism
Population: women with hirsutism
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Participant‐reported improvement of hirsutism ‐ not measured Metformin 500 mg to 2550 mg per day vs placebo | no estimate extracted | NR | No studies |
Change in health‐related quality of life (HRQOL) ‐ not measured Metformin 500 mg to 2550 mg per day vs placebo | no estimate extracted | NR | No studies |
Proportion of participants who reported an adverse event Metformin 500 mg to 2550 mg per day vs placebo | no estimate extracted | 2 studies · 63 participants | Very low Downgraded: risk of bias, imprecision |
Clinician's assessment of improvement of hirsutism Ferriman‐Gallwey score Scale from: 0 to 36 Metformin 500 mg to 2550 mg per day vs placebo | no estimate extracted | 7 studies · 264 participants | Low Downgraded: risk of bias, imprecision |
Change in serum androgen levels Metformin 500 mg to 2550 mg per day vs placebo | no estimate extracted | 8 studies · 309 participants | Moderate Downgraded: risk of bias |
Change in BMI kg/m2 Metformin 500 mg to 2550 mg per day vs placebo | no estimate extracted | 5 studies · 252 participants | Moderate Downgraded: imprecision |
Improvement of other clinical signs of hyperandrogenism ‐ not measured Metformin 500 mg to 2550 mg per day vs placebo | no estimate extracted | NR | No studies |
Finasteride 5 mg compared to spironolactone 100 mg for hirsutism
Population: women with hirsutism
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Participant‐reported improvement of hirsutism 4‐point (Moghetti 2000) and 6‐point (Wong 1995) Likert scale Finasteride 5 mg vs spironolactone 100 mg | no estimate extracted | 2 studies · 34 participants | Low Downgraded: risk of bias, imprecision |
Change in health‐related quality of life (HRQOL) ‐ not measured Finasteride 5 mg vs spironolactone 100 mg | no estimate extracted | NR | No studies |
Proportion of participants who reported an adverse event Finasteride 5 mg vs spironolactone 100 mg | RR 0.2 [0.03, 1.41] | 1 study · 20 participants | Moderate Downgraded: imprecision |
Clinician's assessment of improvement of hirsutism Ferriman‐Gallwey score Scale from: 0 to 36 Finasteride 5 mg vs spironolactone 100 mg | no estimate extracted | 2 studies · 34 participants | Low Downgraded: risk of bias, imprecision |
Change in serum androgen levels Finasteride 5 mg vs spironolactone 100 mg | no estimate extracted | 2 studies · 34 participants | Low Downgraded: imprecision |
Change in BMI ‐ not measured Finasteride 5 mg vs spironolactone 100 mg | no estimate extracted | NR | No studies |
Improvement of other clinical signs of hyperandrogenism ‐ not measured Finasteride 5 mg vs spironolactone 100 mg | no estimate extracted | NR | No studies |
Flutamide 250 mg once to twice daily compared to metformin 1275 mg to 1700 mg per day for hirsutism
Population: women with hirsutism
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Participant‐reported improvement of hirsutism ‐ not measured Flutamide 250 mg once to twice daily vs metformin 1275 mg to 1700 mg per day | no estimate extracted | NR | No studies |
Change in health‐related quality of life (HRQOL) ‐ not measured Flutamide 250 mg once to twice daily vs metformin 1275 mg to 1700 mg per day | no estimate extracted | NR | No studies |
Proportion of participants who reported an adverse event Flutamide 250 mg once to twice daily vs metformin 1275 mg to 1700 mg per day | RR 2 [0.41, 9.71] | 1 study · 40 participants | Very low Downgraded: risk of bias, imprecision |
Clinician's assessment of improvement of hirsutism3 Ferriman‐Gallwey score Scale from: 0 to 36 Flutamide 250 mg once to twice daily vs metformin 1275 mg to 1700 mg per day | no estimate extracted | 3 studies · 95 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Change in serum androgen levels Flutamide 250 mg once to twice daily vs metformin 1275 mg to 1700 mg per day | no estimate extracted | 3 studies · 95 participants | Moderate Downgraded: imprecision |
Change in BMI3 kg/m² Flutamide 250 mg once to twice daily vs metformin 1275 mg to 1700 mg per day | no estimate extracted | 3 studies · 95 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Improvement of other clinical signs of hyperandrogenism Flutamide 250 mg once to twice daily vs metformin 1275 mg to 1700 mg per day | no estimate extracted | 2 studies · 55 participants | Moderate Downgraded: imprecision |
Finasteride 5 mg compared to flutamide 250 mg once to b.i.d. for hirsutism
Population: women with hirsutism
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Participant‐reported improvement of hirsutism 4‐point Likert scale Finasteride 5 mg vs flutamide 250 mg once to b.i.d. | RR 0.63 [0.31, 1.25] | 1 study · 20 participants | Low Downgraded: imprecision |
Change in health‐related quality of life (HRQOL) ‐ not measured Finasteride 5 mg vs flutamide 250 mg once to b.i.d. | no estimate extracted | NR | No studies |
Proportion of participants who reported an adverse event Finasteride 5 mg vs flutamide 250 mg once to b.i.d. | RR 3.87 [0.57, 26.24] | 3 studies · 115 participants | Very low Downgraded: risk of bias, imprecision |
Clinician's assessment of improvement of hirsutism Ferriman‐Gallwey score Scale from: 0 to 36 Finasteride 5 mg vs flutamide 250 mg once to b.i.d. | no estimate extracted | 4 studies · 226 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Change in serum androgen levels Finasteride 5 mg vs flutamide 250 mg once to b.i.d. | no estimate extracted | 4 studies · 226 participants | Moderate Downgraded: imprecision |
Change in BMI ‐ not measured Finasteride 5 mg vs flutamide 250 mg once to b.i.d. | no estimate extracted | NR | No studies |
Improvement of other clinical signs of hyperandrogenism Finasteride 5 mg vs flutamide 250 mg once to b.i.d. | no estimate extracted | 1 study · 110 participants | High |