Massachusetts General Hospital, Boston, Massachusetts.
University of California, San Diego, La Jolla, California.
J Clin Endocrinol Metab. 2018 Apr 1;103(4):1233-1257. doi: 10.1210/jc.2018-00241.
To update the "Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline," published by the Endocrine Society in 2008.
The participants include an Endocrine Society-appointed task force of seven medical experts and a methodologist.
This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation system to describe the strength of recommendations and the quality of evidence. The task force commissioned two systematic reviews and used the best available evidence from other published systematic reviews and individual studies.
Group meetings, conference calls, and e-mail communications facilitated consensus development. Endocrine Society committees, members, and cosponsoring organizations reviewed and commented on preliminary drafts of the guidelines.
We suggest testing for elevated androgen levels in all women with an abnormal hirsutism score. We suggest against testing for elevated androgen levels in eumenorrheic women with unwanted local hair growth (i.e., in the absence of an abnormal hirsutism score). For most women with patient-important hirsutism despite cosmetic measures (shaving, plucking, waxing), we suggest starting with pharmacological therapy and adding direct hair removal methods (electrolysis, photoepilation) for those who desire additional cosmetic benefit. For women with mild hirsutism and no evidence of an endocrine disorder, we suggest either pharmacological therapy or direct hair removal methods. For pharmacological therapy, we suggest oral combined estrogen-progestin contraceptives for the majority of women, adding an antiandrogen after 6 months if the response is suboptimal. We recommend against antiandrogen monotherapy unless adequate contraception is used. We suggest against using insulin-lowering drugs. For most women who choose hair removal therapy, we suggest laser/photoepilation.
更新 2008 年由内分泌学会发布的“绝经前妇女多毛症的评估和治疗：内分泌学会临床实践指南”。
该参与者包括内分泌学会任命的由七名医学专家和一名方法学家组成的工作组。
本循证指南的制定使用了推荐分级的评估、制定与评价系统，以描述建议的强度和证据的质量。工作组委托进行了两项系统评价，并使用了其他已发表的系统评价和单独研究中可获得的最佳证据。
小组会议、电话会议和电子邮件通信促进了共识的形成。内分泌学会委员会、成员和共同赞助组织审查并对指南的初步草案发表了评论。
我们建议对所有多毛症评分异常的女性进行雄激素水平升高的检测。我们建议对月经正常且有不想要的局部毛发生长（即无多毛症评分异常）的女性不进行雄激素水平升高的检测。对于大多数患者有重要的多毛症但美容措施（刮、拔、蜡）无效的女性，我们建议首先使用药物治疗，并对那些希望获得更多美容效果的患者添加直接脱毛方法（电解、光脱毛）。对于有轻度多毛症且无内分泌疾病证据的女性，我们建议使用药物治疗或直接脱毛方法。对于药物治疗，我们建议大多数女性使用口服联合雌激素孕激素避孕药，如果反应不理想，在 6 个月后添加抗雄激素。我们建议除非使用了适当的避孕措施，否则不建议使用抗雄激素单药治疗。我们建议不使用降低胰岛素的药物。对于大多数选择脱毛治疗的女性，我们建议使用激光/光脱毛。
