||What Is Hirsutism?
Hirsutism is a term to describe the growth of excess facial and body hair in women. Many women worry about having too much face or body hair, it is a common problem - partly because there are unrealistic expectations about what is considered a normal amount, and distribution of, body hair in women - and partly because different ethnic groups vary considerably in the amount of body hair they have. Asian and Native American women have relatively little body hair compared to women of Mediterranean extraction. So what is normal? It is normal for a woman to have a few dark hairs on the upper lip, the breasts and on the line from the belly button down to the pubic region; and many have coarse dark hair on the inside of their thighs. It is only when hair in these areas start to significantly increase in number, or hairs appear in areas more traditionally associated with men (chest, chin, upper back) that a diagnosis of hirsutism is considered.
What Are The Symptoms?
Increase in growth of coarse hairs in places ordinarily only found in men. That is, the:
• Upper back.
• Upper abdomen.
If hirsutism is caused by high levels of male hormones you may also experience:
• Irregular periods (oligomenorrhea).
• Masculine traits: voice deepens, male pattern baldness and bigger shoulder muscles (loss of the feminine shape, also called virilism).
If hirsutism is due to Cushing syndrome signs can include:
• Obesity in women, particularly around the tummy and waist.
• Hypertension (high blood pressure).
• Diabetes and prediabetes.
• Thinning skin.
When hair increases all over the body, particularly on the legs, arms, face and scalp, this is a condition called hypertrichosis (also called Ambras syndrome).
What Are The Causes?
An estimated 8 percent of adult American women have hirsutism. In some women there is no underlying cause. It may just be that their genetic makeup is prone to produce more body hair. In about 50 percent of cases, hirsutism is caused by high levels of male sex hormones called androgens. Women with hyperandrogenism usually have other tell-tale symptoms such as irregular menstrual periods, acne and obesity. High levels of androgens can be caused by:
• Oral contraceptive pills that contain certain progestins. One culprit called norgestrel can have an androgenic effect.
• A medication called danazol used as a treatment of endometriosis.
• Polycystic ovary syndrome, which can also cause infertility.
• Tumors or growths on the ovaries or adrenal glands.
• Medications such an anti inflammatory drugs (glucocorticoids), antihypertensives (minoxidil), anticonvulsants (Dilantin) and tranquilizers (phenothiazines) can produce excess hair growth (hypertrichosis).
• Eating disorder, anorexia nervosa.
• Prophyria (excess levels of prophyria in the blood).
• Dermatomyositis (connective tissue disease).
• Cushing syndrome (high levels of the hormone cortisol).
How Is It Diagnosed?
Your doctor will take a complete medical history. He will ask about your menstrual cycle, what medications you take and if there is a family history of coarse hair growth. Next he will examine your body for signs of excessive hair growth and perform a pelvic examination to check for signs of ovarian cysts or tumors. He may also order the following tests:
• Blood test to check your androgen levels.
• MRI scan, CT scan or pelvic ultrasound to check for cysts/tumors on the ovaries or adrenal glands.
The Ferriman-Gallwey System
As there is no specific test for hirsutism some doctors use the Ferriman-Gallwey system to formally diagnose it. This system rates 9 areas with a number between 0 and 4, based on the level of hair present (0 means no hair and 4 means heavy growth). The scores are added together to produce an overall score. Moderate hirsutism is a score between 8 and 15, severe hirsutism is diagnosed with a score over 15.
The 9 rated areas are (see chart for pictures):
• Upper lip
• Upper abdomen
• Lower abdomen
• Upper arms
• Upper back
• Lower back
How Is It Treated?
The treatment plan will depend on the underlying cause, if any. If tumors are discovered on the ovaries or adrenal glands, these can be surgically removed.
If hair growth is caused by PCOS or insulin resistance taking a drug called metformin, which increases insulin sensitivity, may work. In most other instances hirsutism is controlled with a combination of lifestyle adjustments, medications and cosmetic hair removal techniques.
Being obese may contribute to symptoms of hirsutism. Losing weight and exercising regularly may improve your condition. Check your body mass index (BMI): BMI calculator.
The FDA has not approved any drug specifically for the treatment of hirsutism; however some medications may help reduce androgen levels and hair growth. Medications include:
Birth control pill: Some pills slow down hair growth in between 60 and 100 percent of hyperadrogenic women. Prescribing 'the Pill' is therefore considered a first line of treatment.
Spironolactone (Aldactone): This is an antiandrogen. It is a mild diuretic with few side effects but must be taken for at least 6 months before improvements can be seen. It can take up to 18 months for hairs to disappear completely, even after excess androgen has been eliminated from the body. Antiandrogens are often prescribed in addition to the birth control pill.
Finasteride (Proscar, Propecia): Another antiandrogen which is better known for treating hair loss and prostate problems in men. It can also be used to treat hirsutism in women because it blocks the growth of body hair while promoting the growth of hair on the scalp. Side effects are mild but can include breast enlargement and increased sex drive (of course some women may even see this as a bonus!).
Eflorinithine (Vaniqa): A prescription cream to treat unwanted facial hair. It does not get rid of existing hair but does slow the growth of new hair. The benefits stop once you stop using the cream.
Cosmetic Hair Removal Techniques
The options for cosmetic hair removal include shaving, tweezing, bleaching, electrolysis or laser therapy.
Shaving: Contrary to popular myth, shaving does not make hair grow back faster or thicker. Shaving cuts the end of a hair so that when it grows back it feels spikier, but the texture, color or rate of growth is not affected.
Depilatories: These are creams, gels and lotions that are put on the skin and removed after a period of time, taking the hairs with them (such as Veet, Nad's and Olay). Most contain thioglycolate which breaks down the structure of the hair. Women with sensitive skin may not be able to use them.
Waxing: Tends to have longer lasting results than shaving or depilatories, but it is more painful and expensive.
Electrolysis: This involves sending galvanic current (negative charge) through a needle to produce a chemical reaction in the hair follicle so that it is permanently destroyed. As only one hair can be treated at a time, this method is more suitable to treating small areas of growth - such as facial hair.
Laser Therapy: This is becoming increasingly popular. Laser therapy delivers pulses of light which damage hair follicles to such an extent that regrowth is significantly reduced.