What is Hirsutism?


Hirsutism
Hirsutism is a condition in women in which there is excess growth of hair at different places in the body that follows a male pattern. Women may have fine, pale and faint hairs in areas like the moustache, beard, chest etc that is hardly visible. If the excess hair is on the face, it can cause acute embarrassment and affect the quality of life. Unwanted facial hair is one of the commonest complaints for which women seek professional help. It can also have significant psychological effect on the person affected. The condition is very common after menopause due to the change in the balance of hormones and up to 75% of menopausal women might be affected. Hirsutism cannot be cured but can be managed effectively through life style changes, medication and cosmetic treatments.

The condition often begins at puberty. The girl may have other symptoms like an oily skin, acne, hair loss, receding hair line, enlarged clitoris, voice change(deeper voice) etc besides excessive growth of hair. The cause could be hormonal imbalance and the affected person should be evaluated by a doctor, who will give the appropriate treatment. Male hormones like Testosterone stimulate hair growth and pigmentation. Hirsutism is caused due to an excess of the male hormones or an increased sensitivity to them. Obese women are at high risk of developing hirsutism, possibly due to the high circulating levels of insulin in them as a result of insulin resistance. Insulin at high levels stimulates the ovary to produce more androgens. Treatments that lower insulin levels would help in reduction of hirsutism. A woman who has reached menopause is again at risk of developing hirsutism due to hormonal changes. Sometimes there is no underlying condition responsible, which is termed as Idiopathic hirsutism and is seen in some ethnic populations.

Every woman with hirsutism should be evaluated by a doctor. If the menstrual cycles are irregular, the cause could be polycystic ovary syndrome. If the hirsutism and irregular periods have started suddenly, the person should be evaluated for more serious conditions like a tumour of the ovary, adrenal gland, pituitary gland etc. Diabetes and high levels of cholesterol are sometimes associated with hirsutism. If a specific cause is found, the appropriate treatment should be given, which would reduce the problem. In obese women, losing weight could reduce the androgen levels and improve hirsutism.

Medications to reduce the levels of androgen hormones in the body and alter their impact on the body and the skin are helpful. Contraceptive pills containing both oestrogen and progesterone can counterbalance the masculine effects of the androgen hormones. Hirsutism would improve after 6-12 months of consistent use of the pills. However, they should be used only by women with regular menstrual periods and are obviously not indicated in women who have attained their menopause. Anti-androgen drugs like spiranolactone and cyproterone are used in women who need urgent therapy or are otherwise indicated, as decided by the treating doctor.

Cosmetic treatments are useful when the hirsutism will not go away by other means and the woman wants to improve her appearance. Plucking, shaving, depilatory creams, threading and waxing are effective for mild hirsutism. However they can irritate the skin and must be repeated frequently. Waxing needs to be done every four to six weeks. Laser hair removal is quite effective and lasts longer. The technique involves generating heat inside the hair follicles using light and destroying the ability of the hair follicle to grow hair again. It does not prevent new hair follicles forming again. However the procedure is time-consuming and expensive, requiring the services of a specialist doctor, either the dermatologist or the plastic surgeon. Electrolysis is another method of hair removal which uses electricity to generate heat within the hair follicles. However it is likely to leave small areas of scarring. Camouflage or disguise is a simple technique, inexpensive and it may be all that is required in many cases!

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Written By: Dr. Pilli Samuel Rajkumar, MD (Hyderabad, India)

Useful External Resources

Unwanted Hair and Hirsutism: A Book For Women

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Edited by: Rajesh Bihani ( Find me on Google+ )

Disclaimer: The suggestions in the article(wherever applicable) are for informational purposes only. They are not intended as medical or any other type of advice