➤ In patients with severe hirsutism causing emotional distress and/or in those
women who have used OCs in the past and have not experienced sufficient
improvement, ES suggests initiating combination therapy with an oral
contraceptive and antiandrogen (2|⊕⊕
).
• However, ES suggests against combination therapy as a standard first-line approach.
(2|⊕⊕
)
Table 2. Oral Contraceptives (OCs) and Associated Venous
Thromboembolism (VTE) Risks
Progestin
Generation
Progestin
Relative
Androgenicity
Progestin
Relative
VTE
Risk
a,b
Progestin
Absolute
VTE
Risk
b,c
Progestin/Dose
EE
Dose
(mcg)
1 Medium 2.6 7 Norethindrone
0.5–1.0 mg
20, 35
2 High 2.4 6 Levonorgestrel
0.15 mg
20, 30
2–3 Low 2.5 6 Norgestimate 0.25 mg 35
3 Low 3.6 11 Gestodene 0.075 mg 20, 30
3 Low 4.3 14 Desogestrel 0.15 mg 20, 30
4 Antiandrogen 4.1 13 Drospirenone (DSP)
3 mg
20, 30
— Antiandrogen 4.3 14 Cyproterone acetate
(CPA) 2 mg
d
35
a
Relative risk compared with no OC use.
b
Vinogradova et al. BMJ. 2015;350(may26 13):h2135; Stegeman et al. BMJ. 2013;347(sep12 1):
f5298.
c
Extra cases VTE per 10,000 women treated with OCs per year.
d
OCs containing CPA are not available in the United States.
Treatment
