Hirsutism/ Polycystic Ovary Syndrome (PCOS)

What is Hirsutism?

Hirsutism refers to excessive growth of dark, thick and coarse hair in an individual (usually female) but in a male pattern. Commonly affected areas are upper lips, chin, central chest, midline of the stomach, lower back, buttocks and front of thighs. Hirsutism affects approximately 10% of women in Western societies and is commoner in those of Mediterranean or Middle-Eastern descent.

Is Hirsutism hereditary?

No, although some cases can run in families.

What causes Hirsutism?

Hirsutism can be caused by an increased androgen production, increased skin sensitivity to androgens, or both. Androgens are often thought of as exclusively 'male hormones' but, in fact both men and women produce them; men usually in greater amounts 
than women.

In premenopausal women, the majority of endocrine causes for hirsutism (75%) are due to Polycystic Ovaries Syndrome. Rarely, Hirsutism can be caused by medications such as steroids, and other hormonal disorders. Extremely rarely, Hirsutism can be caused by tumours that secrete androgens. In such cases the Hirsutism will be severe and appear in a very short period.

Your GP may request some hormone tests, possibly an ultrasound of the pelvis (to look for PCOS) and may occasionally refer you to an endocrinologist (specialist in hormonal disorders).

It is important to see your doctor if your Hirsutism is associated with any of the following: 
• Developing quickly (over 1-2 years), or before puberty; 
• Accompanied by menstrual problems; 
• Associated with features suggesting an increase in androgens such as thinning of the scalp hair, baldness, or deepening of the voice; 
• Accompanied by obesity or diabetes. 

How can hirsutism be treated?

In the rare cases where there is an underlying hormonal disorder, the treatment is of the underlying disease.

Treatments for Hirsutism where there is no underlying cause or in association with PCOS include: 

Self-care (What can I do?) 
• Shaving. Frequent shaving can irritate your skin. 
• Waxing is effective for some people, but can irritate the skin and should be used with caution on the face. Scarring occasionally follows. Folliculitis (inflammation of the hair 
follicles) can occur with shaving, and waxing. 
• Depilatories (creams that remove hair) chemically dissolve hair shafts thereby leaving no stubble, but may also irritate your skin 
• Bleaching creams are designed to make the dark hairs pale. They can irritate the skin and may be unsuitable for brown and black skins. 

Physical treatments

• Electrolysis. An electrical current is passed into a hair follicle through a needle. The aim is to destroy the hair root permanently. Electrolysis is relatively expensive and time - consuming. Scarring is a potential side effect of this treatment. It is not always available on the NHS. 
• Laser and intense pulsed light (IPL) treatments also aim to destroy the hair root permanently. They are not always available on the NHS. Laser treatment and IPL are expensive and several treatments are given over a period of months. This form of hair reduction must be done at a special clinic by an operator who is properly qualified. Check that they are registered with the Healthcare Commission or British Medical Laser Association. It is better to take the route of a referral from your medical practitioner to a specialist. Possible side effects include redness, darkening or lightening of the skin, and scarring. 
Total compliance during the treatment plan is required; this will include no sun bathing (or fake tanning) and cessation of all forms of hair removal, with the exception of shaving. 

Medical treatments

• Eflornithine cream. This cream works by slowing hair growth. Continued treatment is needed to maintain beneficial effects. 
Side effects are usually mild and include burning or stinging of the skin and acne. 
• Anti-androgens. Your doctor may prescribe these to block the action of the androgens that can cause hirsutism. Anti-androgens usually take 4-6 months to have an effect. Hair growth will then slow, and the hairs will gradually become thinner and less noticeable; the problem, however, tends to return when medication is stopped.
N.B. An important side effect of all anti-androgen drugs is that they can harm an unborn male baby if you take them while you are pregnant. For this reason, they must not be taken unless you are using effective contraception. 

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