Management of Hirsutism and Acne in Women with Polycystic Ovary Syndrome: A Narrative Review of Current Evidence and Emerging Therapies
DOI:
https://doi.org/10.12775/QS.2026.58.72655Keywords
polycystic ovary syndrome, PCOS, hirsutism, acne, hyperandrogenismAbstract
Background: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age and is frequently associated with hyperandrogenic manifestations, including hirsutism and acne. These symptoms significantly impair quality of life and are closely linked to metabolic dysfunction, insulin resistance, and hormonal imbalance. The heterogeneous nature of PCOS contributes to variability in treatment response and complicates the development of optimal therapeutic strategies.
Aim: This narrative review aimed to evaluate current therapeutic approaches for hirsutism and acne in women with PCOS, focusing on clinical efficacy, mechanisms of action, and future therapeutic perspectives.
Materials and Methods: A narrative review of the literature was conducted using PubMed/MEDLINE and Google Scholar databases. Publications from 2015–2026 were analyzed, including randomized controlled trials, systematic reviews, meta-analyses and international clinical guidelines.
Results: Combined oral contraceptives remain the first-line treatment for hirsutism and acne due to their efficacy in reducing androgen excess and regulating menstrual cycles. Antiandrogens, particularly spironolactone, effectively reduce hirsutism, whereas metformin primarily improves metabolic abnormalities and insulin resistance. Emerging evidence suggests that GLP-1 receptor agonists may provide additional benefits through weight reduction, improved insulin sensitivity, and decreased androgen levels. However, current evidence is limited by heterogeneity of study populations, varying diagnostic criteria, short follow-up periods and lack of standardized outcome measures.
Conclusions: Management of hirsutism and acne in PCOS requires an individualized and multidimensional therapeutic approach. Further high-quality long-term studies are needed to optimize treatment strategies and improve clinical outcomes.
References
1. Gautam, R., Jyoti, A., Bhateja, A., Malhotra, N., & Arora, T. (2025). Pharmacological management of PCOS: trends and insights from a 10-year bibliometric analysis. Expert opinion on pharmacotherapy, 26(11-12), 1351–1358. https://doi.org/10.1080/14656566.2025.2535175
2. Muhammed Saeed, A. A., Noreen, S., Awlqadr, F. H., Farooq, M. I., Qadeer, M., Rai, N., Farag, H. A., & Saeed, M. N. (2025). Nutritional and herbal interventions for polycystic ovary syndrome (PCOS): a comprehensive review of dietary approaches, macronutrient impact, and herbal medicine in management. Journal of health, population, and nutrition, 44(1), 143. https://doi.org/10.1186/s41043-025-00899-y
3. Farhan, M., Seyfi, A., Alnuaimi, A., Alamour, M., Alwarafi, S., Elastal, H., Nazir, M. H., Kamaraj, B., Putta Nagarajan, H. D., Delianne, D., Ganesan, S., & Patel, T. (2025). A narrative review on cutaneous manifestations in polycystic ovary syndrome: pathophysiology, diagnosis, management, and psychosocial impact. Annals of medicine and surgery (2012), 87(5), 2804–2811. https://doi.org/10.1097/MS9.0000000000003217
4. Jakubowska-Kowal, K. M., Skrzynska, K. J., & Gawlik-Starzyk, A. M. (2024). Prevalence and diagnosis of polycystic ovary syndrome (PCOS) in adolescents - what's new in 2023? Systematic review. Ginekologia polska, 95(8), 643–649. https://doi.org/10.5603/gpl.98849
5. Bahri Khomami, M., Shorakae, S., Hashemi, S., Harrison, C. L., Piltonen, T. T., Romualdi, D., Tay, C. T., Teede, H. J., Vanky, E., & Mousa, A. (2024). Systematic review and meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome. Nature communications, 15(1), 5591. https://doi.org/10.1038/s41467-024-49749-1
6. Amiri, M., Hatoum, S., Buyalos, R. P., Sheidaei, A., & Azziz, R. (2025). The Influence of Study Quality, Age, and Geographic Factors on PCOS Prevalence-A Systematic Review and Meta-analysis. The Journal of clinical endocrinology and metabolism, 110(7), 2082–2103. https://doi.org/10.1210/clinem/dgae917
7. Fahs, D., Salloum, D., Nasrallah, M., & Ghazeeri, G. (2023). Polycystic Ovary Syndrome: Pathophysiology and Controversies in Diagnosis. Diagnostics (Basel, Switzerland), 13(9), 1559. https://doi.org/10.3390/diagnostics13091559
8. Di Lorenzo, M., Cacciapuoti, N., Lonardo, M. S., Nasti, G., Gautiero, C., Belfiore, A., Guida, B., & Chiurazzi, M. (2023). Pathophysiology and Nutritional Approaches in Polycystic Ovary Syndrome (PCOS): A Comprehensive Review. Current nutrition reports, 12(3), 527–544. https://doi.org/10.1007/s13668-023-00479-8
9. Mumusoglu, S., & Yildiz, B. O. (2020). Polycystic ovary syndrome phenotypes and prevalence: Differential impact of diagnostic criteria and clinical versus unselected population. Current Opinion in Endocrine and Metabolic Research, 12, 66-71. https://doi.org/10.1016/j.coemr.2020.03.004.
