A Cochrane review ([Abstract] 2) assessed different medical interventions. Cyproterone acetate combined with ethinyl estradiol relieved hirsutism more than desogestrel combined with ethinyl estradiol: improvement in hirsutism with Ferriman- Gallwey score (scale 0 to 36) was - 1.69 to -9.51 with desogestrel and -1.84 (95% CI -3.85 to 0.18) lower with cyproterone acetate (non-significant difference) in 3 trials, n=164.
A meta-analysis 3 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. OCPs containing levonorgestrel, cyproterone acetate, or drospirenone were similar in effectiveness to other OCPs or had trivial differences.
Comment: The quality of evidence is downgraded by study quality (inadequate or unclear blinding and allocation concealment).
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