Hirsutism affects around one in 10 of us before the menopause but could the thick, dark hair on your face and body be treatable? Dr Melanie Wynn-Jones explains
Hirsutism (excessive facial and body hair) affects around one in 10 of us before the menopause, and as the hairs are often thicker and darker, and/or in unusual places, this may be embarrassing, distressing or expensive to deal with. Hirsutism can run in families and is more common in some ethnic groups.
Women naturally produce small amounts of hair-stimulating male hormones (testosterone/androgens) in our adrenal glands, and much larger amounts of female hormones (mainly oestrogen from our ovaries) but in hirsutism, the balance is disturbed. Facial hair also increases after the menopause, as the balance tips again.
Around a quarter of women with hirsutism have normal androgen levels, so their skin may be particularly sensitive to these hormones. But most have raised androgen levels, usually with cause unknown or as part of polycystic ovary syndrome (PCOS – multiple small fluid-filled ovarian cysts triggered by androgens), together with hirsutism, scanty periods, acne, weight gain, scalp hair loss, high insulin and cholesterol levels and/or fertility problems.
High androgen levels can also be due to anorexia nervosa, obesity or medication, including the endometriosis drug danazol, body-building steroids and some drugs for high blood pressure, nausea or psychiatric conditions. More rarely, they may be produced by tumours of the ovaries, adrenal or pituitary (brain) glands.
Excess hair follows the male pattern and may affect your face (especially chin and upper lip), chest, nipples, back, tummy, thighs, genitals and bottom. If androgen levels are unusually high, you may also notice scalp hair loss, acne, loss of your female body shape, bigger muscles, deeper voice, clitoris enlargement and period or fertility problems.
Your doctor may detect high blood pressure and cholesterol levels that could lead to cardiovascular disease. If you have one of the rarer causes, you may notice headaches, visual problems, tummy pain or distension, or a milky nipple discharge.
Tests you may need
Your doctor may check nine body areas to assess your hirsutism, and should ask how it affects you. She’ll check your weight, blood pressure and tummy, too.
Blood tests can show whether you have high androgen or cholesterol levels and any other hormone abnormalities. You may need an ultrasound scan of your pelvis or MR/CT scans if your symptoms suggest PCOS or other rarer causes.
Changing relevant medication may help. Other causes will need appropriate treatment. If you are pre-menopausal, an anti-androgenic combined contraceptive pill (Dianette, Yasmin) will help, even if you don’t need contraception. The prescription cream eflornithine can slow facial hair growth but some HS areas blacklist it on grounds of cost.
You may need to see a hormone specialist, who may suggest metformin if you have PCOS. Drugs for severe hirsutism include spironolactone and finasteride.