Hairy body or face

Page last reviewed: 13/07/2011

Hirsutism is when a woman has excessive hair growth. The hair is normally thick and dark and grows on the

  • face - for example, the upper lip and chin
  • chest
  • lower back
  • buttocks

Hirsutism is caused by an excess amount of androgens (male sex hormones), or an increased sensitivity to androgens. In most cases, this is caused by polycystic ovary syndrome (a condition that causes cysts in the ovaries and a number of other symptoms).

How common is hirsutism?

Depending on how hirsutism is defined, the condition may affect one to three women in every 20 who have not yet started the menopause (when a woman's periods stop).

After the menopause, the change in the balance of hormones can make excess hair more common. Up to three quarters of older women may have slightly increased facial hair. Hirsutism in post-menopausal women is also known as ovarian hyperthecosis.

Outlook

There are a number of hair-removal methods that may be effective for hirsutism, such as shaving, waxing or bleaching.

If these do not adequately control the condition, a contraceptive pill can be taken in women who have not yet started the menopause.

A number of unlicensed medications (medicines that have not been specifically tested for this purpose) are known to be effective.

As the life cycle of hair is around six months, treatments can take this long to be effective. It is therefore important to start treatment as soon as possible.

Hirsutism can have a significant psychological effect on the person. If the excess hair is on the face, this can cause embarrassment and affect quality of life.

Hormones
Hormones are groups of powerful chemicals that are produced by the body and have a wide range of effects.

Ovaries
The ovaries are the pair of reproductive organs that produce eggs and sex hormones in females.

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Page last reviewed: 13/07/2011

Hirsutism causes excessive hair growth in women. The hair is usually thick and dark, rather than fine and fair. You may have excess hair on your:

  • upper lip
  • lower jaw (chin)
  • neck
  • chest
  • tummy - in a line from your belly button down to your pubic hair
  • anal and genital area
  • front of your thighs (the top of your legs)

Other symptoms

Besides an excessive amount of hair, you may also have other symptoms, such as:

  • oily skin
  • acne - a skin condition that causes spots to develop on your face, back and chest
  • alopecia (hair loss)
  • a receding hair line around the front of your hair
  • an enlarged clitoris (the small soft bump in front of the entrance to the vagina)
  • voice changes, such as a deeper voice

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Page last reviewed: 13/07/2011

Hirsutism is caused by male sex hormones (chemicals produced by the body) called androgens. Androgens are present in all women, but those with hirsutism have either:

  • an increased production of androgens, or
  • an increased sensitivity to androgens 

Androgens

There are several different types of androgens. The most well known is testosterone. In men, testosterone is involved in making sperm and in the development of male sexual characteristics, such as the voice getting deeper. Testosterone is also found in small amounts in women, where it may:

  • increase your libido (sex drive)
  • affect your menstrual cycle (your periods)
  • affect your fertility

Testosterone levels may be normal in around half of all women with hirsutism. 

Other androgens include:

  • dehydroepiandrosterone
  • androstenedione

These are precursors of testosterone, which means they will go on to become testosterone.

The causes of hirsutism varies in women, depending on whether they are premenopausal or menopausal.

These terms and the possible causes are explained below.

Premenopausal women

Premenopausal means before you have started the menopause (when a woman's periods stop). There are a number of different causes that may explain hirsutism in premenopausal women.

Polycystic ovary syndrome (PCOS)

Almost three quarters of hirsutism cases in premenopausal women are caused by polycystic ovary syndrome (PCOS).

PCOS is a condition in which women have a number of small cysts (fluid-filled sacs) around the edge of their ovaries (the pair of reproductive organs that produce eggs and sex hormones in females). As well as causing excessive hair growth, PCOS can also cause:

  • irregular periods
  • weight gain
  • acne

Many women with PCOS have an imbalance of male sex hormones, such as high levels of testosterone, but it is not known what causes this. See the Health A-Z topic about PCOS for more information about this condition.

Increased sensitivity

Just under a quarter of premenopausal women with hirsutism have normal androgen levels. It is thought that if your androgen levels are normal, your hirsutism may be caused by an increased sensitivity to the androgens.

This means that although you have the same amount of these hormones, you are extra sensitive to them and they have a bigger effect on your body.

