Short answer: No single birth control pill has been proven best for hirsutism. The Endocrine Society’s 2018 guideline says all combined pills appear equally effective,[1] and the 2023 International PCOS Guideline says no specific type can be recommended and advises the lowest effective estrogen dose, such as 20 to 30 µg of ethinyl estradiol.[2] Pills with 35 µg ethinyl estradiol plus cyproterone acetate are a second-line option because of a higher blood clot risk, and any pill needs at least 6 months before you judge it.[2], [1]
The combined pill (estrogen plus a progestin) is the first medicine most guidelines suggest for unwanted hair in women who are not trying to get pregnant.[1] But there are dozens of pills, and online advice often claims one brand is “the best for hair.” This guide explains what the research actually shows, how progestin types differ, how blood clot risk varies between pills, and what to do if the pill is not enough. For an overview of all treatments, see our hirsutism medication guide.
Is there a best birth control pill for hirsutism?
Evidence: Strong No pill has been shown to be clearly better than the others for hair, but combined pills as a group do work. The Endocrine Society’s 2018 guideline suggests a combined oral contraceptive as the first treatment for most women with hirsutism who are not seeking pregnancy, and it does not suggest one pill over another because “all oral contraceptives appear to be equally effective for hirsutism.”[1]
The 2023 International PCOS Guideline, written for women with PMOS (formerly PCOS), reaches the same conclusion: “Specific types or doses of progestins, oestrogens, or combinations of COCP cannot currently be recommended.”[2], [3] It also notes no clinical advantage of higher-dose ethinyl estradiol (30 µg or more) for hirsutism and suggests the lowest effective estrogen dose, such as 20 to 30 µg.[2]
So the “best” pill is usually the one that suits your health, your blood clot risk and your side effects, and that you can take every day. Read more about how this applies to PMOS facial hair.
How does the birth control pill reduce unwanted hair?
The combined pill lowers the amount of active androgen (male-type hormone) reaching your hair follicles in several ways. According to the Endocrine Society, it:[1]
- Suppresses luteinizing hormone (LH), a brain hormone that drives the ovaries to make androgens
- Makes the liver produce more sex hormone-binding globulin (SHBG), a protein that binds testosterone so less of it is “free” and active
- Slightly reduces androgen production by the adrenal glands and the binding of androgens to their receptors
- May slightly block 5-alpha reductase, the enzyme that turns testosterone into the stronger dihydrotestosterone (DHT) in the skin
Which progestins are in birth control pills, and does androgenicity matter?
Progestins differ in how “androgenic” they are, meaning how much they act like a weak male hormone. The Endocrine Society lists norgestimate, desogestrel and gestodene as progestins with low androgenicity, and norgestrel and levonorgestrel as relatively high. Cyproterone acetate and drospirenone act as weak androgen blockers.[1] In theory, a less androgenic or anti-androgenic progestin should be better for hair. In practice, as the next section shows, trials have not found clear differences.
Progestins also differ in blood clot risk, which is why this choice still matters. This table combines what the Endocrine Society says about androgenicity with the UK medicines regulator’s (MHRA) estimates of venous thromboembolism (VTE), meaning blood clots in the legs or lungs.
| Progestin in the pill | Androgenic effect | Estimated blood clots per 10,000 women per year | Notes |
|---|---|---|---|
| None (not using hormonal contraception) | n/a | 2[4] | Baseline for comparison |
| Levonorgestrel | Relatively high[1] | 5 to 7[4] | Lowest clot risk; not clearly worse for hair in trials[5] |
| Norgestimate | Low[1] | 5 to 7[4] | Same clot risk as levonorgestrel |
| Norethisterone (norethindrone) | Not classified in the guideline | 5 to 7[4] | Same clot risk as levonorgestrel |
| Desogestrel | Low[1] | 9 to 12[4] | Reduced hair scores in Cochrane review trials[6] |
| Gestodene | Low[1] | 9 to 12[4] | Higher clot risk |
| Drospirenone | Anti-androgenic (weak)[1] | 9 to 12[4] | Can raise potassium; check with kidney or adrenal problems[7] |
| Cyproterone acetate (with 35 µg ethinyl estradiol) | Anti-androgenic[1] | 1.5 to 2 times the levonorgestrel risk[8] | Not available in the US;[9] second-line in the 2023 guideline[2] |
Even the higher numbers are small in absolute terms: 9 to 12 clots per 10,000 women per year means roughly 1 in 1,000 women each year. The MHRA says no woman needs to change her pill because of these figures alone, but the differences matter if you already have risk factors for clots.[4]
Do drospirenone or cyproterone pills work better for hair?
Evidence: Limited Possibly slightly, but the evidence is weak and the difference may not matter in real life. A 2018 network meta-analysis of randomized trials, done for the Endocrine Society guideline, compared pill types:[5]
- Drospirenone pills reduced hirsutism slightly more than other pills, a small effect the authors said may not be clinically relevant.
