Hirsutism

Published by Bupa's Health Information Team, September 2010.

This factsheet is for women who have hirsutism, or people who would like information about it.

Hirsutism is when a woman has excessive and thick hair growth in areas which are less cosmetically acceptable such as on the chin. There are a number of reasons why a woman may develop hirsutism. There are several treatment options, but the condition often returns if treatment stops.

About hirsutism

Hirsutism affects about one in 10 women. The excess hair that grows is thicker, darker and coarser than the fine hair (vellus hair) that covers most of your skin, and is called terminal hair. If you have hirsutism, you may also have acne or seborrhoea, which is a condition where your skin produces too much sebum (a natural oil produced by the skin).

Hirsutism usually starts around puberty and may get worse as you get older. After the menopause, you may find you have more hair growth on your face and body. If you are of Mediterranean or Indian descent, you may naturally have more hair on your body than others. This doesn't mean, however, that you have hirsutism.

Symptoms of hirsutism

The pattern of hair growth in hirsutism is different for every woman, and can vary depending on the cause of your condition. The excess hair grows in places where you wouldn't usually expect it to grow, such as your face, chest, around your nipples, abdomen (tummy), thighs, buttocks and lower back.

Some women find hirsutism very upsetting. It may affect your confidence and self-esteem, and some people avoid doing the things they enjoy, such as swimming, because of how they feel about their hair growth. It's important to talk to your GP if you feel this way.

If you have hirsutism, especially if it developed before puberty, gets much worse, or develops very quickly, you should see your GP.

Causes of hirsutism

Hirsutism is linked to the male sex hormones called androgens. Hormones are natural chemicals produced by your body that make things grow or change. All women produce low levels of androgens. However, if you have hirsutism, you may produce higher levels of androgens, or it may be that your hair follicles are more sensitive to androgens than normal.

High levels of androgens have been linked to a condition called polycystic ovary syndrome (PCOS). This is when your ovaries don't work properly. As well as causing the symptoms of hirsutism, PCOS can cause other symptoms such as:

• acne
• irregular periods that may stop altogether
• thinning or loss of hair from your head
• an increase in weight that can lead to you becoming overweight or obese

If you have hirsutism and any of these symptoms, especially if your symptoms get worse or develop very quickly, you should see your GP.

Hirsutism can be a symptom of other medical conditions, for example acromegaly (a condition caused by too much growth hormone). It can also occur as a side-effect of medicines such as steroids, danazol (used to treat endometriosis) and sodium valproate (used to treat epilepsy). The condition can also run in families.

The majority of women have no explainable medical reason for developing hirsutism and the cause, therefore, isn't known. This is called idiopathic hirsutism.

Diagnosis of hirsutism

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. If you have mild hirsutism and your periods are regular, you probably don't have an underlying medical condition that needs treating.

If your GP thinks your condition isn't idiopathic hirsutism, you may have blood tests to check the level of androgens and other hormones in your blood.

Your GP may refer you to an endocrinologist (a doctor who specialises in treating conditions affecting hormones), or a dermatologist (a doctor who specialises in skin conditions), or a gynaecologist (a doctor who specialises in women's reproductive health).

Treatment of hirsutism

There are several ways to treat hirsutism, although none of them will cure the condition. If you have severe hirsutism, you may need to use several different types of treatment at the same time.

Self-help

If you are overweight or obese, it's a good idea to try to lose excess weight as this can reduce the level of androgens that your body produces. Eating a healthy, balanced diet and taking regular exercise will help you lose excess weight.

There are also a number of methods of hair removal or treatment that you can try.

Shaving
This is easy to do but you may need to shave every day, and this can irritate your skin. Shaving doesn't make your hair grow back thicker or darker but you may find that when the hair grows back, the stubble is uncomfortable and the blunt ends can make the hair appear coarser.

Depilation
This uses creams that dissolve the hair above your skin. Your hair will grow back, but the hairs won't have the blunt ends that they do after shaving, so stubble isn't such a problem. However, these creams can irritate your skin, especially if it's sensitive.

Bleaching
You can buy creams that contain bleach to lighten the colour of the hair on your face or body. As with shaving and depilation, these creams may irritate your skin. Bleaching is generally most useful for women with fine dark hair, especially on the face.

Plucking/waxing/threading
Plucking and waxing your hair will remove the whole hair follicle, but you may find it's uncomfortable. The hair will grow back, but more slowly than if you use shaving or creams because it must grow to skin level before it appears. Plucking and waxing can cause scarring, but this is rare. Folliculitis can also develop; this is when the hair follicle becomes inflamed and occasionally infected.

Threading involves winding fine cotton around the hair follicle, which can then be pulled out.

Electrolysis

Electrolysis is a way of removing hair that can sometimes be permanent. An electric current is passed down a needle and into the hair follicle, damaging it. It can be quite painful and you will need several treatment sessions.

If you decide to have electrolysis, it's important that you make sure that the practitioner who treats you is fully trained and registered with the British Institute and Association of Electrolysis. You should also make sure you are treated with new, unused needles and not ones that have been used before or that haven't been sterilised. This is important to prevent the risk of infection.

Laser treatment

Laser hair removal uses a laser light to damage hair follicles and reduce hair growth. Laser treatment can be very effective. Although it isn't usually permanent, you may be able to go for long periods between treatments. Each treatment reduces the thickness of any hair that grows back. You will probably need at least five treatments, with a one- to three-month gap between each one. Laser treatment is more effective on people with light skin and dark hair. It's normal for the treated area to be red after each treatment, but this should get better after a few hours. You can reduce any pain and redness with a cold compress such as a clean cloth dampened with cold water, or an ice pack.

Complications are problems that occur either during or after a procedure. The complications of laser treatment include blistering, scabbing, scarring or a change in skin colour (either darker or lighter).

It's important that you check you are being treated by someone who is qualified and experienced. Make sure that you choose a practitioner who is registered with the Healthcare Commission or the British Medical Laser Association. If possible, ask your GP to refer you to someone.

Medicines

Anti-androgens
These medicines work by blocking the action of androgen hormones. It can take six months before you notice any effect because of the lifespan of the hair. They can cause side-effects such as headaches, weight gain, loss of interest in sex and bleeding in between your periods. Treatment with anti-androgen medicines can slow down hair growth and make it thinner but once you stop taking the medicines, hirsutism will probably come back.

The first medicine your GP will offer you will probably be a type of contraceptive pill. Other medicines, which are more likely to be offered if you see a specialist doctor, include:

• cyproterone acetate
• spironolactone
• finasteride
• flutamide

Anti-androgen medicines can be harmful to unborn babies. It's important to tell your GP if you are or think you may be pregnant, and you should always use effective contraception while taking these medicines. If you want to try for a baby, stop taking anti-androgen medicines and wait until you've had two periods before you start trying.

Metformin
Your doctor may offer you metformin if PCOS is causing your hirsutism and tests have shown that your body is not responding normally to insulin. This can have side-effects such as abdominal (tummy) pain, vomiting and diarrhoea.

Eflornithine
Eflornithine is an option if other treatments haven't worked. It's available in a cream that you rub into your skin to slow hair growth.

Eflornithine usually takes six to eight weeks to start to work, and you should stop using it if there is no improvement after four months. Even if it does work for your hirsutism, the condition will probably come back when you stop using the cream. It may not completely prevent your hair growth but if it works successfully, it will make the hair much finer, shorter and less visible. Eflornithine cream can cause side-effects including a burning or stinging sensation and acne.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources .