About hirsutism

Hirsutism is a condition that affects about one in 10 women. The hair is thicker, darker and coarser than the fine hair that covers most of your skin. This thick hair is similar to that of the hair on your head and is called terminal hair. The fine hair that covers the rest of your body is called vellous hair. Hirsutism can generally be described as the growth of terminal hair in areas where usually only vellous hair grows.

Some women from particular ethnic groups naturally have more terminal hair on their bodies than others. This doesn't mean they have hirsutism.

Hirsutism usually starts towards the end of your teenage years and may get worse as you get older. It's possible that you will have more hair growth on your face and body after the menopause.

Symptoms of hirsutism

The symptoms of hirsutism are different for every woman. They will also vary depending on what is causing your condition. The main symptom of hirsutism is excess growth of terminal hair in places where usually you wouldn't expect it to grow, such as on your face, chest, around your nipples, abdomen (tummy) and upper back.

Complications of hirsutism
It's possible that you will find hirsutism an upsetting condition. You may find it affects your confidence and self-esteem. It's important to talk to your GP about this - he or she will be able to offer you treatment options.

If you have hirsutism, you may also have acne or seborrhoea - this is a condition where your skin produces too much sebum (an oily substance).

Causes of hirsutism
There are a number of reasons why you may develop hirsutism. However, most women don't have an underlying medical condition. Therefore, it often isn't possible to find a definite cause for hirsutism. This is called idiopathic hirsutism.

Some women who have hirsutism have a condition called polycystic ovary syndrome (PCOS). This is when your ovaries don't work properly. As well as hirsutism, it can lead to other symptoms such as:

•  irregular periods or your periods stopping

• thinning or loss of hair from your head

• your voice getting deeper

If you have any of these symptoms or if hirsutism develops before puberty, you should see your GP, especially if they get worse or develop very quickly.

If you have hirsutism, it may be that you produce too much of the male sex hormones (hormones are chemicals produced naturally by your body). These hormones are called androgens and all women produce low levels of them. It's also possible that you produce usual levels of androgens, but your hair follicles are more sensitive to it. High levels of androgens can be related to PCOS.

Hirsutism can also be a symptom of other medical conditions.

If you are overweight or obese, or have diabetes, you may be more at risk of developing hirsutism.

Hirsutism can occur as a side-effect of taking some medicines. These include:

• anabolic steroids

• certain types of contraceptive pill

• corticosteroids

There is some evidence that hirsutism runs in families.

Diagnosis of hirsutism

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. If you have mild hirsutism and your periods are regular, you probably don't have an underlying medical condition that needs treating. If there is a possibility that your condition isn't idiopathic hirsutism, you may have blood tests to check the level of androgens and other hormones in your blood. If these are increased, it may mean that you have another condition.

Treatment of hirsutism
There is a variety of ways to treat hirsutism, although it's unlikely that any of them will completely cure the condition. If you have severe hirsutism, you may need to use several different types of treatment at the same time.

Self-help

If you are overweight or obese, it's a good idea to try to lose excess weight as this can reduce the level of androgens that your body produces. Eating a healthy, balanced diet and taking regular exercise may also be beneficial.

There are a number of methods of hair removal that you may wish to try.

Shaving
This is easy to do but you may need to shave every day and this can irritate your skin. Shaving doesn't make your hair grow back thicker or darker, but you may find that when the hair grows back, the stubble is uncomfortable.

Depilation
This uses creams that dissolve the whole hair. In time your hair will grow back but the hairs won't have the sharp end that occurs after shaving, so stubble isn't usually a problem. These creams can cause irritation, especially if you have sensitive skin.

Bleaching
You can buy creams that contain bleach to lighten the colour of the hair on your face or body. As with shaving and depilating, these may also lead to skin irritation.

Plucking/waxing
These procedures remove the whole hair follicle but you may find them uncomfortable. The hair will regrow following this procedure. Plucking and waxing may also cause scarring if your hairs move out of position and don't grow as they usually would. This may lead to a condition called folliculitis where the hair follicle becomes inflamed and occasionally infected.

Medicines
Anti-androgens

These medicines work by blocking the action of androgen hormones. It may take several months before you notice any effect from the medicines and they can cause side-effects such as headaches, depression and bleeding in between your periods. Although treatment with anti-androgen medicines can slow down hair growth and make it thinner, once you stop taking the medicines hirsutism will probably come back.

Examples of anti-androgens include:

• certain types of contraceptive pill

• cyproterone acetate

• spironolactone (although this isn't commonly used in the UK)

Anti-androgen medicines can be harmful to unborn male babies. It's important to tell your GP if you are or think you may be pregnant and are seeking treatment for hirsutism.

Metformin
There are a number of other medicines that your GP may prescribe for you. If PCOS is causing your hirsutism, you may be prescribed metformin. This can have side-effects such as abdominal pain, vomiting and diarrhoea.

Finasteride
Another medicine called finasteride may be helpful. It has fewer side-effects than some other medicines and you can take a lower dose of it and still have the same effect as with a larger dose of some other medicines. However, at the moment, it isn't licensed in the UK to treat women who have hirsutism.

Eflornithine
A cream called eflornithine has been licensed to treat women with facial hirsutism if other treatments haven't worked. This affects the hair follicles so your hair grows more slowly and the follicles get thinner making the hair less visible. You may find it takes a while to have an effect, but if there is no improvement after four months of treatment, you should stop using it. If eflornithine is effective in treating your hirsutism, it's likely that when you stop using it the condition will return. Therefore, it's most useful as a treatment while you are waiting for other medicines such as anti-androgens to take effect.

Eflornithine cream can cause side-effects including a burning or stinging sensation and acne.

Electrolysis
Electrolysis is a way of removing hair and can be very effective for treating hirsutism.

The process involves passing an electric current down a needle and into the hair follicle. This creates heat which damages the hair follicle. It can be quite painful and you are likely to need several treatment sessions. This means that electrolysis can be expensive. It also takes up a lot of time.

If you decide to have electrolysis, it's important that you make sure that the practitioner who treats you is fully trained and registered with the British Institute and Association of Electrolysis. You should also ensure that you are treated with new, unused needles, not ones that have been used before and sterilised. This is important to prevent the risk of infection.

Laser treatment

If you have laser treatment, a light laser will be used to damage your hair follicles. This leads to reduced hair growth.

Laser treatment can be very effective. Although it isn't usually permanent, you may be able to go for long periods between treatments. It's possible that even one treatment can reduce the thickness of any hair that grows back. As with electrolysis, you are likely to need more than one treatment, probably over several weeks - this can be expensive and time-consuming.

Laser treatment is more effective on some skin types and colours than others. If the procedure isn't done correctly, you may have side-effects such as redness, scarring or a change in skin colour (either darker or lighter). Therefore, it's important that you are treated by someone who is fully trained and experienced. Make sure that you choose a qualified practitioner who is registered with the Healthcare Commission or the British Medical Laser Association. If possible, ask your GP to refer you to someone he or she can recommend.