- Cyproterone acetate pills were not significantly different from other pills.
- Levonorgestrel pills, despite their more androgenic progestin, were also not significantly different from other pills.
The Endocrine Society described the extra benefit of anti-androgenic progestins as “a difference that is probably not clinically important.”[1] A Cochrane review of 157 trials found that pills with ethinyl estradiol plus cyproterone acetate and pills with ethinyl estradiol plus desogestrel both lowered hair scores, with no statistically significant difference between them.[6] The Cochrane authors also noted that adding cyproterone acetate to a pill seemed to increase its effect on hair, and they rated the overall quality of evidence as moderate to very low, mostly because many trials were small and unblinded.[10]
Is cyproterone acetate (Diane-35) the best pill for hirsutism?
It is effective, but it is not a first choice in current guidelines. The 2023 International PCOS Guideline says pills containing 35 µg ethinyl estradiol plus cyproterone acetate should be considered as second-line therapy, “balancing benefits and adverse effects, including venous thromboembolic risks.”[2] The European Medicines Agency (EMA) reviewed these pills (best known as Diane-35) in 2013. It found the blood clot risk is 1.5 to 2 times higher than with levonorgestrel pills and restricted their use to moderate to severe acne related to androgens or hirsutism. It also said they should not be combined with other hormonal contraceptives.[8]
Cyproterone acetate is not available in the United States.[9] Higher-dose cyproterone tablets (10 mg a day or more) have been restricted in Europe since 2020 because of a link to meningioma, a usually non-cancerous brain tumor. The EMA said available data do not indicate this risk for the low-dose (1 to 2 mg) pills, but these should not be used by anyone who has had a meningioma.[11]
How long does the pill take to work on hirsutism?
Give it at least 6 months. The Endocrine Society says hormonal treatment takes about 6 months to show an effect and about 9 months to reach its full effect, and it suggests a trial of at least 6 months before changing the dose, switching pills or adding another medicine.[1]
This is because of the hair cycle. Hairs grow in cycles that are out of sync with each other, and the growth phase for facial hair lasts about 4 months.[1] The pill affects the hairs that grow next, not the ones already growing. Switching from pill to pill every few weeks rarely helps, because no pill can show its effect that fast.
Does the pill increase the risk of blood clots?
Yes, slightly. The Endocrine Society notes that combined pills carry about a threefold higher VTE risk in first-time users, and that pills with desogestrel, gestodene, cyproterone acetate or drospirenone may carry a 50% to 100% higher risk than levonorgestrel pills.[1] The US label for a drospirenone pill says studies have found anything from no increase to a threefold increase compared with levonorgestrel and some other progestins.[7]
For women with hirsutism who are at higher risk of clots, the Endocrine Society suggests a pill with the lowest effective dose of ethinyl estradiol (usually 20 µg) and a low-risk progestin.[1] Based on the MHRA figures in the table above, levonorgestrel, norgestimate and norethisterone pills have the lowest clot risk.[4]
Who can’t take an estrogen-containing pill?
Estrogen is not safe for everyone. The NHS says the combined pill may not be suitable if you are living with obesity, if you are 35 or older and smoke, or if you have ever had:[12]
- A blood clot, or a close family member who had one before age 45
- A stroke or narrowed or blocked arteries
- Heart disease or high blood pressure
- Migraines with aura (warning signs before the headache)
- Breast cancer
- Gallbladder or bile duct problems, liver cancer or severe cirrhosis
- Complications from diabetes
The US label for a drospirenone pill carries a boxed warning that combined pills should not be used by women over 35 who smoke.[7] Drospirenone pills are also not suitable if you have kidney problems or adrenal insufficiency, because drospirenone can raise potassium.[7] If you cannot take estrogen, an anti-androgen with another reliable form of contraception is an option to discuss. The Endocrine Society says anti-androgens can be used as the first treatment in women using long-acting reversible contraception such as an IUD or implant.[1]
Do progestin-only pills help hirsutism?
Evidence: Limited No. The Endocrine Society’s 2018 guideline states that oral progestin-only contraceptives “are ineffective for hirsutism.”[1] We could not find trials testing newer progestin-only pills, such as the drospirenone-only pill, for hirsutism.
Can some birth control pills make hirsutism worse?
In theory, pills with more androgenic progestins such as levonorgestrel could be less helpful, because these progestins have some androgen-like activity.[1] But in the 2018 network meta-analysis, levonorgestrel pills were not significantly worse for hair than other pills,[5] so a levonorgestrel pill is a reasonable choice if you need the lowest clot risk.
If your hair growth clearly got worse after starting a new contraceptive, tell your doctor. Some hormonal medicines can contribute to unwanted hair, as we explain in drugs that can cause hirsutism. Hair that seems to appear after stopping the pill is a different issue, covered in hirsutism after stopping birth control.
