A Cochrane review ( «Interventions for hirsutism (excluding laser and photoepilation therapy alone)»1 «van Zuuren EJ, Fedorowicz Z, Carter B et al. Inter...»1) assessed different medical interventions. Cyproterone acetate combined with ethinyl estradiol relieved hirsutism more than desogestrel combined with ethinyl estradiol: improvement in hirsutism with Ferriman- Gallwey score (scale 0 to 36) was - 1.69 to -9.51 with desogestrel and -1.84 (95% CI -3.85 to 0.18) lower with cyproterone acetate (non-significant difference) in 3 trials, n=164.
A meta-analysis «Barrionuevo P, Nabhan M, Altayar O et al. Treatmen...»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. OCPs containing levonorgestrel, cyproterone acetate, or drospirenone were similar in effectiveness to other OCPs or had trivial differences.
A Cochrane review ( «Cyproterone acetate for hirsutism»2 «...»3) included 23 very small studies. There was little to no difference in effect for cyproterone acetate (CPA) plus ethinylestradiol on Ferriman Gallwey scores at six months compared with finasteride (MD 4.70, 95% CI −1.86 to 11.26; 1 RCT, 27 women; low‐certainty evidence), spironolactone (MD 0.90, 95% CI −2.86 to 4.66; 1 RCT, 77 women; moderate‐certainty evidence), or ketoconazole (MD 0.70, 95% CI −0.84 to 2.24; 1 RCT, 81 women; moderate‐certainty evidence). CPA plus ethinylestradiol may improve hirsutism slightly compared with flutamide (MD 4.00, 95% CI 0.10 to 7.90; 1 RCT, 28 women).
Comment: The quality of evidence is downgraded by study quality (inadequate or unclear blinding and allocation concealment).