Hirsutism

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Hirsutism

Hirsutism is excessive hair growth in certain areas of the body. It's a problem that mainly affects women.

It's relatively common, although some women may find it embarrassing or distressing to live with.

It's often a long-term problem, but there are a number of treatments that can help keep it under control.

This page covers:

Symptoms of hirsutism

When to see your GP

Treatments for hirsutism

Causes of hirsutism

Symptoms of hirsutism

The excessive hair in hirsutism is usually thick and dark, rather than fine and fair.

It develops in areas where men often have hair, such as the:

  • face
  • neck
  • chest
  • tummy
  • lower back
  • buttocks
  • thighs

You may also have some additional symptoms, such as oily skin, acne, a deep voice, irregular periods or no periods at all.

When to see your GP

It's a good idea to see your GP if you have hirsutism. They can look for any underlying cause and advise you about the treatments available.

Your GP may:

  • examine the areas of excess hair growth
  • ask about any other symptoms
  • ask about your medical history, such as whether you're taking any medication
  • carry out a blood test to check your hormone levels

Depending on what your GP thinks may be causing your symptoms, they may treat you themselves or you may be referred to a specialist.

Treatments for hirsutism

Treatment for hirsutism usually involves techniques to remove the excess hair and treatment to help slow its growth or stop it coming back.

The main treatments are:

  • home hair removal methods - such as shaving, plucking or waxing
  • specialist hair removal treatments - such as laser hair removal
  • eflornithine cream - a prescription cream that can help slow down the growth of facial hair
  • oral contraceptives, including co-cyprindiol tablets - a type of contraceptive pill available on prescription that can help prevent excess hair growth

It may take a few months to notice the effects of treatment, so it's important to persist with it. In many cases, treatment will need to be continued indefinitely.

Read more about the treatments for hirsutism.

Causes of hirsutism

Hirsutism is caused by an excess of male hormones called androgens in your body, or by your body being more sensitive to these hormones.

In many cases, it's not clear why this happens. Some women just seem to develop extra hair growth as they get older, particularly after the menopause.

In younger women, the most common cause is polycystic ovary syndrome (PCOS), a condition that can cause irregular periods and fluid-filled sacs (cysts) on the ovaries.

Less common causes of hirsutism include:

  • Cushing's syndrome - a hormonal disorder that causes sudden weight gain and bloating around the face and neck
  • congenital adrenal hyperplasia - an inherited condition affecting the adrenal glands, the glands above the kidneys that produce hormones
  • obesity - losing weight may help improve the symptoms in these cases
  • acromegaly - a condition in which the body produces too much growth hormone
  • medicines - such as anabolic steroids, used by some people to build muscle and improve athletic performance
  • a tumour (growth) - that increases the production of androgens and usually affects the ovaries or adrenal glands

treatment

Treatment

There are a number of different treatments that can remove the excess hair in women with hirsutism, and help stop it coming back.

The main treatments are:

Hair removal methods

Eflornithine cream

Oral contraceptives

There are also several additional medicines that may be prescribed by a specialist if the above treatments haven't helped.

Hair removal methods

There are a number of ways to remove or disguise excess hair. Some can be tried at home, while more specialist treatments are carried out in clinics.

Your GP can advise you about the hair removal options available. You may need to try a number of methods to find one you prefer.

Home hair removal techniques

Home hair removal techniques are relatively inexpensive, although they need to be carried out regularly because the results are only temporary.

The main techniques are:

  • shaving - quick and easy, and won't make the hair grow back quicker or thicker, but may irritate your skin and there may be unpleasant stubble growth between shaves
  • bleaching - can make dark hair look better in the short term, but may irritate your skin and isn't effective if you have dark skin
  • waxing, plucking or threading - can reduce regrowth if done regularly, but can be painful and may cause inflammation of the hair follicles (folliculitis) and, occasionally, scarring
  • hair removal (depilatory) creams - can remove hair from large areas of skin without leaving stubble behind, but can irritate the skin and should be tested on a small area at first
  • epilators (electrical hair removal devices) - can remove hair from large areas relatively easily, but can be painful and cause folliculitis

Specialist hair removal techniques

Specialist hair removal techniques may have longer-lasting results than the techniques you can try at home, although they're rarely available on the NHS and can be expensive.

The main treatments are:

  • electrolysis (where electricity is used to destroy hair follicles) - can be a permanent solution, but may require several treatments; can also be painful and may cause scarring or changes to your skin colour
  • laser hair removal (where powerful beams of light are used to destroy hair) - can remove hair for longer periods than home removal methods, but the results aren't permanent; side effects can include redness, darkening or lightening of the skin, and scarring

Eflornithine cream

Eflornithine cream is a prescription medicine applied twice daily that can help treat excessive hair growth on the face and under the chin.

It can be prescribed for both premenopausal women and menopausal women, but isn't suitable for women who are pregnant, breastfeeding or under the age of 19.

The cream helps slow down hair growth and can be used alongside the hair removal methods mentioned above.

You should notice an effect within eight weeks. Treatment will be stopped if no benefit is seen after four months.

If eflornithine cream does work, you'll usually need to continue using it, as hair growth will return within eight weeks of stopping treatment.

Side effects of eflornithine cream can include:

  • mild acne
  • skin redness
  • a burning or stinging sensation
  • dry, itchy skin

Oral contraceptives

For hirsutism affecting large areas of the body, your GP may prescribe oral contraceptives or co-cyprindiol (Dianette).

Co-cyprindiol is a type of combined contraceptive pill that can treat excess hair growth by blocking the effects of male hormones (androgens) in the body. It's only suitable for premenopausal women with hirsutism.

The pills are taken once a day in cycles lasting 21 days, followed by a seven-day break before you start the next cycle. It may take around six months to see an effect.

Once your excess hair growth has improved, you'll be advised to stop taking the pills after a further three or four months because continuous long-term treatment increases your risk of developing a blood clot.

If your hirsutism returns after you stop taking the tablets, your GP may recommend starting treatment again or changing to a different combined contraceptive pill.

Common side effects of co-cyprindiol include:

Additional medicines

Your GP may refer you to a specialist if the treatments above aren't suitable or don't work. There are several additional medications a specialist can prescribe if necessary.

These include:

  • anti-androgens (medicines that suppress androgens) - such as cyproterone acetate and spironolactone
  • finasteride - a type of medication that works by preventing testosterone (an androgen) from turning into a stronger form of testosterone inside your body's cells
  • insulin-sensitising medication (medicines that make your body more sensitive to insulin) - metformin and pioglitazone
  • gonadotrophin-releasing hormone (GnRH) analogues (man-made hormones) - such as goserelin and leuprorelin

Many of these medicines are unlicensed for the treatment of hirsutism.

This means they haven't undergone clinical trials for this use, but your doctor believes they're likely to be effective. They will discuss the possible benefits and risks with you.