10. Houston, E. J., & Templeman, N. M. (2025). Reappraising the relationship between hyperinsulinemia and insulin resistance in PCOS. The Journal of endocrinology, 265(2), e240269. https://doi.org/10.1530/JOE-24-0269
11. Yasmin, A., Roychoudhury, S., Paul Choudhury, A., Ahmed, A. B. F., Dutta, S., Mottola, F., Verma, V., Kalita, J. C., Kumar, D., Sengupta, P., & Kolesarova, A. (2022). Polycystic Ovary Syndrome: An Updated Overview Foregrounding Impacts of Ethnicities and Geographic Variations. Life (Basel, Switzerland), 12(12), 1974. https://doi.org/10.3390/life12121974
12. Joham, A. E., Rees, D. A., Shinkai, K., Forslund, M., Tay, C. T., & Teede, H. J. (2025). POLYCYSTIC OVARY SYNDROME: ORIGINS AND IMPLICATIONS: Epidemiological aspects of polycystic ovary syndrome. Reproduction (Cambridge, England), 170(2), e250121. https://doi.org/10.1530/REP-25-0121
13. Tay, C. T., Mousa, A., Vyas, A., Pattuwage, L., Tehrani, F. R., & Teede, H. (2024). 2023 International Evidence-Based Polycystic Ovary Syndrome Guideline Update: Insights From a Systematic Review and Meta-Analysis on Elevated Clinical Cardiovascular Disease in Polycystic Ovary Syndrome. Journal of the American Heart Association, 13(16), e033572. https://doi.org/10.1161/JAHA.123.033572
14. Ramezani Tehrani, F., Behboudi-Gandevani, S., Bidhendi Yarandi, R., Saei Ghare Naz, M., & Carmina, E. (2021). Prevalence of acne vulgaris among women with polycystic ovary syndrome: a systemic review and meta-analysis. Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology, 37(5), 392–405. https://doi.org/10.1080/09513590.2020.1859474
15. Oğuz, S. H., Yalici Armagan, B., & Okan Yildiz, B. (2026). Skin deep: dermatologic challenges in PCOS through the female lifespan. Expert review of endocrinology & metabolism, 21(2), 123–142. https://doi.org/10.1080/17446651.2026.2632020
16. Ben Abdessalem, F., Ach, T., Fetoui, N. G., Mraihi, E., & Abdelkarim, A. B. (2024). Characterizing clinical and hormonal profiles of acne in north African women with polycystic ovary syndrome. Archives of dermatological research, 316(10), 711. https://doi.org/10.1007/s00403-024-03466-3
17. National Institute for Health and Care Excellence. (2021). Acne vulgaris: Management (NICE Guideline NG128). NICE. https://www.nice.org.uk/guidance/ng198
18. Adshead, C., Sheffield, D., Fido, D., Lagojda, L., Kyrou, I., Randeva, H. S., Williams, S., & Kite, C. (2026). Psychological Interventions for Women with Polycystic Ovary Syndrome (PCOS): A Systematic Review and Meta-Analysis of Randomised and Non-Randomised Controlled Trials. Psychology International, 8(1), 15. https://doi.org/10.3390/psycholint8010015
19. Malini, N. A., & Roy, G. K. (2021). Influence of Insulin on LH, Testosterone and SHBG in various PCOS Categories based on the Mode of Secretion of LH in relation to FSH Levels. Acta endocrinologica (Bucharest, Romania : 2005), 17(3), 313–318. https://doi.org/10.4183/aeb.2021.313
20. Balogh, Z., Csehely, S., Orosz, M., Bhattoa, H. P., Krasznai, Z. T., Deli, T., & Jakab, A. (2025). Relations of Insulin Resistance, Body Weight, Vitamin D Deficiency, SHBG and Androgen Levels in PCOS Patients. Biomedicines, 13(8), 1803. https://doi.org/10.3390/biomedicines13081803
