Hirsutism

Hirsutism is a condition that causes excessive growth of coarse dark hair in women. The main symptom is excessive hair growth in places you don’t usually see coarse hair in women such as:

• face
• neck
• lower back
• chest
• stomach
• buttocks
• thighs

It’s not a serious condition, but it can impact your self-esteem and self-confidence.

Irregular excess hair growth is the main symptom of hirsutism. Other symptoms will depend on the cause.

If hirsutism is due to high androgen levels (e.g. from PCOS) you may also experience:

• acne
• irregular periods
• loss of feminine body shape
• masculine features (e.g. deep voice)

Others may also have diabetes and high blood pressure in other conditions.

Hirsutism vs hypertrichosis

These conditions may appear very similar on the surface. Both conditions cause excessive hair growth, so what is the difference?

Hirsutism is specific to women and causes hair growth in areas where men grow the most hair.

Hypertrichosis, on the other hand, is a much rarer condition. It causes hair growth across the body and can affect men and women. For instance, people with hypertrichosis may see excess hair growth all over the face, not just the chin or upper lip.

Hair growth is controlled by hormone levels in both women and men. It is specifically androgens, the male hormones, that are responsible for hair. This is why men have more hair than women. Some women have higher levels of androgens which can result in hair growth in places it wouldn’t normally grow.

The most common cause of hirsutism is polycystic ovary syndrome (PCOS). Women with PCOS have harmless cysts on their ovaries that cause high testosterone levels. As well as hair growth, this can result in irregular periods, acne and weight gain.

Other more uncommon causes of excess hair growth include:

• certain medications
• family history
• using anabolic steroids to gain muscle
• Cushing’s syndrome (high cortisol levels)
• acromegaly
• congenital adrenal hyperplasia (CAH)
• a tumour (very rare)

Other factors can cause excessive hair growth. Some women have naturally more hair due to their genetics or ethnicity. It is also common during menopause to have some fine wispy hairs on the upper lip. However, these cases are not hirsutism.

Hirsutism is graded using the Ferriman-Gallwey scoring system. Clinicians use it to assess hair growth across 9 parts of the body.

Each area is rated on a scale of 0 to 4 (0 being no terminal hair growth and 4 being extensive growth). The points add up for each area and your total points indicate how severe your hirsutism is. The maximum score is 36. Guidelines can be seen below based on the British Hair & Nail Society (BHNS).

• 8 points or less - signs of high testosterone levels, but not enough to be diagnosed as hirsutism
• 8 - 15 points - mild hirsutism
• 15 points or more - moderate to severe hirsutism

Using this scoring system, your doctor can understand the extent of your hair growth and advise you. You may also need blood tests done to check your hormone levels.

For mild hirsutism or unwanted hair, you can control it with regular hair removal or hair-lightening methods.

• shaving
• plucking
• hair removal cream (depilatory lotion)
• waxing
• bleaching
• laser hair removal
• electrolysis

Most of these methods are easy to do yourself. You can access these methods at beauty stores or local pharmacies.

You can also get these treatments done by a beautician at specific clinics, such as laser treatment, waxing, plucking and bleaching.

For others, hair removal methods may not be enough. Depending on the nature of your hair growth, you may be suitable for prescription treatment.

The main treatment available for excessive hair growth on the face is Vaniqa. It contains eflornithine, which works by blocking enzymes needed for hair growth on the face. It is a preventative treatment and you will still need to use other hair removal methods.

In some cases, combined oral contraceptive pills and other combined contraceptives can help reduce unwanted body hair. It will increase your female hormone production (oestrogen and progesterone) which can help prevent hair growth. In particular, your doctor will recommend a combined pill that contains a manmade progesterone like desogestrel (e.g. Marvelon) or drospierone (e.g. Yasmin).

Another prescription medicine for hirsutism is spironolactone. It is typically prescribed for fluid retention and high blood pressure. However, evidence shows it has anti-androgen effects.

Other countries sometimes prescribe finasteride (Propecia) for women with hirsutism due to its anti-androgen effects. However, it is not licensed for this in the UK.

Can I prevent excessive hair growth?

There is no guaranteed way to prevent excess hair growth. Weight loss is one way to help with unwanted hair growth. Excess body fat, especially around the middle, can affect your hormone levels.

You can order Vaniqa online at euroClinix for unwanted facial hair in women. Our service is certified safe by the MHRA, GMC and GPhC.

All you have to do is complete an online consultation. It is a short medical questionnaire about your medical history so our doctors can ensure the treatment is safe for you. Once approved, our pharmacy will send your treatment discreetly to your address.