Polycystic Ovarian Syndrome(PCOS) affected 5-15% of women and is the commonest cause of hirsutism in women. The prevalence of hirsutism in PCOS patients is 70-80% compared with 4%-11% in women in the general population. Methods: A search in the Medline, Pub Med, Cochrane library database and Embase was made. Prospective randomized trials, systematic reviews,meta-analysis and retrospective studies on hirsutism and PCOS were extracted and reviewed. Evidence for the different outcomes and recommendations for interventions were used on the best available data. Review of Evidence: Evidence revealed that there is no universal agreement on the definition of PCOS. The NIH, ESHRE and ASRM and Androgen Excess and PCOS Society use different definitions based on the three criteria of Oligo anovulation (OA), biochemical or clinical hyperandrogenamia (HA) and polycystic ovarian morphology (PCOM). Moleular pathways modulating androgen biosynthesis and their relationship to insulin metabolism have enhanced our understanding of the pathophysiology of PCOS and its therapy. Hirsutism in PCOS is due to excess production of ovarian androgen driven by high level of LH. Life style modification and loss of body weight in PCOS patient complaining of hirsutism should be advised. Effective medical treatment includes, combined hormonal contraceptives (CHCs), antiandrogens or combined CHCs and antiandrogens. Insulin sentizers are also useful when there is associated hyperinsulinaemia. Short term and long term effective methods for treatment of hirsutism are also available and effective. Conclusion: The strategy for management of PCOS patients with hirsutism should be patient centered. Medical treatment and cosmetic treatment are effective. Long term sequela of PCOS should not be overlooked..