What if the pill is not enough?
Evidence: Moderate Add an anti-androgen after 6 months. The Endocrine Society suggests adding an anti-androgen if bothersome hair remains after 6 months on the pill,[1] and the 2023 International PCOS Guideline gives the same advice for women with PMOS.[2] In the network meta-analysis, the pill plus an anti-androgen worked better than the pill alone.[5] The most commonly discussed option is spironolactone for hirsutism. The pill also provides the contraception that anti-androgens require.[1]
For hair that is already there, the Endocrine Society suggests combining medicines with laser hair removal to reduce regrowth.[1]
When should you see a doctor?
You need a prescription and a check of your clot risk before starting any combined pill. See a doctor promptly if you notice:
- Hair growth that started suddenly or is worsening within months
- A deepening voice, an enlarged clitoris or male-pattern balding (signs of virilization)
- Irregular or missing periods
- On the pill: Pain or swelling in one leg, chest pain, sudden breathlessness, or a severe headache, which can be signs of a blood clot and need emergency care
Our guide to which doctor to see for hirsutism can help you choose, and the hirsutism self-check helps you describe your symptoms.
Frequently asked questions
What is the best birth control pill for PCOS (PMOS) hirsutism?
There is no single best pill. The 2023 International PCOS Guideline says no specific type can be recommended and advises the lowest effective estrogen dose, with cyproterone acetate pills as a second-line option.[2]
Is drospirenone (Yaz, Yasmin) good for hirsutism?
It works, and a network meta-analysis found a slightly larger effect than other pills, but the difference may not be clinically meaningful.[5] It carries a higher blood clot risk than levonorgestrel pills.[4]
Is Diane-35 available in the US?
No. Cyproterone acetate is not available in the United States.[9] In Europe and the UK, pills with cyproterone acetate and ethinyl estradiol are restricted to androgen-related acne or hirsutism.[8]
Can the pill get rid of facial hair permanently?
No. It reduces new hair growth while you take it but does not destroy hair follicles. For longer-lasting results, guidelines suggest combining medication with laser or electrolysis.[1]
How long should I try a pill before switching?
At least 6 months. The full effect takes about 9 months, so switching earlier makes it hard to know whether a pill is working.[1]
Key takeaways
- Combined pills reduce hirsutism, but no specific pill has been proven best. Both major guidelines say so.
- Use the lowest effective estrogen dose (20 to 30 µg ethinyl estradiol), and choose the progestin with your blood clot risk in mind.
- Cyproterone acetate pills are second-line because of higher clot risk and are not available in the US.
- Progestin-only pills do not treat hirsutism.
- Give any pill at least 6 months. If hair is still a problem, guidelines suggest adding an anti-androgen such as spironolactone.
Sources
- Martin KA, Anderson RR, Chang RJ, et al. Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(4):1233-1257. PubMed 29522147
- Teede HJ, Tay CT, Laven JJE, et al. Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2023;108(10):2447-2469. PubMed 37580314
- Teede HJ, Bahri Khomami M, Morman R, et al. Polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome: a multistep global consensus process. Lancet. 2026;407(10545):2329-2339. PubMed 42119588
- Medicines and Healthcare products Regulatory Agency (MHRA). Combined hormonal contraceptives and venous thromboembolism: review confirms risk is small. Drug Safety Update, 2014. Accessed October 2026. Link
- Barrionuevo P, Nabhan M, Altayar O, et al. Treatment Options for Hirsutism: A Systematic Review and Network Meta-Analysis. J Clin Endocrinol Metab. 2018;103(4):1258-1264. PubMed 29522176
- van Zuuren EJ, Fedorowicz Z. Interventions for hirsutism excluding laser and photoepilation therapy alone: abridged Cochrane systematic review including GRADE assessments. Br J Dermatol. 2016;175(1):45-61. PubMed 26892495
- US Food and Drug Administration. Yaz (drospirenone/ethinyl estradiol) tablets: prescribing information (revised May 2023). Accessed October 2026. Link
- European Medicines Agency. Cyproterone- and ethinylestradiol-containing medicines: referral (2013). Accessed October 2026. Link
- Martin KA, Chang RJ, Ehrmann DA, et al. Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2008;93(4):1105-1120. PubMed 18252793
- Cochrane. Treatments for unwanted male pattern hair growth in women (plain language summary of van Zuuren EJ, Fedorowicz Z, Carter B, Pandis N. Interventions for hirsutism (excluding laser and photoepilation therapy alone). Cochrane Database Syst Rev. 2015;(4):CD010334). Accessed October 2026. Link
- European Medicines Agency. Restrictions in use of cyproterone due to meningioma risk (February 14, 2020). Accessed October 2026. Link
- NHS. Who can take the combined pill. Accessed October 2026. Link
This article is for education and is not medical advice. Talk to a doctor about diagnosis and treatment.