21. Biernacka-Bartnik, A., Kocełak, P., Owczarek, A. J., Choręza, P., Puzianowska-Kuźnicka, M., Markuszewski, L., Madej, P., Chudek, J., & Olszanecka-Glinianowicz, M. (2022). Prediction of Insulin Resistance and Impaired Fasting Glucose Based on Sex Hormone-Binding Globulin (SHBG) Levels in Polycystic Ovary Syndrome. International journal of endocrinology, 2022, 6498768. https://doi.org/10.1155/2022/6498768
22. Shaaban, Z., Khoradmehr, A., Amiri-Yekta, A., Nowzari, F., Jafarzadeh Shirazi, M. R., & Tamadon, A. (2021). Pathophysiologic Mechanisms of Insulin Secretion and Signaling-Related Genes in Etiology of Polycystic Ovary Syndrome. Genetics research, 2021, 7781823. https://doi.org/10.1155/2021/7781823
23. Armanini, D., Boscaro, M., Bordin, L., & Sabbadin, C. (2022). Controversies in the Pathogenesis, Diagnosis and Treatment of PCOS: Focus on Insulin Resistance, Inflammation, and Hyperandrogenism. International journal of molecular sciences, 23(8), 4110. https://doi.org/10.3390/ijms23084110
24. Wang, T. M., Chou, C. H., Lee, Y. L., Chung, C. H., Huang, Y. C., Lai, X. C., Sun, C. A., Kang, C. Y., Wu, G. J., & Chien, W. C. (2022). Clinical Characteristics of Hyperandrogenism Include Hirsutism, Polycystic Ovary Syndrome, and Acne: Association with Psychiatric Disease in Women -A Nationwide Population-Based Cohort Study in Taiwan. International journal of women's health, 14, 1173–1189. https://doi.org/10.2147/IJWH.S376244
25. Zeng, H., Zhang, Y., Huang, S., Wu, J., Ren, W., Zhou, L., Huang, L., & Ye, Y. (2023). Metformin combined with spironolactone vs. metformin alone in polycystic ovary syndrome: a meta-analysis. Frontiers in endocrinology, 14, 1223768. https://doi.org/10.3389/fendo.2023.1223768
26. Austregésilo de Athayde De Hollanda Morais, B., Martins Prizão, V., de Moura de Souza, M., Ximenes Mendes, B., Rodrigues Defante, M. L., Cosendey Martins, O., & Rodrigues, A. M. (2024). The efficacy and safety of GLP-1 agonists in PCOS women living with obesity in promoting weight loss and hormonal regulation: A meta-analysis of randomized controlled trials. Journal of diabetes and its complications, 38(10), 108834. https://doi.org/10.1016/j.jdiacomp.2024.108834
27. Alesi, S., Forslund, M., Melin, J., Romualdi, D., Peña, A., Tay, C. T., Witchel, S. F., Teede, H., & Mousa, A. (2023). Efficacy and safety of anti-androgens in the management of polycystic ovary syndrome: a systematic review and meta-analysis of randomised controlled trials. EClinicalMedicine, 63, 102162. https://doi.org/10.1016/j.eclinm.2023.102162
28. Bashir, R., Asrar, M. M., Shah, I. A., Wani, I. A., & Ganie, M. A. (2023). Do Pleiotropic Effects of Spironolactone in Women with PCOS Make it More than an Anti-androgen? Evidence from a Systematic Review and Meta-analysis. Current pharmaceutical design, 29(19), 1486–1496. https://doi.org/10.2174/1381612829666230331093912
29. Diri, H., Karaburgu, S., Acmaz, B., Unluhizarci, K., Tanriverdi, F., Karaca, Z., & Kelestimur, F. (2016). Comparison of spironolactone and spironolactone plus metformin in the treatment of polycystic ovary syndrome. Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology, 32(1), 42–45. https://doi.org/10.3109/09513590.2015.1080679
