Causes and Prevention of Unwanted Hair in Women

Hirsutism

Hirsutism (or hirsutes) is the term used for increased hair growth in women. It refers to a male pattern of hair, i.e. in the moustache and beard areas (chin), or occurring more thickly than usual on the limbs. Hirsutism is very common.

There may be hairs on the chest or an extension of pubic hair on to the abdomen and thighs. What is considered normal for a woman, and
what is considered hirsute, depends on cultural factors and race.

What is the cause of hirsutism?

Hirsutism is nearly always genetic in origin. Female and male relatives may also have more hair than the average so hirsutism is normal in that family. Unfortunately in our society, to be hirsute is thought unattractive.
The only reason that fashion models appear to have little hair, is that they spend a lot of time and energy removing it.
Although some women with hirsutism have increased amounts of male hormones or androgens (e.g. testosterone), most have normal levels. The problem in these women is that the hairs are more sensitive than normal to small amounts of hormone. The hairs grow more quickly and thicker in response to it. The increased hair growth is usually first noted in late teenage years and tends to gradually get more severe as the woman gets older.
The main conditions associated with excessive androgens are polycystic ovaries and less often, congenital adrenal hyperplasia.

Investigations

Blood tests may be arranged to evaluate male hormone levels, which could be due to a tumour or overactivity of the pituitary gland, the adrenal gland or the ovary. Other causes of excessive hair and associated medical problems may also need to be evaluated. The tests may include one or more of the following:

• Total and free testosterone
• Sex hormone binding globulin
• Free androgen index
• Dihydroxyepiandrosterone sulfate
• Androstenedione (drawn after 10 a.m.)

If there is also menstrual disorder, additional tests may be requested.

• Luteinizing hormone (LH) and follicle stimulating hormone (FSH)
• Oestradiol, 17-hydroxy progesterone
• Prolactin

Tests may be requested to evaluate other related aspects of health, for example:

• Thyroid function
• Cortisol or overnight dexamethasone test
• Glucose
• Lipids (cholesterol and triglyceride)

A pelvic examination and abodominal / transvaginal ultrasound examination of the ovaries may be necessary as one common cause of hirsutism is polycystic ovaries.

Physical methods of hair removal

Bleaching
Bleaching makes the excessive hair less obvious.

Depilatory creams
Depilatory creams are generally based on thioglycolate (also used in perming solutions). A thick layer is applied for 15-30 minutes to the hairy area, then wiped off and the hair comes off with the cream. Depilatory creams can irritate and cause dermatitis.

Shaving
Shaving, if necessary twice daily, will prevent unsightly stubble. Shaving does not make the hair grow more thickly.

Waxing
Waxing needs to be repeated every six weeks. The warm wax hardens on the skin and as it is stripped off, the hairs are pulled out with it from the roots.

Electric hair removers
These remove the hair by a combined cut and pull.

Electrolysis/thermolysis
Electrolysis or thermolysis may result in permanent hair loss but it takes time. A small probe is inserted along each hair, and a small electrical or heat discharge destroys the hair. A small area is treated every few weeks. It can be expensive if the area affected is extensive. Unskilled treatment may cause scarring.

Laser therapy
New long wavelength lasers and intense pulsed light are under investigation for the removal of body hair. Time will tell how effective these will be.

Complications of physical methods of hair removal

Folliculitis is an unfortunate risk of plucking, shaving, and waxing. The treated hair follicles become inflamed, and painful pustules may develop.
Folliculitis may take weeks to settle. Hair removal has to be stopped, at least temporarily.

Folliculitis due to hair removal

Medical Treatment

Women with polycystic ovarian syndrome, particularly if they are overweight or have metabolic syndrome, may be prescribed metformin (more commonly used in type 2 diabetes).
Hormonal treatment using antiandrogen medicines (which counteract the male hormone) may be used for women with moderate or severe hirsutism. In many cases the hair growth slows down and the hairs become thinner and less noticeable. It takes between six and twelve months to notice much difference, and then the medicine should be continued for several years.

Spironolactone

Spironolactone 50-200 mg daily can slowly reduce excessive hair growth. It is sometimes combined with the oral contraceptive pill. Side effects include tender breasts and irregular menstrual bleeding.

