Hirsutism

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at February 26, 2016
StartDiseasesHirsutism

Hirsutism is unwanted hair growth in women that results in an excess amount of hair on the face, back, chest, arms, legs and/or genitalia. It can be caused by excess male hormones though sometimes its cause is unknown or idiopathic. Hirsutism is derived from the Latin term “hairy” or “shaggy”

Contents

Definition & Facts

About 5-10% of women are estimated to have hirsutism. Medical therapies along with self-care can mitigate hirsutism. Hair that excessively grows because of hirsutism is often thick and coarse as opposed to the typical thin hair that most women grow. It is more common in women of Mediterranean, Middle Eastern and South Asian descent.

Symptoms & Complaints

Besides hair in unwanted areas, hirsutism can be accompanied by other symptoms due to underlying hormonal imbalances:

Body image issues such as body dysmorphic disorder as well as anxiety, and depression are possible complications of hirsutism.

Causes

Hirsutism can be caused by an imbalance in female and male hormones, in which the body has a higher proportion of male sex hormones than female. Conditions such as polycystic ovary syndrome (PCOS), Cushing’s syndrome, congenital adrenal hyperplasia, certain medications and tumors can cause this imbalance.

Polycystic ovary syndrome is a common condition that can cause ovarian cysts while Cushing’s syndrome is caused by excess exposure to the hormone called cortisol. Congenital adrenal hyperplasia is an inherited condition. Medications used to treat endometriosis can cause hirsutism, and tumors on the adrenal glands or ovaries may also cause hirsutism.

Diagnosis & Tests

The first steps for hirsutism diagnosis is the detection of excess hair on the face, chest, thighs and buttocks. The practitioner will next look at the grade of any hair growing and its location, and apply the Ferriman-Galwey score, rating hair from zero to four, with zero meaning no hair and four for heavy growth. The maximum number of growth is 36, and any number above 15 determines hirsutism to be moderate to severe.

Accompanying symptoms such as weight gain and irregular periods are taken into consideration, as well as any medications being taken to find the cause of hirsutism. Further tests such as a blood test to check testosterone levels, a urine sample to monitor cortisol levels and an ultrasound scan by also be used.

It is important that a doctor tests for ovarian cysts, ovarian cancer, adrenal cysts, adrenal tumors when hirsutism symptoms appear. Along with a physical examination, tests such as a pelvic examination, transvaginal ultrasound, CT scan, a lower gastrointestinal series and biopsies may be necessary to detect or diagnose possible cysts or cancers causing the hirsutism.

Treatment & Therapy

Successful hirsutism treatment combines medications, self-care methods and hair-removal therapies. Medications for this condition include hormonal contraceptives such as birth control pills, which limits androgen that the ovaries produce. Common side effects of this medication include headache, upset stomach, nausea and dizziness.

Other medications such as antiandrogens and topical medications are also used in hirsutism treatments. Antiandrogens prohibit androgens from attaching to receptors, but may also cause birth defects. Prescription topical medications applied directly to areas affected with excess hair doesn’t rid the body of the hair, but can slow hair from growing.

Other treatments used to treat hirsutism include electrolysis and laser hair removal. These hair removal treatments can permanently remove hair. Electrolysis involves a needle being placed into each hair follicle to destroy it, and laser therapy prevents hair from growing with the use of a concentrated light. Both procedures may be painful, and laser treatments may be especially expensive. Individuals may also opt to pluck, shave, wax or use chemical depilatories at home to temporarily remove unwanted hair though these methods may also exacerbate hirsutism in some women.

Holistic or alternative methods that some claim to enable treatment include ingesting certain foods such as cinnamon, lettuce, mushrooms, spearmint and apricots. Cinnamon may treat hirsutism in insulin-resistant women by regulating blood sugar levels. Lettuce also treats insulin resistance often related to hirsutism, crimini mushrooms assist in metabolism and thyroid function, spearmint regulates testosterone levels and the vitamin B6 in apricots have an important role in hormonal balance.

Self-esteem issues caused by hirsutism can be treated with counseling such as psychotherapy including cognitive behavioral therapy. A doctor should never brush off these issues and merely tell women to find a way to remove the hair. A positive mental state can also affect how well treatments work for symptoms that directly affect the woman’s physical health. Women should be reassured that they are not becoming a male or losing their femininity, and that proper treatment along with cosmetic remedies should effectively control hirsutism.

Prevention & Prophylaxis

There are no specific ways to prevent hirsutism though it may be possible to prevent it from worsening by carefully considering which treatment methods are used (shaving, tweezing, etc) and how they may exacerbate existing unwanted hair.