Excessive or unwanted hair in women

Definition

The normal amount of body hair varies widely among women. When coarse, dark hairs grow where women typically do not grow dark hair, such as the lip, chin, chest, abdomen, or back, the condition is called hirsutism.

Common Causes

Excessive hair growth in women is usually from too much male hormone (androgen). A common cause is polycystic ovarian syndrome (PCOS). In most cases, however, the specific cause is never identified. It tends to run in families. In general, hirsutism is a harmless condition. But many women find it bothersome, even embarrassing.

If hirsutism develops suddenly and is accompanied by other typical male features, such as deepening voice, acne, or increased muscle mass, it may be caused by a more serious disorder. These causes, such as hormone-secreting tumors or cancer, are rare.

Rare causes include:

• Tumor or cancer of the adrenal gland.
• Tumor or cancer of the ovary
• Cushing's syndrome
• Congenital adrenal hyperplasia
• Hyperthecosis
• Medications (testosterone, danazol, anabolic steroids, glucocorticoids, cyclosporine, minoxidil, phenytoin)

Home Care

There are a variety of ways to remove unwanted hair:

• Bleaching -- lightening hair to make it less noticeable.
• Hair removal -- shaving, plucking, waxing, or chemical depilation.
• Electrolysis -- using electrical current to damage individual hair follicles so they do not grow back. This is expensive and requires multiple treatments.
• Laser hair removal -- using laser to damage individual hair follicles so they do not grow back. This is expensive and requires multiple treatments.
• Weight loss -- in overweight women, weight loss can decrease male hormone levels and reduce hair growth.

Birth control pills and anti-androgen medications can also help reduce hair growth. A doctor must prescribe these medications.

Call your health care provider if

Call your doctor if:

• The hair grows rapidly.
• The hair growth is associated with male features such as acne, deepening voice, increased muscle mass, and decreased breast size.
• You are concerned that medication may be worsening unwanted hair growth.

What to expect at your health care provider's office

Your doctor will perform a physical examination, including a pelvic examination if appropriate. The doctor will ask questions such as:

• Do other members of your family also have excessive amounts of hair?
• What medications are you taking?
• Have your periods been regular?
• Are you pregnant?
• Have you noticed other signs of excess male hormones such as increased muscle mass, deepening voice, acne, or decreased breast size?

Diagnostic blood tests may be performed to measure levels of :

• Testosterone
• Dihydroepiandrosterone sulfate (DHEA-S)
• Luteinizing hormone (LH)
• Follicle stimulating hormone (FSH)
• Prolactin
• 17-hydroxyprogesterone

If a tumor is suspected, x-ray tests such as a CT scan or ultrasound may be recommended.

References

Habif TP. Clinical Dermatology. 4^th ed. St. Louis, Mo: Mosby, Inc. 2004.

Claman P. SOGC clinical practice guidelines. Hirsutism: evaluation and treatment. J Obstet Gynaecol Can. 2002; 24(1): 62-73, 77-79.

Illustrations

Ovarian cysts

Overproductive ovaries

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