Hirsutism

What is hirsutism?

Hirsutism is the growth of coarse, dark and thick hair in women in areas where hair is normally absent. These areas include:

• upper lip and chin
• chest and around the navel
• lower back
• upper arms
• thighs

Male-pattern hair loss and virilisation

Hair loss in the frontal area in women, similar to that seen in men, is called male-pattern hair loss.

A more severe but rare form of androgen excess is virilisation. Its signs are:

• deepening of the voice
• absence of menstrual periods
• reduction in breast size
• male-pattern hair loss
• male-type muscle development
• clitoromegaly (enlargement of the clitoris)

Causes

The interaction between androgens and the hair follicles in the skin plays a major role in the development of hirsutism. Elevated androgens usually originate from the adrenal glands and the ovaries.

One of the most common causes of hirsutism is polycystic ovary syndrome (PCOS). Signs of hirsutism and androgen excess are also seen in women who gain weight, particularly after childbirth or over a short period of time.

Virilisation, in turn, usually develops after menopause and is caused by androgen-producing tumours of the adrenal glands or ovaries. Certain medications can also raise male hormone levels.

Diagnosis and treatment

Diagnosis involves hormone tests on days 2–5 of the menstrual cycle and an ultrasound examination of the ovaries. Please note that different patients may require different tests, and the treatment approach may also differ.

In overweight women, weight loss leads to improvement in menstrual irregularities and hair growth. Treatment is based on hormonal medications; shaving and laser hair removal may be used alongside them.

The effect of hormonal treatment appears after 6 months at the earliest, and treatment may last 2–3 years. If the underlying cause is not treated, hirsutism may return.