Most patients presenting with a combination of hirsutism and menstrual disturbances will be shown to have polycystic ovary sydrome, but the rarer alternative diagnoses should always be born in mind, and excluded with appropriate investigations if suspected. The extent of investigation will depend on clinical context. In many cases a single serum testosterone may be sufficient to exclude rare causes. Other therapy depends upon whether the aim is to reduce hirsutism, regularize periods or produce fertility. Local Therapy for Hirsutism Plucking, bleaching, depilatory cream or wax and shaving may all help and are often underused.
Electrolysis is slow and expensive.
This always requires a year or more of treatment for maximal benefit, and long-term treatment is frequently required as the problem tens to recur when treatment is stopped. The patient must therefore be an active participant in the decision to use systemic therapy and must understand the rare risks as well as benefits. Given continuously it produces amenorrhoea, and so is nomrally given for days 1-14 of each cycle. In women of child bearing age, contraception is essential. Other agents of doubtful efficacy include bromocriptine and cimetidine .