Other causes

In a small number of cases, hirsutism in premenopausal women may be caused by:

  • Cushing's syndrome - a rare hormonal disorder that causes sudden weight gain and bloating around the chest and stomach
  • congenital adrenal hyperplasia - an inherited condition that affects the adrenal glands (two glands above the kidneys that produce steroid hormones and male and female sex hormones)
  • a tumour (growth) that produces androgens
  • drugs - such as anabolic steroids (drugs that are often used illegally to build muscle and improve athletic performance)
  • acromegaly - a hormonal disorder that causes the body to produce too much growth hormone, causing abnormal growth of the hand and feet

Menopausal women

Menopausal women are those who have started the menopause (when a woman's periods stop) and have not had a period for a year. During the menopause, several of your body's hormones change, which can cause symptoms such as hot flushes.

In some women, as your hormone levels change, you will be left with a high amount of testosterone (an androgen), which can cause hirsutism. Hirsutism in post-menopausal women is also known as ovarian hyperthecosis.

See the Health A-Z topic about the Menopause for more information.

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Page last reviewed: 13/07/2011

If you think you have hirsutism, see your GP as soon as possible. Although the condition can be embarrassing, the sooner it is diagnosed and treated, the sooner you will see some improvement.

Your GP will look for excessive amounts of hair on your body, including on your:

  • face
  • chest
  • thighs (upper legs)
  • buttocks

As some people may have more hair than others anyway, there is no clear definition of when excess hair becomes hirsutism. However, if your excess hair is thick and dark instead of fine and fair, then you may have hirsutism.

Assessing the severity

Your GP may assess the severity of your hirsutism by grading the growth of your hair in different areas of your body. This will be done by:

  • looking at the hair growth in nine different body areas, including the upper lip, chin, chest and upper arms
  • grading this hair growth from zero to four, with zero meaning no hair and four meaning heavy hair growth

This will then give you a score from zero to a maximum of 36. Generally, a score above 15 is considered moderate to severe hirsutism.

Finding the cause

As well as diagnosing hirsutism and assessing its severity, your GP will try to find out if there is an underlying cause (see Hirsutism - causes). They may ask you if:

  • you have any other symptoms, such as irregular periods or weight gain - these can be signs of polycystic ovary syndrome (PCOS - a condition that causes a number of other symptoms, including cysts in your ovaries)
  • your hirsutism has come on suddenly - this may a sign of a tumour (growth)
  • you are taking any medication or drugs that may cause hirsutism

Further tests

If your symptoms suggest another condition is causing your hirsutism, you may need further tests, such as:

  • a blood test to check your levels of testosterone (the male sex hormone)
  • an ultrasound scan (when high-frequency sound waves are used to create an image of your womb) to look for cysts (fluid-filled sacs) if your GP thinks you may have PCOS
  • testing a urine sample for the stress hormone cortisol if your GP thinks you may have Cushing's syndrome (a rare hormonal disorder)

If you do not have any other symptoms and your hirsutism is mild, then further tests are not usually necessary.

Hormones
Hormones are groups of powerful chemicals that are produced by the body and have a wide range of effects.

Ovaries
The ovaries are the pair of reproductive organs that produce eggs and sex hormones in females.

Useful Links

Page last reviewed: 13/07/2011

Hirsutism can be treated by:

  • removing the excess hair
  • taking medication
  • losing weight if necessary

Hair removal

There are several different ways to remove your excess hair.

Methods of hair removal include:

  • shaving is quick and easy and will not make the hair grow back quicker or thicker; however, it causes unpleasant stubble between shaves
  • bleaching can make dark hair look better in the short term, but may irritate your skin and is not effective for everyone
  • waxing and plucking can reduce regrowth if you use them regularly, but they can be painful and may cause scarring or folliculitis (inflammation of a hair follicle, see Hirsutism - complications)
  • electrolysis is when electricity is used to destroy the hair cells and can remove hairs permanently; however, it can take a long time, be painful and may cause scarring or changes to your skin colour 
  • laser hair removal involves special beams of light (lasers) that are used to destroy the hair; it can last several months, although it is more effective on women with pale skin and dark hair

Your GP can discuss the different methods with you in more detail if you wish. The method that you choose will depend on:

  • what works for you - if your skin becomes irritated because of one of these hair-removal methods, it can be itchy, look unpleasant and make regrowth worse
  • what you can afford - electrolysis and laser hair removal may only be available in specialist clinics

If your hirsutism is mild, using hair-removal methods may be all the treatment you need. However, if the hirsutism is affecting your quality of life, you may require further treatment, such as medication.

