Interventions for Hirsutism Excluding Laser and Photoepilation Therapy Alone

Abridged Cochrane Systematic Review Including GRADE Assessments

E.J. van Zuuren; Z. Fedorowicz


The British Journal of Dermatology. 2016;175(1):45-61. 

In This Article

Materials and Methods

This Cochrane review followed a prespecified protocol.[16]

Search Strategies

Searches included the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library, Medline, Embase and five trials registers up to June 2014.[15] Two reviewers independently assessed abstracts and resolved disagreements through discussion.

Inclusion Criteria

We included only RCTs that evaluated women with hirsutism with PCOS, idiopathic hyperandrogenism or idiopathic hirsutism. Other causes of hirsutism were excluded. Any intervention either as a stand-alone intervention or in combination comparing active treatment, no treatment or placebo was considered. We excluded light-based therapies and lasers alone as these were covered in another Cochrane review.[17]

Outcome Measures

Primary outcomes

  1. Participant-reported improvement of hirsutism

  2. Change in health-related quality of life

  3. Proportion of participants reporting an adverse event.

Secondary outcomes

  1. Clinician's assessment of improvement of hirsutism

  2. Change in serum androgen levels (e.g. total testosterone, free testosterone, dehydroepiandrosterone, androstenedione, dihydrotestosterone) and sex hormone-binding globulin (SHBG)

  3. Change in body mass index (BMI)

  4. Improvement of other signs of hyperandrogenism (e.g. acne, seborrhoea, female-pattern hair loss, ovulatory dysfunction).

Data Extraction and Synthesis

Two reviewers independently extracted data and assessed the risk of bias in the included studies.[18] Dichotomous outcomes were expressed as risk ratios (RRs) and continuous outcomes as mean differences (MDs) with 95% CI. The number needed to treat (NNT) and number needed to harm were calculated when the RR for outcomes were statistically significant. Data were pooled only if at least three studies investigated similar treatments and only if heterogeneity, as measured by the I2 statistic, was < 60%.[18,19] We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) profiler to rate the quality of evidence for the individual outcomes and to produce summary of findings tables.[20]