Short answer: The main prescription treatments for hirsutism are the combined birth control pill, anti-androgen medicines such as spironolactone, and eflornithine cream for the face. The Endocrine Society recommends the pill as the first medicine for most women who are not trying to get pregnant, and adding an anti-androgen if hair growth is still bothersome after 6 months. [1] No pill stops hair growth for good, and all of these medicines take at least 6 months to show their full effect.
If you have unwanted dark, coarse hair on your face or body, medication can slow it down and make it finer. It works on the cause: androgens, the hormones such as testosterone that turn soft, fine hair into thick, dark hair in sensitive areas. [1] Medication does not remove hair that is already there, so most women combine it with shaving, waxing, laser or electrolysis.
This guide covers every option in the 2018 Endocrine Society hirsutism guideline and the 2023 International PCOS Guideline, how well each one works, and the safety points you should know. [1][2] It also answers three questions we hear often: Which birth control pill is best for PMOS (formerly PCOS) and hirsutism? Does birth control help with hair growth? And is there a pill that stops body hair growth?
A note on names: In May 2026, polycystic ovary syndrome (PCOS) was renamed polyendocrine metabolic ovarian syndrome (PMOS) after a global consensus process. The change is being phased in over three years. [3] Most of the studies below were done under the old name, so you will see both.
Hirsutism medication at a glance
| Medicine | What it does | Evidence | Main cautions |
|---|---|---|---|
| Combined birth control pill | Lowers androgen production and raises the protein that binds testosterone | Strong. First-line in guidelines | Blood clot risk; not for some smokers over 35 or women with migraine with aura |
| Spironolactone | Blocks androgens from acting on the hair follicle | Strong as an add-on to the pill | Must not be taken in pregnancy; can raise potassium; irregular bleeding |
| Cyproterone acetate (where available) | Blocks androgens; also in some birth control pills | Moderate | Meningioma risk at high doses |
| Finasteride | Anti-androgen | Moderate | Must not be taken in pregnancy; benefit may be small |
| Flutamide, bicalutamide | Block androgen receptors | Moderate (flutamide), Limited (bicalutamide) | Liver damage; guideline advises against flutamide |
| Eflornithine cream | Slows facial hair growth | Strong for facial hair | Hair returns within about 8 weeks of stopping |
| Metformin | Lowers insulin | Limited for hair | Guideline advises against using it for hirsutism alone |
| GnRH analogs | Switch off ovarian hormone production | Limited | Only for severe cases |
| Glucocorticoids | Lower adrenal androgens in NCAH | Limited | Only for specific adrenal causes |
Evidence ratings are ours, based on the guidelines and reviews cited in each section below.
Before you start: get the cause checked
Hirsutism is usually a sign of something else, most often PMOS. Other causes include an inherited adrenal condition called non-classic congenital adrenal hyperplasia (NCAH), certain medicines and, rarely, hormone-producing tumors. The Endocrine Society recommends checking blood androgen levels in women with abnormal hair growth, with further tests depending on the results. [1] The right medicine can depend on the cause, so it pays to find out first. You can score your hair growth with our hirsutism self-check and read about the tests used to diagnose hirsutism and what causes hirsutism.
Birth control pills for hirsutism
Evidence: Strong Combined oral contraceptives, meaning pills that contain both an estrogen and a progestin (a synthetic version of progesterone), are the guideline-recommended first treatment for most women with bothersome hirsutism who do not want to get pregnant. [1] A 2018 network meta-analysis, which pooled 43 randomized trials, found that the pill reduced hirsutism more than placebo, and the evidence for this was rated moderate quality. [4]
Does birth control help with hair growth?
For unwanted hair on the face and body, yes. The pill lowers androgen activity in two main ways. It suppresses luteinizing hormone (LH), the brain signal that drives the ovaries to make androgens. It also makes the liver produce more sex hormone-binding globulin (SHBG), a protein that binds testosterone and leaves less of it free to act on hair follicles. It may also slightly reduce androgen production by the adrenal glands. [1]
The effect is gradual. Hair follicles go through long growth cycles, so it takes around 6 months to see a change and about 9 months for the full effect. The guideline advises giving any hirsutism medicine at least 6 months before changing the dose, switching or adding another drug. [1]
If you are asking about the hair on your head, that is a different question. Female pattern hair loss is sometimes treated with oral anti-androgens such as spironolactone, and treatment needs at least 6 months before you can judge whether it works. [5] Read more in can hair loss from PCOS be reversed.