Oral contraceptives  

If your hirsutism requires further treatment, you may be prescribed contraceptive pills. These are only suitable if you have not yet started the menopause (when a woman's periods stop).

You may be prescribed:

  • a combined oral contraceptive or
  • co-cyprindiol

Both of these may take at least six months to work. This is because the hairs that have already grown live for around six months anyway.

You take your first pill on the first day of your menstrual cycle (the day you get your period), taking one pill a day for 21 days. You then have a seven-day break, during which you get your period, before starting the 28-day cycle again.

Combined oral contraceptive

Combined contraceptive pills that contain drospirenone, such as Yasmin, suppress androgens (male sex hormones), therefore they can be used to treat hirsutism. Drospirenone is anti-androgenic, which means that it prevents the androgens from working and so prevents excess hair growth.

Combined oral contraceptive pills are usually the first choice of treatment in premenopausal women, and are particularly useful if long-term treatment is necessary.

Co-cyprindiol

Co-cyprindiol is a contraceptive pill that contains ingredients that make it anti-androgenic (prevents the androgens from working). It is used to treat both acne (a skin condition that causes spots) and hirsutism.

Once the medication has treated your hirsutism, you should stop taking co-cyprindiol after three or four more 28-day cycles. This is because the risk of venous thromboembolism (a blood clot in a vein) is higher if you are taking co-cyprindiol than with other types of oral contraceptives.

Co-cyprindiol will not be suitable for you if you or anyone in your close family has a history of venous thromboembolism.

If your hirsutism returns after you stop taking co-cyprindiol, your GP may recommend starting treatment with it again. Alternatively, you can try changing to a combined contraceptive pill (see above).

Side effects

Both combined contraceptive pills and co-cyprindiol can cause side effects, including:

  • changes in body weight
  • breast tenderness
  • mood changes, such as irritability or a low mood
  • nausea (feeling sick)
  • vomiting
  • headache

For a full list of side effects, see the patient information leaflet that comes with your medicine. See the Heath A-Z topic about Combined contraceptive pills for more details.

Eflornithine

Eflornithine is an alternative medication that can be prescribed to both premenopausal women and menopausal women (women who have started the menopause). You may be prescribed eflornithine if:

  • you have mild excess hair growth on your face
  • hair-removal treatments alone are not effective
  • contraceptive pills are either not suitable for you or have not worked

Eflornithine is a cream that can be applied thinly to your face twice a day. It should be thoroughly rubbed in. After five minutes you can apply make-up on top of the cream if you wish. You should not wash your face for at least four hours after applying the cream. 

Eflornithine acts on your hair follicles (the small hole in your skin that an individual hair grows out of) to prevent hair growth. You should notice an effect within six to eight weeks. If no benefit is seen after four months, treatment will be stopped.

If eflornithine works then you will need to continue using it, as hair growth will return around eight weeks after you stop using it.

Eflornithine is not suitable if you are pregnant or breastfeeding.

Side effects

Eflornithine can cause some side effects, including:

  • a burning or stinging sensation when you apply the cream 
  • acne (a skin condition that causes spots)

Referral

Your GP may refer you for further treatment with a specialist, such as an endocrinologist (a specialist in hormone conditions), if:

  • treatment has not worked after 6 to 12 months
  • the hair growth gets worse despite treatment 

If your GP suspects an underlying cause for your condition (see Hirsutism - causes), they may also refer you to a specialist. For example:

  • a high level of testosterone in your blood or hirsutism that comes on very quickly may indicate a tumour (growth) - your GP may therefore refer you to an oncologist, a doctor who specialises in treating tumours
  • sudden weight gain around your face may be a sign of Cushing's syndrome, a rare hormonal disorder - your GP may therefore refer you to an endocrinologist

Your specialist will then be able to recommend suitable further treatments.

Further treatment

There are several other medications that can be used to treat hirsutism. However, because many of these medications are unlicensed for the treatment of hirsutism, they will only be prescribed by a specialist, not your GP.

