Hirsutism - Excess Facial Hair Growth in Women
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Hirsutism is excess facial hair growth in women. It is a fairly common problem, affecting up to 5% of women depending on their ethnic background. Among women with hirsutism, about 75-80% of them have polycystic ovary syndrome. This is a hormonal disorder where there is too much circulating male hormone ( we have both male and female hormones in the blood) which causes women to grow hair in a male pattern, such as on the chin, upper lip, neck, chest, upper back, and buttocks.
Some of the presenting symptoms of polycystic ovary syndrome are irregular menstrual periods, excess facial hair, and acne. These women also tend to be overweight and they have an increased risk of diabetes.
Some facial hair can be completely normal, especially for certain ethnic groups. If someone has an unusual amount of hair, especially if it is of rapid onset, they should have an endocrine work-up.
Most women with polycystic ovary syndrome start treatment for their hair growth with medication that suppresses the male hormone levels in the body. Some women then choose to undergo hair removal methods such as laser. Laser hair removal works very well, but you also need to stay on the medication or the male hormone levels will increase again and the hair will regrow quickly
The first choice of medications is the birth control pill. It is recommended that this be used initially for about 6 months. If there is no improvement, an anti-androgen (anti-male hormone) blocker, such as spironolactone, is added. Because spironoloactone could affect the development of a male fetus, it is not recommended for women of child-bearing age.
Metformin has also been recommended for PCO. However a recent study that analyzed all of the available clinical trials showed that it is no more effective than placebo for decreasing the hair growth.
Interestingly, even with good medical therapy, women with PCO rarely feel like their hair growth is well controlled.