Comment: The quality of evidence is downgraded by study limitations and by imprecise results.
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.
Another systematic review and meta-analysis 3 included 36 RCTs. For hirsutism, no differences were seen when comparing metformin vs COC, nor when comparing COC vs combination treatment with metformin and COC. Metformin was inferior on free androgen index (FAI), sex hormone binding globulin and testosterone compared with COC. COC was inferior for FAI and SHBG compared with combination treatment, whereas testosterone did not differ.
Date of latest search: 2021-09-10
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