Treating hirsutism in PCOS with combination of medical & laser therapy

Abstract

Background: Hirsutism is one of the most distressing manifestations of polycystic ovary syndrome (PCOS), often leading to significant psychological burden. Conventional treatments such as shaving or waxing offer temporary relief. Myo-inositol and D-chiro-inositol have shown efficacy in addressing the hormonal and metabolic dysfunctions of PCOS, while laser hair removal offers long-term improvement. However, the combined effect of these therapies has not been well studied.

Aim of the study: To evaluate the efficacy and safety of combining medical therapy (myo-inositol and D-chiro-inositol) with laser treatment in managing hirsutism among women with PCOS.

Methods: This prospective case-control study was conducted from July 2023 to June 2024 in two tertiary care centers in Bangladesh. A total of 80 women aged 18–40 years with PCOS and hirsutism (Ferriman-Gallwey score ≥8) were enrolled and divided equally into an intervention group (medical therapy + laser treatment) and a control group (medical therapy only).

Result: Both groups were comparable at baseline. The intervention group showed a significantly greater reduction in Ferriman-Gallwey scores at 6 months (mean reduction: 9.2 ± 2.7 vs. 3.5 ± 1.8; p < 0.001), with a large effect size (d = 2.24). Satisfaction scores were higher in the intervention group (overall satisfaction: 8.7 ± 1.1 vs. 6.1 ± 1.4; p < 0.001), and DLQI scores improved significantly (mean improvement: 8.6 ± 3.9 vs. 4.0 ± 2.7; p < 0.01). Mild, transient adverse events related to laser therapy occurred in 20% of patients but resolved without intervention. Multivariable regression confirmed that the combination treatment independently predicted greater improvement in hirsutism.

Conclusion: Combining myo-inositol and D-chiro-inositol with laser therapy is a highly effective and well-tolerated treatment strategy for hirsutism in PCOS patients. It significantly enhances clinical, psychosocial, and patient-centered outcomes compared to medical therapy alone.

Keywords: Polycystic Ovary Syndrome (PCOS), D-chiro-inositol, Ferriman-Gallwey Score, Dermatology Life Quality Index (DLQI), Visual Analog Scale (VAS)