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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Living with PCOS- Survival Kit!

The affected woman has to take the ownership of her treatment in order to beat PCOS.

How to tackle PCOS?
How to tackle PCOS?

         If you are one of those 30% of women having PCOS, then this is your space! 

PCOS is a very common, yet often misdiagnosed condition and many women will call themselves as polycystic ovarian disease (PCOD) or polycystic ovarian syndrome (PCOS) without knowing its full meaning and implications.

What is PCOS?

It is important to understand that PCOS is not a disease, but a syndrome- which literally means that it is a group of symptoms resulting from involvement of multiple systems of body. It can affect anyone from a young adolescent girl to an adult woman even beyond a woman’s reproductive age. The name polycystic ovary is derived from the typical appearance of the ovaries, wherein multiple small cyst like spaces can be seen inside the ovaries. But, one must understand that this polycystic appearance of the ovaries is an outcome of the syndrome rather than being a cause for that. The PCOS can present in many ways, which can range from common symptoms such as weight gain, acne, facial and excessive body hair (hirsutism) and irregular menstruation to very serious medico-social issues such as infertility, diabetes, hypertension and uterine cancers.

Polycystic ovaries
Polycystic ovaries

So, how does one suspect if she is having PCOS?

PCOS can manifest for the first time right at puberty. The affected girls may gain a lot of weight all of a sudden and may continue to struggle controlling weight for many years. Weight gain could be accompanied by menstrual irregularities, facial hair and acne, besides many other similar symptoms. While diagnosing PCOS at this stage can be really tricky because there is no single test that’s diagnostic of this condition, most of the symptoms described above can actually be controlled with help of oral contraceptive pills. However, when these women on birth control pills start planning a baby and have to stop taking the pills, many of them discover that they are unable to conceive. Consultation with an expert is very helpful at this stage, as the expert can correctly diagnose the problem and also advise on the best way to manage the symptoms. But, the affected woman has to take the ownership of her treatment in order to beat PCOS. This would include maintaining an active lifestyle with regular exercise and having a low carbohydrate diet in an effort to keep the weight under check. These interventions go a long way in controlling the symptoms of PCOS, as weight gain initiates a vicious cycle of further hormonal imbalance, which in turn leads to more weight gain. Lifestyle correction coupled with appropriate use of medications to reduce the insulin resistance is the best way to manage PCOS.

What if one gets diagnosed with PCOS? Is it over for her now?

Most common question that I get asked is if PCOS can be cured? Very sadly the answer is No- PCOS cannot be cured! But, the symptoms of PCOS can most certainly be controlled using appropriate medical treatment and lifestyle interventions described above. The key to control of these symptoms is diagnosis at an early age and well titrated intervention from an expert. Remember that it is a condition of hormonal imbalance in the body, which results in irregular ovulation, over production of male sex hormones and resistance to the action of insulin. So, in very simple words, all the interventions would be focused on correcting this hormonal imbalance in the body.

So, what can be done to manage infertility in PCOS patients?

Most women with PCOS are able to overcome the challenge to their fertility with proper treatment. This treatment may vary from simple measures such as oral tablets to induce ovulation to IUI and all the way to IVF. One should always seek an expert’s opinion for management of PCOS when planning for a baby, as the doctor is the best person to support in this endeavor. Always remember that PCOS stays with the woman throughout her journey of life and she has to remain vigilant to identify its long term risks such as diabetes, hypertension and uterine cancers in their early stage!

Reading resources

You can use the following resources to understand more about PCOS, its implications and treatment options-

1. http://www.patient.co.uk/health/polycystic-ovary-syndrome-leaflet

2. http://www.uptodate.com/contents/polycystic-ovary-syndrome-pcos-beyond-the-basics

3. http://www.hormone.org/patient-guides/2014/pcos

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

Mind your weight so you don’t have to wait!

Mind your weight so you don’t have to wait!

An anxious, overweight woman came in to consult me a couple of weeks back. She has been trying to conceive for two years but has been unsuccessful. Now she has not had her menses for last 9 weeks but her pregnancy test was negative. She has been having her periods irregularly for last many years.

A rapidly growing and often ignored problem

The number of young overweight women and men seeking medical assistance for planning family is on a rise. Being overweight not only affects ones’ chances of becoming a parent, but also can lead to complications in pregnancy- adversely affecting both mother and baby.  Therefore, it is very important for all young men and women to know the fundamentals of causation and detection of this important disorder.

Mind your weight so you don’t have to wait!

When to be concerned?

The most often asked questions in this context are- what is a normal acceptable weight, when does one get labelled as overweight and what is the definition of obesity? Another important question we often get asked is- what’s the difference between being overweight and obese? In very simple terms, what a physician evaluates to check for obesity in a person is a simple index known as “body mass Indexor BMI. BMI can be calculated by simply dividing the person’s body weight in Kg by the square of person’s height measured in meters.

BMI is measured as Kg/m2

In very simple terms, a BMI of 18-24 is considered to be normal and anyone having a BMI beyond this range is either overweight or obese. Many simple calculators to measure one’s BMI are freely available on internet. You can try one of the following links to check your BMI-

The following are broad guidelines for detection of obesity-

  • BMI of < 18.5 indicates that the person is underweight
  • BMI between 18.5 and 24.9 indicates that the person has got normal weight
  • BMI between 25 and 29.9 indicates that the person is overweight
  • BMI of > 30 indicates obesity

How does Obesity affect fertility?

Excessive body weight in women causes multiple hormonal imbalances, which can result in irregular menstruation and reduced frequency of ovulation, thus leading to infertility. Also, the outcome of Infertility treatment in obese women is poorer than in their normal weight counterparts. Obesity also increases the chances of pregnancy related complications such as miscarriage, pregnancy induced hypertension and gestational diabetes and hence increases the requirement offers cesarean delivery. And not to forget that the labor is that much harder and prolonged for obese women.

Obese males also suffer from reduced fertility as they tend to have lower level of testosterone, which suppresses sperm production. Obesity can also case erectile dysfunction in men, which can result in reduced fertility.

What can you do?

So, what to do if you are struggling getting a baby and have been diagnosed as overweight or obese? Here are five easy weight management tips to help you realize your dream of having a child-

  • Watch your meals- take a healthy diet and avoid excess carbohydrates and fat
  • Watch your beverages- drink adequate quantity of water, avoid soft drinks as they contain empty calories and refrain from alcohol
  • Stop smoking and keep in mind that there is nothing like occasional/ moderate smoking
  • Exercise regularly and maintain a healthy, active lifestyle- short sessions of brisk walking, swimming, jogging or skipping are good means to keep one active and healthy
  • Avoid stress and practice Yoga/ meditation or other stress buster techniques that suit you

Want to know more or seek an expert opinion, write to us at ivfgurgaon@gmail.com today!