Vol. 9, Issue - 3, Part A (2025)

Hirsutism due to polycystic ovarian syndrome: An integrative review of pathophysiology and management

Hirsutism -excessive male pattern terminal hair growth in women, is a distressing clinical manifestation commonly associated with Polycystic Ovarian Syndrome (PCOS), arising from complex endocrine and metabolic dysfunctions. This integrative review explores the pathophysiology and management of hirsutism from both modern biomedical and Unani perspectives. In modern medicine, hyperandrogenism, insulin resistance, and altered ovarian steroidogenesis lead to elevated androgen levels and decreased sex hormone-binding capacity, stimulating hair follicles in androgen-sensitive areas. Unani medicine explains these symptoms through concepts of deranged Mizaj (temperament), accumulation of morbid humors (Su-i-Mizaj), phlegmatic dominance, and menstrual disturbances, causing internal waste (fuzlat) to be expelled via abnormal routes such as excessive hair growth. Conventional treatments include lifestyle modification, weight management, oral contraceptives, anti- androgens, insulin sensitizers, and cosmetic procedures, while Unani approaches emphasize Ilaj bil Tadbeer (regimenal therapies), herbal and compound formulations, dieto-therapy, and temperament correction. The review advocates an integrative approach combining modern and Unani therapies to provide holistic, individualized care. Future research should focus on clinical trials comparing treatment outcomes, integration of Mizaj assessment with biochemical markers, and standardization of Unani protocols to enhance efficacy, safety, and patient adherence.