Unlicensed medication means that the manufacturers of the medications have not applied for a licence for their medication to be used in treating hirsutism. In other words, the medication has not undergone clinical trials (research that tests one treatment against another) to see if it is effective and safe in the treatment of hirsutism.

Many specialists will use an unlicensed medication if they think the medication is likely to be effective and the benefits of treatment outweigh any associated risk. If your specialist is considering prescribing an unlicensed medication, they should inform you that it is unlicensed, and will discuss the possible risks and benefits with you.

Some possible alternative medications are explained below.

Anti-androgens

Anti-androgens are medications that suppress androgens, which means they prevent the androgens from working and so prevent excess hair growth. Possible types of anti-androgens include:

  • cyproterone acetate
  • spironolactone
  • flutamide

Some of these may be prescribed in combination with contraceptive pills (see above).

One review of a number of different studies found weak evidence to suggest that anti-androgens are effective for treating hirsutism. The review also suggested that anti-androgens may work best when combined with other medications, such as contraceptive pills.

Side effects were not reported in the studies that this review looked at. It may be that at low doses, anti-androgens do not often cause side effects.

Finasteride

Finasteride is a type of medication known as a 5-alpha-reductase inhibitor. It works by preventing testosterone (an androgen) from turning into a stronger form of testosterone inside your body's cells. Finasteride is normally used in men to treat an enlarged prostate gland (a small gland, found only in men, located in the pelvis). 

When finasteride is taken for its usual purpose (to treat men) it can cause side effects, such as:

  • lip and facial swelling
  • itchiness
  • rash
  • decreased sex drive
  • breast tenderness 

Few side effects have been reported when finasteride is used in women, so the above side effects may not apply.

Insulin-sensitising medication

Insulin-sensitising medication makes your body more sensitive to insulin. Insulin is a hormone produced by the pancreas, a gland that is located behind the stomach.

A high amount of insulin in the blood (hyperinsulinaemia) is thought to play a role in causing hirsutism. Because insulin-sensitising medication makes your body more responsive to insulin, your body does not need as much insulin and so produces less of it. The level of insulin in your blood should therefore fall, and your hirsutism may improve.

Possible insulin-sensitising mediations include:

  • metformin
  • pioglitazone
  • rosiglitazone

So far, there is only limited research into the benefits of insulin-sensitising medication for hirsutism. Some of this research found a small benefit, while some suggested that insulin-sensitising medication is no better than the alternative medications already available. The conclusions may change in the future if more long-term studies of insulin-sensitising medications are carried out. 

Gonadotrophin-releasing hormone (GnRH) analogues

Gonadotrophin-releasing hormone (GnRH) analogues are synthetic (man-made) hormones. They are used to treat hormone-related conditions, such as endometriosis (a condition in which small pieces of the womb lining are found outside the womb).  

Possible GnRH analogues include:

  • goserelin
  • leuprorelin

These may causes side effects, such as:

  • hot flushes
  • sweating
  • dryness or bleeding of the vagina (the tube of muscle that runs from the opening of the womb to the external sexual organs)
  • rashes
  • itchiness

For a full list of side effects, see the patient information leaflet that comes with your medication.

Hormones
Hormones are groups of powerful chemicals that are produced by the body and have a wide range of effects.

Insulin
Insulin is a hormone produced by the pancreas. When food is digested and enters the bloodstream, insulin helps to move any glucose out of the blood and into cells, where it is broken down to produce energy.

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Obesity is having a body mass index (BMI) of 30 or higher.

If you are obese, losing weight may improve your hirsutism. This is because weight loss reduces the production of androgens (male sex hormones) from your ovaries (the pair of reproductive organs that produce eggs and sex hormones in females).

Page last reviewed: 13/07/2011

As well as the physical signs of excess hair, hirsutism can affect you psychologically (mentally). It can cause embarrassment and affect your self-confidence, and therefore your quality of life.

It is important to see your GP if you have hirsutism as there are a number of treatments that you can try (see Hirsutism - treatment).

Folliculitis

Folliculitis is inflammation (redness and swelling) of a hair follicle (the small hole in your skin that an individual hair grows out of). This can cause painful spots to form at the site of the follicle. The following hair-removal methods may cause folliculitis:

  • shaving
  • plucking
  • waxing

Folliculitis may take a few weeks to resolve, and may mean that you cannot continue removing the hair until it has cleared up.

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Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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