Response to Oliveira and Comim

Drs. Oliveira and Comim ² note the potential for women with uterine fibroids to be less likely to develop polycystic ovary syndrome (PCOS) than women without fibroids resulting in an underestimate of PCOS and, therefore, hirsutism in the Study of Environment, Lifestyle & Fibroids (SELF) cohort. Eligibility criteria for participation in SELF included not having a clinical diagnosis of fibroids, although some women in the study had previously undiagnosed fibroids detected by ultrasound at their initial study visit.

The objective was to estimate the prevalence of hirsutism in a community-based sample, not one that was selected for PCOS. We agree that the prevalence of PCOS in SELF may be an underestimate, as it was based on self-reported physician-diagnosed PCOS and not directly assessed by the study. Women with undiagnosed PCOS likely exist in our cohort, but we do not think this would influence the report of hair growth patterns, which was assessed in all participants.

Although Pasch et al. reported women overestimated their modified Ferriman-Gallwey (mFG) score in comparison with clinician assessment, women only had to discontinue hair removal methods for at least one week before examination. ³ This short time period may not have been long enough for hair to fully regrow by the time of clinician assessment. In SELF, women were asked to report hair growth patterns when they were not using any type of hair removal method. It is possible that this self-administered mFG assessment resulted in higher scores compared with a clinical assessment. The lack of both clinician and self-report was noted as a potential limitation of our study.

We agree that an important next step is to better understand women's feelings about facial and body hair. Women with low mFG scores may have been bothered by nonandrogen-related hair growth, highlighting the importance of addressing both hirsutism and other perceived excess hair growth patterns.

Drs. Oliveira and Comim ² raise an important point regarding the exclusion of current oral contraception users from the analysis. Although we excluded women who took hormonal contraceptives in the four weeks leading up to the hair growth assessment, it is possible some women in our study continued to have reduced hair growth due to oral contraceptive use in the recent past. We were unable to exclude women using oral contraceptives for >4 weeks before the hair growth assessment because we did not collect detailed information on the timing of past oral contraceptive use.