Tackling the Problem of Female Hirsutism

This condition can be an indication of hormonal problems and must be tackled at the earliest to control its extent

Hirsutism is a condition wherein a woman has excessive hair growth and the hair is usually thick and dark, rather than fine and fair. Excess hair may appear on the face – such as the upper lip or chin, or neck. Hair could also be seen on the chest, the tummy (in a line from your belly button) and the front of your thighs. Hirsutism is often associated with other symptoms, including oily skin acne – a skin condition that causes spots to develop on your face, back and chest as well as hair loss or alopecia. Voice changes could also take place.

"The gradual onset of hair growth on the face of an 18-year-old girl who never had a history of similar complaints suddenly made things quite hard for her. The hair was prominent on her upper lip and cheek. She became self-conscious and was underperforming in her education, which was a new thing. Thankfully, her parents recognized that the reason behind her behaviour was not just a mood swing. She was referred to a gynecologist, an endocrinologist and internal medicine specialists.  She was investigated and therapy for Polycystic Ovarian Syndrome or PCOS (the most common cause of hirsutism) was started. This suppressed  the further spread of hirsutism," says Dr Jaidev Yadav NC, Consultant Dermatologist and Medical Laser Cosmetologist, Guna Skin and Laser Clinic.

A 35-year-old woman experienced a sudden outgrowth of hair in the past 2 months. Her blood was evaluated and found to be within normal parameters. However, she had concealed one vital bit of information — that she used over-the-counter creams which happened to be steroidal in nature. She was asked to stop the same immediately. Steroid creams which are supposed to be given under prescription are grossly misused, and their affordable costs and easy availability have an adverse impact on India's large population. On skin examination, she had characteristic ringed darkening in the creases of folds in the neck, arm pit, and other areas. She was referred to an endocrinologist where lifestyle management was advised and treatment instituted for preventing further spread of the problem. It was also revealed that she suffered from insulin- resistance which in turn led to the condition known as Acanthosis nigricans.

Women with sudden weight gain, excessive unwanted hair growth on the face and chest and those who have a history of diabetes in the family should get tested  for the above-mentioned disease. 

Dr Jaidev says, "In all the cases above the aim of treatment is to suppress further spread of hirsutism."

"This condition may also push women into depression as many people like friends and relatives may pass negative comments about their appearance. This may lead to low self-esteem, low performance, lessened social interaction and cause anxiety,"  opines Dr Bhupendra Chaudry, Consultant Psychiatrist, Manipal Hospital.

Guidelines for parents

•     The person in question should be accepted by family and friends and be encouraged to face society boldly.
•     Help the person develop positive attitude as this condition is manageable.
•     Recognize the symptoms and consult a general practitioner.

 "According to the laws of nature, the body transforms during puberty and the resultant change that is brought about is  due to normal androgen production. Androgens  are a group of essential collective hormones which are secreted by various organs in the body namely the ovaries, pituitary glands,  pancreas, thyroid and adrenal glands.  The same androgens are sadly also the cause for unwanted hair growth in females," says Dr Jaidev.

"Females may notice this condition during reproduction as the estrogen levels (female hormones) will become less and the male hormones testosterone  will increase. And in case of those suffering from PCOS there might be weight gain as well as unwanted hair growth on the face," says Dr KN Satish Babu, Consultant Endocrinologist, BGS Hospital.

Treatments for hirsutism:

•     Treatments that are targeted above the level of  the root of hairs and are temporary.
•    Treatments that target the root of the hair and are permanent. Complications and laser-related damage can take place when an inexperienced doctor handles the cases. Patients have experienced great improvement with the laser hair reduction procedure.
•  For a successful treatment of hirsutism, a multidisciplinary approach is needed with the help of  medical specialists, endocrinologists, dermatologists and plastic surgeons.

What causes hirsutism?

•      Hirsutism is caused by an excess of male sex hormones called androgens or an increased sensitivity to androgens.
•      In most cases, this condition is caused by polycystic ovary syndrome (PCOS). However, in around 10 percent of cases there are no obvious causes.
•      Hirsutism may affect between one and three women in 20 who have not yet started menopause (the point when her periods stop and she is unable to bear children any longer).
•      After 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.

When to see your health expert?

•      It's important to see experts  if you have hirsutism – especially if you have severe or unusual symptoms – as it can cause psychological harm, including depression, embarrassment and lack of self-confidence.
•      Your health expert will assess the severity of your hirsutism and ask you about any other symptoms before suggesting the best treatment.