Hirsutism in Women: causes and treatment

According to recent statistics, 2 in 8 women suffer from hirsutism sometimes during their life. But what is hirsutism? What causes it? And how can it be treated?
Well, hirsutism is the medical term that refers to the growth of coarse, dark hair in areas where women typically grow fine hair or no hair at all - above the lip and on the chin, chest, abdomen, and back.

If you have excess hair growth, you need to be evaluated by a healthcare provider, especially if the hair develops or worsens rapidly, if you’re 20 years old, or if your relatives have comparatively less hair growth. In the vast majority of cases, hirsutism is not caused by a serious medical condition; however, the cause of hirsutism should be determined and underlying conditions may need to be treated.
Hirsutism is caused by an increased level of male hormones (androgens). Although all women produce androgens, increased levels of androgens can lead to hirsutism. Several different conditions can lead to hirsutism. The two most common causes of hirsutism are polycystic ovary syndrome (PCOS) and idiopathic hirsutism. Both are diagnosed by physical examination, medical and family history, and, sometimes, blood tests.
Polycystic ovary syndrome (PCOS) - Women with PCOS often have hirsutism in combination with acne, balding near the front of their head, and menstrual irregularities. PCOS is a chronic condition, but several treatments can reduce hair growth.
PCOS is also associated with other medical problems, such as infertility due to irregular menstrual cycles, obesity, diabetes mellitus, high cholesterol levels, and possibly heart disease. But don’t be scared! There are effective treatments for PCOS.
Idiopathic hirsutism - Idiopathic hirsutism refers to hirsutism that has no identifiable cause. It is usually chronic and may be a mild variation of PCOS. A gradual, increased growth of coarse body hair is typically the only symptom in women with this condition. Menstrual cycles are always normal in women with idiopathic hirsutism.
However, in rare cases, hirsutism can be caused by hormone-secreting tumors of the ovary or adrenal gland, by an ovarian condition called hyperthecosis (which may be an extreme form of PCOS), by certain medications that have androgen-like effects, or by an inherited condition called congenital adrenal hyperplasia.
The hirsutism associated with these conditions often develops suddenly in women over age 20 (rather than at puberty) and progresses rapidly. The sudden growth of body hair may be accompanied by other signs of androgen excess, such as deepening of the voice and increased muscle mass.
Don’t forget that the decision to treat hirsutism is sometimes a matter of personal choice. There is a wide range of “normal” amounts of body hair among women. Race and ethnicity play a major role in the growth of body hair. As an example, Asian and Native American women tend to have little body hair, whereas Middle Eastern and Mediterranean women tend to have moderate to large amounts of body hair.
Our culture also determines how much hair is cosmetically acceptable and how important it is to remove “excessive” hair. The psychological impact of hirsutism can range from annoying to severely disabling. But, if you are troubled by hirsutism, do not hesitate to ask your healthcare provider about treatment options.
Before prescribing any treatment, your healthcare provider will carefully assess your degree of hirsutism, so that the effectiveness of treatment can be gauged over time.
Arm yourself with patience because hair follicles have a life cycle of about six months. Most medications must be taken for three to six months before a noticeable improvement occurs. In the meantime, the existing hair can be mechanically removed or bleached, and some women continue to use these methods in combination with medication.
The treatment of hirsutism is usually continued indefinitely because, in most cases, the body continues to produce excess androgens. However, if you want to get pregnant, you must discontinue all medications for hirsutism before that. Furthermore, some women eventually decide that the results of treatment are not worth the time, effort, and cost, or they grow more comfortable with their body and the presence of body hair.

Here are some methods to help you get rid of the unpleasant hair:

- Shaving - Shaving is a safe and effective method for hair removal, but may require daily sessions.

- Chemical depilation, waxing, and bleaching - Hair removal (depilatory) agents and wax can be used to remove hair, and bleaches can be used to lighten hair. Depilatories and bleaches may cause skin sensitivity in some women, so be certain to follow the directions for patch testing.

- Electrolysis - Electrolysis damages individual hair follicles by inserting a very fine needle into the hair follicle and applying an electrical current; hair does not grow back after treatment. Electrolysis is best suited for treatment of small areas, although larger areas may be treated with multiple sessions over time. The treatment is safe and effective, but it can be painful and is often expensive.

- Laser hair removal - Although expensive, laser hair removal is effective, faster, and less painful than electrolysis. It can often permanently reduce hair growth, particularly in those who are fair-skinned with dark hair. Most people require four to six treatments spaced approximately four to six weeks apart in order to achieve satisfactory hair removal, and maintenance treatments may be needed once every six to twelve months to remove the smaller fine hairs that grow back.

- Creams - Eflornithine hydrochloride (Vaniqua®) is a skin cream that can be used to slow the growth of unwanted facial hair in women. It does not remove hair permanently. Noticeable results take about six to eight weeks, and once the cream is discontinued, hair returns to pretreatment levels after about eight weeks.

- Weight loss - Weight loss in overweight women can decrease levels of androgens and lessen hirsutism. Women with menstrual irregularities may also notice that their cycles become more regular after losing weight.

Several medications are available for the treatment of hirsutism. These medications can decrease the amount of body hair, stop the growth of new hair, and decrease the growth rate and coarseness of existing hair. Most of these medications must be taken for at least six months before improvement is detectable, and not all medications are equally effective in all women.
- Birth control pills
- Anti-androgens
- The most commonly used anti-androgen is spironolactone. Spironolactone may be recommended, in addition to the birth control pill, if excess hair growth does not improve adequately after taking a birth control pill for 6 months. Between 60 and 70 percent of women with hirsutism will notice improvement when taking spironolactone.
- Finasteride (Propecia®; Proscar®)
- Cyproterone acetate reduces hirsutism in about 70 percent of women. It is used commonly in Europe and Canada, where it is a component of a birth control pill (Diane®, Diane-35®, Dianette®).
- Metformin - Metformin (Glucophage®, Fortamet®) is a medication that is commonly used for the treatment of type 2 diabetes. However, expert groups do not recommend metformin as a treatment for excessive hair growth because it is not as effective as other available treatments (birth control pills alone or or in combination with an anti-androgen).

Therefore, if your hair excess bothers you, do not hesitate to do to the doctor and find out what kind of treatment suits you best. Do not panic no matter the cause! There is treatment for hirsutism!