Hirsutism- There is far more to a woman than just her looks!

Concept of Hair Growing At Wrong Places Do You Have Hirsutism
Hair growing at wrong places – Do you have Hirsutism too?

I often come across women who are concerned about their looks, which they feel are spoilt due to presence of excessive body hair. This is a serious concern in our society- which is just too influenced by one’s looks- and this can potentially cause serious mental and emotional  stress among young women. If you or someone you know of is having anxious moments because of presence if facial hair, this is a very useful piece of information.

What is Hirsutism?

Hirsutism can be defined as growth of excessive facial and body hair in women.

With the world obsessed with flawless skin, such changes from feminine hair pattern (soft, fine, vellus hair) to masculine hair pattern (hard, dark, terminal hair) in a woman is generally unwelcoming and, hence, very distressing for the woman.

Why do some women develop Hirsutism?

In order to understand the reasons for such excessive growth in some women, we need to understand the differences in physiology of men and women. The male or female appearance of one’s body is dependent on a delicate balance between male and female sex hormones. There is predominance of hormone estrogen in a woman’s body, whereas androgens (testosterone) are the predominant sex hormones among men. However, some amount of androgens is secreted by the ovaries and adrenal glands (located next to kidneys) in women also. But, an excessive production of these hormones results in hirsutism. Hormonal imbalance is by far the most common cause of Hirsutism.

What are the causes for Hirsutism?

The common causes of hirsutism include-

  • Endocrine causes
    • Polycystic Ovarian Syndrome (PCOS) – PCOS is a condition of hormonal imbalance in body, which can result in irregular menstrual cycle, enlarged ovaries with cystic appearance on USG, infertility, obesity and hirsutism. For more information on the causes and management of PCOS, read here.
    • Cushing’s syndrome – Excessive production of hormone Cortisol by the adrenal glands can lead to symptoms such as high blood pressure, abdominal obesity, skin discoloration, muscle weakness, irregular menstruation and hirsutism etc. This syndrome is known as Cushing’s syndrome.
    • Congenital Adrenal Hyperplasia (CAH) – CAH is condition of excessive production of hormones Androgens and Cortisol by the adrenal glands and generally manifests in childhood in form of virilization. In such cases, CAH can present with symptoms such as ambiguous genitals, obesity, hypertension etc. However, sometimes the manifestation of CAH is deferred to early adulthood and results in milder symptoms, hirsutism being one of them.
  • Tumors
    • Tumors in ovary or adrenal glands can again cause hirsutism due to excessive production of androgens
  • Medications
    • Long term steroid consumption (commonly used for immunosuppression, rheumatoid arthritis and multiple sclerosis)
    • Performance enhancing drugs (often used by athletes)
  • Idiopathic – the woman may be having hirsutism despite normal hormone levels

When to suspect hirsutism and consult an expert?

One has to understand that there is a difference between hairiness and hirsutism. Some women may have prominent hair on their arms and legs and may still be perfectly normal otherwise. On the other hand, women with hirsutism not only have excessive hair on arms and legs, but also have thick hair in other areas of body, such as upper lips, beard area, chest, breasts, abdomen, inner thighs and lower back. So, we suggest that patients who have got extra hair in abnormal locations in body should consult a reproductive endocrinologist for proper evaluation and early diagnosis.

Hirsutism

Your doctor may advise you to undergo some blood tests, ultrasound abdomen, special X rays and some hormonal estimation to evaluate the function of your ovaries and adrenal glands. This will help the doctor in identifying a specific cause for hirsutism and suggest an appropriate treatment.

What is the treatment or hirsutism? Can it be cured?

There are essentially two lines of treatment for hirsutism- one is medical management and the other is cosmetic treatment.

Medical treatments for hirsutism –

  1. Birth control pills – It’s possible to reduce the severity and intensity of hair growth using birth control pills- the most commonly prescribed medical intervention! The birth control pills help by decreasing production of androgens by ovaries. Besides this, estrogen present in the pills also helps the liver to produce more of sex hormone binding protein- these proteins bind to circulating androgens, thereby reducing their action on body. Both these actions help in reducing the growth of hair on body.
  2. Anti-androgen medications – There are three categories of anti-androgen medications,whicharecommonlyusedfortreatmentofhirsutism.
    1. Spironolactone – Spironolactone is a diuretic medicine, which blocks the effects of androgens on the hair follicles, thus controlling hair growth.
    2. Finasteride – Finasteride works by blocking conversion of body testosterone into its more potent chemical entity, thereby limiting the effect of testosterone on hair growth.
    3. Flutamide – Flutamide is a potent anti-androgen, which blocks the actions of androgens and helps in controlling the hair growth.

However, we have to ensure that the woman is not pregnant when taking any of these three medications. These medicines are often combined with oral contraceptives, which also have a synergistic effect in reducing the severity of hirsutism. One should also seek an expert opinion before staring these medications as there can be serious side effects especially on liver.

  1. Steroids – Low dose dexamethasone can be used to control the overactive adrenal glands, when used carefully. However, long term steroid therapy has got its own side effects and this therapy should only be considered under expert care and guidance.
  2. Insulin sensitizing medicines – Medicines such as Metformin and Pioglitazone (Basically these are anti diabetic medications) help in reducing insulin resistance in the body, which, in turn, helps in controlling the effects of excessive circulating androgens.

Please be mindful that the medical treatment takes time to show its effects- it takes up to about 6 months in most of the cases to show any detectable reduction in body hair. All medications have got potential for side effects. So, they should be used only on prescription by an expert and proper follow up with the treating doctor is very important in order to pick up any potential side effects of the drugs.

Cosmetic treatment for hirsutism –

One very important aspect of cosmetic management of hirsutism is self-care. This can include shaving, waxing, use of depilators and bleaching creams. All these measures help to reduce the amount of visible hair in undesired parts of body. But, this needs to be done very frequently for a sustained visible effect.

Permanent hair removal is also possible using electrolysis or LASER treatment. In electrolysis treatment, electric current is passed into the hair follicle using a needle, which damages the root of the hair permanently. Similarly, LASER treatment uses LASER to destroy the hair follicle. Both these are effective methods to get rid of the undesired hair. However, we do not yet know if there are any long term complications or side effects of these methods and these methods are not yet approved by the US FDA.

I am sure you will find the above information on hirsutism and its management useful. Please go through the following resources for more detailed information on this subject.

https://www.asrm.org/BOOKLET_Hirsutism_and_Polycystic_Ovary_Syndrome_PCOS/

http://www.mayoclinic.org/diseases-conditions/hirsutism/basics/definition/con-20028919

http://www.uptodate.com/contents/hirsutism-excess-hair-growth-in-women-beyond-the-basics

http://www.patient.co.uk/doctor/hirsutism-and-virilism

 

Women should be able to discuss such issues more openly and should remember that “there is far more to a woman than just her looks!”

 

Alternatively, you can write to us at ivfgurgaon@gmail.com with your queries.

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Author: Dr Parul Katiyar MD (Infertility & Reproductive Medicine)

Senior Consultant Infertility and Reproductive Medicine Nova IVI Fertility Block B 2/1A, Africa Avenue, Safdarjung Enclave, RK Puram, Sector 2, New Delhi, Delhi 110029

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