Patient education: Hirsutism (excess hair growth in women) (The Basics)

What is hirsutism? — "Hirsutism" means excess body hair in women. The hair is dark and thick, and grows in places where only males tend to grow dark hair. This includes the upper lip (mustache area), chin, chest, back, and upper part of the belly.

Hirsutism is common. Women with hirsutism often find it very upsetting. It affects as many as 1 in 10 women who have not gone through menopause yet. (Menopause is when a person naturally stops having periods.)

What causes hirsutism? — Many women have extra body hair because of their family background. They might or might not be bothered by it, but it is not a sign of a hormonal problem. Other women get hirsutism because they have high levels of male hormones, called "androgens." Or it can happen if the hair follicles (the part of the skin that grows hair) are very sensitive to normal levels of androgens. Testosterone is the most important androgen. High levels are normal in males, while females have much lower levels.

The most common condition that leads to extra androgens in women is called "polycystic ovary syndrome" ("PCOS"). This condition also causes irregular periods, weight gain, acne, and other symptoms.

There are some more serious causes of hirsutism (tumors in the ovary or adrenal glands, which are located on top of the kidneys). But these are very rare.

What other symptoms should I watch for? — Watch for other symptoms of PCOS. These can include:

●Irregular periods

●Acne

●Obesity or weight gain

●Hair loss from the scalp

●Sleep apnea

Should I see a doctor or nurse? — See your doctor or nurse if you:

●Have hirsutism that appeared suddenly, or is getting worse quickly

●Think that you have PCOS

●Are bothered by your excess hair, and want treatment

Should I have tests? — Your doctor or nurse will decide which tests you should have based on your age, other symptoms, and individual situation.

Possible tests include:

●Blood tests to measure hormone levels

●Pelvic ultrasound – This test uses sound waves to create pictures of your uterus and ovaries. The pictures can show if you have PCOS or another problem.

●Imaging tests, such as CT or MRI scans – These can show if a tumor is causing the problem. This is only done if you have very high levels of testosterone.

Is there anything I can do on my own to treat the condition? — Yes. If you have excess body weight or obesity, losing weight can lower androgen levels, which might improve symptoms. Losing just 5 percent of your body weight can help a lot. For someone who weighs 200 pounds, this means losing 10 pounds.

You might also choose to remove extra body hair by shaving, plucking, or waxing. Some people bleach hair to lighten it.

How is hirsutism treated? — That depends on what is causing your hirsutism and how bad your symptoms are. If you choose to get treatment, options include:

●Birth control pills – These are the most common treatment. They lower androgen levels and make periods regular.

●Medicines called anti-androgens – These medicines lower androgen levels or block the effects of androgens. The medicine most often used to treat hirsutism is called spironolactone (brand name: Aldactone).

●Long-term hair removal treatments – These include:

•Electrolysis, which uses a tiny needle and a mild electrical zap to destroy hair roots 1 by 1. Electrolysis works best on small areas of skin.

•Laser hair removal, which uses a laser to destroy hairs. This procedure works faster and is less painful than electrolysis. It is also more expensive. Most people need 4 to 6 treatments that happen every month or so. If you choose laser hair removal, it is best to continue taking your medicines during and after laser treatment, or the hair will gradually grow back.

What if I want to get pregnant? — Most people with hirsutism are able to get pregnant. If you have PCOS, and you are overweight, losing weight can also make it easier to get pregnant. There are also medicines that can help you get pregnant. Do not take medicines to control hair growth if you are pregnant or trying to get pregnant.

What will my life be like? — Having extra hair makes many women feel self-conscious or distressed. None of the treatments make the hair go away completely. But they make it grow more slowly and help to decrease the amount of hair. Most people eventually feel better about their appearance. If you are not happy with the results of your treatment, ask your doctor about other options.

More on this topic

Patient education: Polycystic ovary syndrome (The Basics)

Patient education: Hirsutism (excess hair growth in females) (Beyond the Basics)
Patient education: Polycystic ovary syndrome (PCOS) (Beyond the Basics)