What is the best birth control pill for PCOS (PMOS) and hirsutism?
There is no single best pill. Both major guidelines looked at this question and did not find one type that works better than the others:
- The Endocrine Society suggests not choosing one pill over another as a starting treatment. [1]
- The International PCOS Guideline says specific types or doses of progestins, estrogens or combinations cannot currently be recommended for PMOS, and that pills with a higher estrogen dose (30 micrograms of ethinyl estradiol or more) have no clinical advantage over lower doses. [2]
- In the network meta-analysis, pills containing levonorgestrel, cyproterone acetate or drospirenone worked about as well as other pills. [4]
Some progestins have anti-androgen activity of their own, such as drospirenone and cyproterone acetate, and you will often see them marketed for skin and hair. In head-to-head studies, though, they were not clearly more effective than other pills. [1]
What matters more is safety and how well you tolerate the pill. The Endocrine Society notes that the combined pill raises the risk of blood clots in the veins (venous thromboembolism) about threefold in first-time users, and that some newer progestins may carry a 50% to 100% higher clot risk than levonorgestrel. For women at higher risk, such as those with obesity or over 39, it suggests the lowest effective estrogen dose (usually 20 micrograms of ethinyl estradiol) with a lower-risk progestin. [1] It also says it tends to avoid levonorgestrel in women with PCOS because of possible effects on metabolism. [1]
The International PCOS Guideline suggests that pills containing 35 micrograms of ethinyl estradiol plus cyproterone acetate should be considered second-line, after weighing the risk of blood clots. [2]
The combined pill may not be suitable if you are 35 or older and smoke, live with obesity, have had a blood clot (or a close relative had one before 45), have migraines with aura, high blood pressure, heart disease, a history of stroke or breast cancer, or certain liver problems. [6] Common side effects include nausea and headaches. [7] Talk these through with your doctor, who can match a pill to your health history.
What about the progestin-only pill (minipill)?
The guideline recommendations and trials we reviewed are about combined pills, not progestin-only pills, so we cannot say whether a minipill will help your hair. [1][2] If you cannot take estrogen, ask your doctor about other options below, such as an anti-androgen with a long-acting contraceptive.
Spironolactone and other anti-androgens
Anti-androgens block androgens from attaching to cells, including hair follicles. [7] The Endocrine Society suggests adding one if hirsutism is still bothersome after 6 months on the pill alone. Adding an anti-androgen to the pill was slightly more effective than the pill alone. [1]
Pregnancy warning: Anti-androgens can affect the development of a male baby. The guidelines recommend against taking them on their own unless you use reliable contraception, and the International PCOS Guideline says women who could become pregnant should be strongly counseled about effective contraception. [1][2] That is one reason they are often combined with the pill. Women who are not sexually active, are sterilized or use a long-acting contraceptive such as an IUD or implant may use an anti-androgen without the pill. [1]
The Endocrine Society does not prefer one anti-androgen over another, with one exception: It recommends against flutamide because of the risk of liver damage. [1]
Spironolactone
Evidence: Strong Spironolactone is the most commonly used anti-androgen for hirsutism. [7] It is also used for heart failure, high blood pressure and fluid retention, and is available only on prescription. [8] In a Cochrane review, spironolactone 100 mg a day lowered hirsutism scores more than placebo and worked about as well as flutamide and finasteride, although the evidence was low quality. [9] The Endocrine Society guideline refers to 100 to 200 mg a day as the usual dose for hirsutism. [1]
Side effects can include irregular periods or spotting. [9][7] It can also raise potassium levels, so tell your doctor if you take potassium supplements or salt substitutes. [8] Your doctor will tell you whether you need blood tests.
Cyproterone acetate
Evidence: Moderate Cyproterone acetate is an anti-androgen and progestin that is available in some countries but not others. It comes in a low dose (2 mg) inside some combined pills [1] and in higher-dose tablets. [10] In the Cochrane review, adding cyproterone acetate to the pill reduced hirsutism scores more than the pill alone, though the trials were too different to pool. [9]
In 2020, the European Medicines Agency restricted products with 10 mg or more per day because of a rare risk of meningioma, a usually noncancerous brain tumor. The risk rises with the total dose over time and is mainly linked to 25 mg a day or more for several years. For hirsutism, these higher doses should be used only after other options, including lower-dose treatments, have failed. The agency found no risk for the low-dose combined pills, but as a precaution they should not be used by anyone who has had a meningioma. [10]
Finasteride
Evidence: Moderate Finasteride beat placebo in the 2018 network meta-analysis. [4] The Cochrane review found that 5 to 7.5 mg a day lowered hirsutism scores compared with placebo, but the evidence was very low quality and the authors doubted the difference was large enough to matter clinically. [9] Like other anti-androgens, it must not be taken if you could become pregnant without reliable contraception. [1]
Flutamide and bicalutamide
Evidence: Moderate Flutamide reduced hirsutism more than placebo in trials, but the evidence was very low quality. [9] The Endocrine Society recommends against using it because it can damage the liver. [1]
Evidence: Limited Bicalutamide is a related drug that some specialists prescribe off-label. It is approved only for prostate cancer, and its US label states that it has no indication for women. The label warns that severe liver injury, including cases leading to death or hospitalization, has been reported, and it requires regular liver blood tests. It is also contraindicated in pregnancy. [11] It was not covered by the guideline or reviews we relied on, so if it is offered to you, ask your doctor about the evidence and the monitoring plan.
Eflornithine cream for facial hair
Evidence: Strong Eflornithine cream (Vaniqa, labeled in the US as 13.9% eflornithine hydrochloride) is a prescription cream that slows the growth of unwanted facial hair in women. In two randomized trials of 594 women who used it twice a day for 24 weeks, about 32% saw marked improvement or better, compared with 8% using a cream without the active ingredient. Some women noticed a difference within 4 to 8 weeks. [12]
It does not remove hair, so you keep using your usual hair removal method. If you stop, hair growth returns to near its previous level within about 8 weeks. The most common side effects are stinging, burning and redness of the skin. It was studied only on the face and under the chin. [12] The Endocrine Society suggests considering it alongside laser treatment for a faster response. [1] For more on facial hair, see how to stop hair growth on a woman’s face.
Metformin and insulin sensitizers
Evidence: Limited Metformin lowers insulin, which can play a role in PMOS. For hirsutism alone, though, the Endocrine Society suggests against insulin-lowering drugs. [1] The evidence is mixed: A Cochrane review found metformin was no better than placebo for hirsutism scores, [9] while the network meta-analysis found a modest benefit based on very low-quality evidence. [4] The International PCOS Guideline says the pill could be used over metformin for hirsutism, and that metformin should be considered over inositol for hirsutism. [2] Metformin may still be useful for other reasons in PMOS, such as metabolic health, so talk to your doctor about what it is meant to treat in your case.
GnRH analogs
Evidence: Limited Gonadotropin-releasing hormone (GnRH) analogs are medicines that shut down the ovaries’ hormone production. The Endocrine Society suggests against them for hirsutism, except in women with severe androgen excess, such as a condition called ovarian hyperthecosis, who have not responded well enough to the pill and anti-androgens. [1]
Glucocorticoids for NCAH
Evidence: Limited In non-classic congenital adrenal hyperplasia, the adrenal glands make too many androgens because of an inherited enzyme problem. Glucocorticoids, steroid medicines similar to the body’s own cortisol, can lower this adrenal output. The Endocrine Society’s CAH guideline suggests glucocorticoids for adult women with NCAH who have bothersome androgen-related symptoms or infertility. This is a weak recommendation based on low-quality evidence, and the same guideline recommends against treating people with NCAH who have no symptoms. [13]
Is there a pill that stops body hair growth?