30. Melin, J. M., Forslund, M., Alesi, S. J., Piltonen, T., Romualdi, D., Spritzer, P. M., Tay, C. T., Pena, A. S., Witchel, S. F., Mousa, A., & Teede, H. J. (2024). Effects of different insulin sensitisers in the management of polycystic ovary syndrome: A systematic review and meta-analysis. Clinical endocrinology, 100(2), 149–163. https://doi.org/10.1111/cen.14983
31. Fontes, A. F. S., Reis, F. M., Cândido, A. L., Gomes, K. B., & Tosatti, J. A. G. (2023). Influence of metformin on hyperandrogenism in women with polycystic ovary syndrome: a systematic review and meta-analysis of randomized clinical trials. European journal of clinical pharmacology, 79(4), 445–460. https://doi.org/10.1007/s00228-023-03461-z
32. Mandvia, A., George, R., Kumari, K., Kumari, K., Sabbagh, L. I., Bhullar, A., Mohamed Ismail, D., Kolanu, N. D., & Ali, A. (2025). Comparative Efficacy of Metformin and Combined Oral Contraceptives in the Management of Adolescent Polycystic Ovary Syndrome: A Systematic Review of Randomized Controlled Trials. Cureus, 17(5), e83850. https://doi.org/10.7759/cureus.83850
33. Fitz, V., Graca, S., Mahalingaiah, S., Liu, J., Lai, L., Butt, A., Armour, M., Rao, V., Naidoo, D., Maunder, A., Yang, G., Vaddiparthi, V., Witchel, S. F., Pena, A., Spritzer, P. M., Li, R., Tay, C., Mousa, A., Teede, H., & Ee, C. (2024). Inositol for Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis to Inform the 2023 Update of the International Evidence-based PCOS Guidelines. The Journal of clinical endocrinology and metabolism, 109(6), 1630–1655. https://doi.org/10.1210/clinem/dgad762
34. Forslund, M., Wändell, P., Forsberg, L., Österberg, M., Dagerhamn, J., Wernersson, E., Kärrman Fredriksson, M., Ringborg, A., & Lindén Hirschberg, A. (2026). GLP-1 receptor agonist treatment in women with polycystic ovary syndrome-a systematic review and meta-analysis. European journal of endocrinology, 194(3), 25–39. https://doi.org/10.1093/ejendo/lvag033
35. Szczesnowicz, A., Szeliga, A., Niwczyk, O., Bala, G., & Meczekalski, B. (2023). Do GLP-1 Analogs Have a Place in the Treatment of PCOS? New Insights and Promising Therapies. Journal of clinical medicine, 12(18), 5915. https://doi.org/10.3390/jcm12185915
36. Almalki, H. H., Alshibani, T. M., Alhifany, A. A., & Almohammed, O. A. (2020). Comparative efficacy of statins, metformin, spironolactone and combined oral contraceptives in reducing testosterone levels in women with polycystic ovary syndrome: a network meta-analysis of randomized clinical trials. BMC women's health, 20(1), 68. https://doi.org/10.1186/s12905-020-00919-5
37. Bo, Y., Zhao, J., Liu, C., & Yu, T. (2025). Comparative efficacy of pharmacological interventions on metabolic and hormonal outcomes in polycystic ovary syndrome: a Network Meta-Analysis of Randomized controlled trials. BMC women's health, 25(1), 64. https://doi.org/10.1186/s12905-025-03594-6
38. Xie, M., Qing, X., Huang, H., Xie, B., & Zhang, J. (2025). The clinical efficacy of digital health interventions in patients with polycystic ovary syndrome: a systematic review and meta-analysis. Journal of health, population, and nutrition, 44(1), 433. https://doi.org/10.1186/s41043-025-01167-9
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Aleksandra Papuga, Makary Hejduk, Joanna Makowska, Jerzy Darmoń, Natalia Piegza, Karolina Domańska, Anna Sieczka, Maria Windyga, Justyna Bury
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 9
Number of citations: 0
