Women with mild, gradually progressing hirsutism and regular menstruation do not usually require extensive laboratory evaluation. Measurement of serum testosterone levels is useful if the patient has menstrual dysfunction or a suspicious history. Elevated testosterone levels may be found in polycystic ovary syndrome and in androgen-secreting tumors. Ovarian ultrasonography may be diagnostic. When polycystic ovary syndrome is identified, patients should be screened for diabetes and hyperlidipemia.
Oral contraceptives are the initial treatment for hirsutism caused by ovarian hyperandrogenism.
Approximately 10 percent of cases improve and 50 percent stabilize with the use of oral contraceptives alone. Besides the cost and the discomfort of parenteral administration of these agents, treatment with these agents necessitates estrogen-progesterone supplementation. A simpler antiandrogen is spironolactone. A dosage of 50 mg twice daily is reported to provide improvement of hirsutism in 70 percent of patients within six months. The addition of oral contraceptives prevents the side effect of menstrual irregularity and enhances the antihirsutism effect.