Editing Polycystic ovary syndrome (section)

=== Hirsutism and acne ===
{{Further|Hirsutism}}
When appropriate (e.g., in women of childbearing age who require contraception), a standard contraceptive pill is frequently effective in reducing hirsutism.<ref name=emedicine_treatment /> Progestogens such as norgestrel and levonorgestrel should be avoided due to their androgenic effects.<ref name=emedicine_treatment /> Metformin combined with an oral contraceptive may be more effective than either metformin or the oral contraceptive on its own.<ref>{{cite journal | vauthors = Fraison E, Kostova E, Moran LJ, Bilal S, Ee CC, Venetis C, Costello MF | title = Metformin versus the combined oral contraceptive pill for hirsutism, acne, and menstrual pattern in polycystic ovary syndrome | journal = The Cochrane Database of Systematic Reviews | volume = 2020 | issue = 8 | pages = CD005552 | date = August 2020 | pmid = 32794179 | pmc = 7437400 | doi = 10.1002/14651858.CD005552.pub3 }}</ref>

In the case of taking medication for acne, Kelly Morrow-Baez PHD, in her exposition titled ''Thriving with PCOS,'' informs that it "takes time for medications to adjust hormone levels, and once those hormone levels are adjusted, it takes more time still for pores to be unclogged of overproduced oil and for any bacterial infections under the skin to clear up before you will see discernible results." (p.&nbsp;138) <ref name=":2" />

Other medications with anti-androgen effects include [[flutamide]],<ref name=flutamide>{{cite web|url=http://www.nhs.uk/Conditions/Polycystic-ovarian-syndrome/Pages/Treatment.aspx|title=Polycystic ovary syndrome&nbsp;– Treatment|publisher=National Health Service|location=United Kingdom|date=17 October 2011|access-date=19 November 2011|url-status=live|archive-url=https://web.archive.org/web/20111106005039/http://www.nhs.uk/Conditions/Polycystic-ovarian-syndrome/Pages/Treatment.aspx|archive-date=6 November 2011}}</ref> and [[spironolactone]],<ref name=emedicine_treatment /> which can improve hirsutism. Metformin can reduce hirsutism, perhaps by reducing insulin resistance, and is often used if there are other features such as insulin resistance, diabetes, or obesity that are likely to respond to metformin. [[Eflornithine]] (Vaniqa) is a medication that is applied to the skin in cream form, and acts directly on the hair follicles to inhibit hair growth. It is usually applied to the face.<ref name=emedicine_treatment /> [[5-alpha reductase inhibitor]]s (such as [[finasteride]] and [[dutasteride]]) may also be used;<ref name=emedicine_medications>{{EMedicine|article|256806|Polycystic Ovarian Syndrome|medication}}</ref> they work by blocking the conversion of [[testosterone]] to [[dihydrotestosterone]] (the latter of which is responsible for most hair growth alterations and [[Acne vulgaris#Hormones|androgenic acne]]).

Although these agents have shown significant efficacy in clinical trials (for oral contraceptives, in 60–100% of individuals<ref name=emedicine_treatment />), the reduction in hair growth may not be enough to eliminate the social embarrassment of hirsutism or the inconvenience of plucking or shaving. Individuals vary in their response to different therapies. It is usually worth trying other medications if one does not work, but medications do not work well for all individuals.<ref>{{cite journal | vauthors = van Zuuren EJ, Fedorowicz Z, Carter B, Pandis N | title = Interventions for hirsutism (excluding laser and photoepilation therapy alone) | journal = The Cochrane Database of Systematic Reviews | volume = 2015 | issue = 4 | pages = CD010334 | date = April 2015 | pmid = 25918921 | pmc = 6481758 | doi = 10.1002/14651858.CD010334.pub2 }}</ref>