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Evidence summaries

Metformin for Hirsutism

Metformin may be effective for hirsutism compared to placebo. Level of evidence: "C"

Comment: The quality of evidence is downgraded by study limitations and by imprecise results.

Summary

A Cochrane review [Abstract] 1 assessed different medical interventions for hirsutism. Metformin demonstrated no benefit over placebo in reduction of Ferriman-Gallwey scores (score 0 to 36) (MD 0.05, 95% CI -1.02 to 1.12; 7 trials, n=264), however, the dose varied from 500mg to 2550mg per day and the quality of evidence was low. Ferriman-Gallwey scores from 3 studies comparing flutamide versus metformin could not be pooled (I² = 62%) because of inconsistent findings.

A meta-analysis 2 assessing treatment options for hirsutism included 43 trials. Estrogen-progestin oral contraceptives pills (OCP) (standardized mean reduction -0.94, 95% CI-1.49 to -0.38), antiandrogens (-1.29, 95% CI -1.80 to -0.79), and insulin sensitizers (-0.62, 95% CI 1.00 to -0.23) were superior to placebo. Antiandrogen monotherapy, the combination of OCP and antiandrogen, the combination of OCPs and insulin sensitizer, and the combination of antiandrogen and insulin sensitizer were superior to insulin sensitizer monotherapy. The combination of OCPs and antiandrogen was superior to OCPs.

Clinical comments

Note

Date of latest search: 2021-09-10

References

  • van Zuuren EJ, Fedorowicz Z, Carter B et al. Interventions for hirsutism (excluding laser and photoepilation therapy alone). Cochrane Database Syst Rev 2015;(4):CD010334. [PubMed]
  • Barrionuevo P, Nabhan M, Altayar O et al. Treatment Options for Hirsutism: A Systematic Review and Network Meta-Analysis. J Clin Endocrinol Metab 2018;103(4):1258-1264. [PubMed]

Primary/Secondary Keywords