Excessive or unwanted hair in women

Definition

The normal amount of body hair for women varies. Most of the time, a woman only has fine hair, or peach fuzz, above the lips and on the chin, chest, abdomen, or back. If you have coarse, dark hairs in these areas, the condition is called hirsutism. Such hair growth is more typical of men.

Alternative Names

Hypertrichosis; Hirsutism; Hair - excessive (women); Excessive hair in women; Hair - women - excessive or unwanted

Considerations

Common Causes

Women normally produce low levels of male hormones (androgens). If your body makes too much of this hormone, you may have unwanted hair growth.

In most cases, the exact cause is never identified. It tends to run in families. In general, hirsutism is a harmless condition. But many women find it bothersome, or even embarrassing.

A common cause of hirsutism is polycystic ovarian syndrome (PCOS). Women with PCOS and other hormone conditions that cause unwanted hair growth may also have acne, problems with menstrual periods, trouble losing weight, and diabetes. If these symptoms start suddenly, you may have a tumor that releases male hormones.

Other, rare causes of unwanted hair growth may include:

• Tumor or cancer of the adrenal gland
• Tumor or cancer of the ovary
• Cushing syndrome
• Congenital adrenal hyperplasia
• Hyperthecosis (a condition in which the ovaries produce too much male hormones)
• Use of certain medicines, including testosterone, danazol, anabolic steroids, glucocorticoids, cyclosporine, minoxidil, and phenytoin

Rarely a woman with hirsutism will have normal levels of male hormones, and the specific cause of the unwanted hair growth cannot be identified.

Home Care

Hirsutism is generally a long-term problem. There are a number of ways to remove or treat unwanted hair. Some treatment effects last longer than others.

• Weight loss in overweight women can reduce hair growth.
• Bleaching or lightening hair may make it less noticeable.

Temporary hair removal options include:

• Shaving does not cause more hair to grow, but the hair may look thicker.
• Plucking and waxing are fairly safe and are not expensive. However, they can be painful and there is a risk for scarring, swelling, and skin darkening.
• Chemicals may be used, but most have a bad odor.

Permanent hair removal options include:

Electrolysis uses electrical current to permanently damage individual hair follicles so they do not grow back. This method is expensive, and multiple treatments are needed. Swelling, scarring, and redness of the skin may occur.

Laser hair removal uses laser aimed at the dark color (melanin) in the hairs. This method is best if a very large area needs to be treated and only if the hair is particularly dark (does not work on blond or red hair).

Call your health care provider if

Call your health care provider if:

• The hair grows rapidly
• You also have 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 health care provider will perform a physical examination. A pelvic exam may be done. You will be asked questions about your medical history and symptoms, including:

• Do other family members also have excessive amounts of hair?
• What medications are you taking?
• Have your periods been regular?
• Are you pregnant?
• Do you have increased muscle mass, acne, or decreased breast size?
• When did you first notice these symptoms?

Blood tests may be done, including:

• 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.

Medications or other treatments your doctor may prescribe include:

• Birth control pills. It may take several months to begin noticing a difference.
• Anti-androgen medications such as spironolactone may be tried if birth control pills do not work. There is a risk of birth defects if you become pregnant while taking these medicines.
• Laser hair removal or electrolysis

Prevention

visHeader

References

Bulun SE. Physiology and pathology of the female reproductive axis. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 17.

Habif TP. Hair diseases. In: Habif TP, ed. Clinical Dermatology. 5th ed. St. Louis, Mo: Mosby Elsevier; 2009:chap 24.