No single pill switches body hair off. Medicines reduce how fast hair grows and how thick and dark it is, and they work best on hair driven by androgens. Even the most effective options, the pill combined with an anti-androgen, reduce hirsutism scores rather than clearing hair completely. [4] Results build up slowly over 6 to 9 months. [1] Eflornithine shows what happens when treatment stops: Hair returned to near pretreatment levels within about 8 weeks. [12] Read more in can hirsutism be cured permanently.
Pills and creams sold online as “hair growth inhibitors” or natural anti-androgens are not the same as these tested medicines. See our guide to over-the-counter anti-androgens for what the evidence says about them.
Combining medication with laser or electrolysis
Medication slows new growth, while hair removal deals with the hair you already have. For most women, the Endocrine Society suggests starting with medication and adding direct hair removal if you want more improvement. For mild hirsutism without an underlying hormone condition, either approach is reasonable. If you have raised androgens and choose laser or electrolysis, it suggests also using medication to reduce regrowth. [1] The International PCOS Guideline notes that women with PMOS may need more laser sessions. [2] Read our guide to permanent hair removal for the options.
How long does hirsutism medication take to work?
- Pill and anti-androgens: Allow at least 6 months before judging. The full effect is usually seen at about 9 months. [1]
- Eflornithine cream: Some improvement in 4 to 8 weeks, with trials running 24 weeks. [12]
- Taking photos in the same light every month, or rescoring yourself with the self-check, can help you see slow changes.
When to see a doctor
See a doctor before starting any hormone treatment, and see one promptly if you notice:
- Hair growth that starts suddenly or gets worse within months
- A deepening voice, an enlarged clitoris, increased muscle mass or male-pattern balding, which are signs of virilization
- Irregular or missing periods
These can point to a higher androgen level that needs investigating, and in rare cases to a hormone-producing tumor. [1] Not sure who to book with? Read which doctor to see for hirsutism.
Frequently asked questions
What is the best birth control pill for PCOS and hirsutism?
There isn’t one. Guidelines do not recommend any specific pill over others for hirsutism, and pills with anti-androgenic progestins were not clearly more effective in trials. [1][2] Your doctor will choose based on your clot risk, side effects and preferences.
Does birth control help with hair growth?
Yes, combined pills reduce unwanted facial and body hair in many women by lowering androgen activity, but the change takes about 6 months to show. [1][4]
Is there a pill that stops body hair growth?
No medicine stops hair growth permanently. The pill, anti-androgens and eflornithine slow growth and make hair finer while you use them. [4][12]
Can I take spironolactone without the pill?
Only if you use another reliable form of contraception or cannot become pregnant, because anti-androgens can affect a developing baby. [1][2]
Does metformin help with facial hair?
Probably not much. Guidelines advise against using it for hirsutism alone. [1][2]
Key takeaways
- The combined birth control pill is the first-line medicine for hirsutism in most women not trying to get pregnant, and no single pill is best.
- If hair is still bothersome after 6 months, an anti-androgen such as spironolactone can be added, always with reliable contraception.
- Eflornithine cream slows facial hair but works only while you use it.
- Metformin, GnRH analogs and glucocorticoids are for specific situations, not routine hirsutism treatment.
- Give any medicine at least 6 months, and combine it with hair removal for the best results.
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Sources
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- 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, Khomami MB, 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
- 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
- DermNet. Female pattern hair loss. Accessed October 2026. Link
- NHS. Combined pill: Who can take it. Accessed October 2026. Link
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- NHS. Spironolactone. Accessed October 2026. Link
- 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. PubMed 25918921
- European Medicines Agency. Restrictions in use of cyproterone due to meningioma risk (February 2020). Accessed October 2026. Link
- US National Library of Medicine, DailyMed. Bicalutamide tablets: Prescribing information. Accessed October 2026. Link
- US National Library of Medicine, DailyMed. Vaniqa (eflornithine hydrochloride) cream, 13.9%: Prescribing information. Accessed October 2026. Link
- Speiser PW, Arlt W, Auchus RJ, et al. Congenital Adrenal Hyperplasia Due to Steroid 21-Hydroxylase Deficiency: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(11):4043-4088. PubMed 30272171
This article is for education and is not medical advice. Talk to a doctor about diagnosis and treatment.