Oral contraceptive

Although several low dose combined birth control pills may be helpful, it is best to select one that has been specifically formulated to treat hirsutism. These contain oestrogen and an antiandrogenic progesterone: cyproterone (co-pyrindiol, with trade names Diane™-35, Estelle™ 35, Gien™ 84), drospirenone (Yasmin™, Yaz™) or dienogest (Valette™). Side effects include spotting (bleeding between periods), tender breasts, nausea and headaches, especially in the first few months. The oral contraceptive pill is not suitable for everyone. Please refer to the New Zealand Ministry of Health (Medsafe) advice on the use of combined oral contraceptives.

Cyproterone

Larger doses of cyproterone i.e. 50-200 mg for 10 days each cycle, are combined with the oral contraceptive pill and are very effective for most women with hirsutism. Side effects include weight gain, depression, and loss of libido. Specialist approval is required for prescription in New Zealand.
Hair removal creams containing eflornithine are available in some countries.

The normal amount of body hair for women varies. Most of the time, a woman only has fine hair, or peach fuzz, above the lips and on the chin, chest, abdomen, or back. If you have coarse, dark hairs in these areas, the condition is called hirsutism. Such hair growth is more typical of men.

Causes

Women normally produce low levels of male hormones (androgens). If your body makes too much of this hormone, you may have unwanted hair growth.
In most cases, the exact cause is never identified. It tends to run in families. In general, hirsutism is a harmless condition. But many women find it bothersome, or even embarrassing.

A common cause of hirsutism is polycystic ovarian syndrome (PCOS). Women with PCOS and other hormone conditions that cause unwanted hair growth may also have acne, problems with menstrual periods, trouble losing weight, and diabetes. If these symptoms start suddenly, you may have a tumor that releases male hormones.
Other, rare causes of unwanted hair growth may include:

• Tumor or cancer of the adrenal gland
• Tumor or cancer of the ovary
• Cushing syndrome
• Congenital adrenal hyperplasia
• Hyperthecosis (a condition in which the ovaries produce too much male hormones)
• Use of certain medicines, including testosterone, danazol, anabolic steroids, glucocorticoids, cyclosporine, minoxidil, and phenytoin

Rarely a woman with hirsutism will have normal levels of male hormones, and the specific cause of the unwanted hair growth cannot be identified.

Home Care

Hirsutism is generally a long-term problem. There are a number of ways to remove or treat unwanted hair. Some treatment effects last longer than others.

• Weight loss in overweight women can reduce hair growth.
• Bleaching or lightening hair may make it less noticeable.

 
Temporary hair removal options include:

• Shaving does not cause more hair to grow, but the hair may look thicker.
• Plucking and waxing are fairly safe and are not expensive. However, they can be painful and there is a risk for scarring, swelling, and skin darkening.
• Chemicals may be used, but most have a bad odor.

Permanent hair removal options include:
Electrolysis uses electrical current to permanently damage individual hair follicles so they do not grow back. This method is expensive, and multiple treatments are needed. Swelling, scarring, and redness of the skin may occur.
Laser hair removal uses laser aimed at the dark color (melanin) in the hairs. This method is best if a very large area needs to be treated and only if the hair is particularly dark (does not work on blond or red hair).

When to Contact a Medical Professional

Call your health care provider if:

• The hair grows rapidly
• You also have male features such as acne, deepening voice, increased muscle mass, and decreased breast size
• You are concerned that medication may be worsening unwanted hair growth

 

What to Expect at Your Office Visit

Your health care provider will perform a physical examination. A pelvic exam may be done. You will be asked questions about your medical history and symptoms, including:

• Do other family members also have excessive amounts of hair?
• What medications are you taking?
• Have your periods been regular?
• Are you pregnant?
• Do you have increased muscle mass, acne, or decreased breast size?
• When did you first notice these symptoms?

Blood tests may be done, including:

• Testosterone
• Dihydroepiandrosterone sulfate (DHEA-S)
• Luteinizing hormone (LH)
• Follicle stimulating hormone (FSH)
• Prolactin
• 17-hydroxyprogesterone

If a tumor is suspected, x-ray tests such as a CT scan or ultrasound may be recommended.
Medications or other treatments your doctor may prescribe include:

• Birth control pills. It may take several months to begin noticing a difference.
• Anti-androgen medications such as spironolactone may be tried if birth control pills do not work. There is a risk of birth defects if you become pregnant while taking these medicines.
• Laser hair removal or electrolysis

Alternative Names

Hypertrichosis; Hirsutism; Hair - excessive (women); Excessive hair in women; Hair - women - excessive or unwanted