Excessive or unwanted hair in women

Definition

Most of the time, women have fine hair above their lips and on their chins, chests, abdomens, or backs. The growth of coarse dark hair in these areas (more typical of male-pattern hair growth) is called hirsutism.

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

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 known. The condition often runs in families.

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 may also be the cause of unwanted hair growth, including:

Testosterone
Danazol
Anabolic steroids
DHEA
Glucocorticoids
Cyclosporine
Minoxidil
Phenytoin

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

Symptoms

The main symptom of this condition is the presence of coarse dark hair in areas that are sensitive to male hormones. These areas include:

Chin and upper lip
Chest and upper abdomen
Back and buttocks
Inner thigh

Testosterone test
DHEA-sulfate test
Pelvic ultrasound (if virilization is present)
CT scan or MRI (if virilzation is present)
17-hydroxyprogesterone blood test
ACTH stimulation test

Treatment

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

Medicines. Drugs such as birth control pills and anti-androgen medicines are an option for some women.
Electrolysis. Electrical current is used 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 energy directed at the dark color (melanin) in the hairs. This method is best for a large area of very dark hair. It does not work on blond or red hair.

Temporary options include:

Shaving. Although this does not cause more hair to grow, it may make hair look thicker.
Chemicals, plucking, and waxing. These options are safe and inexpensive. However, chemical products may irritate the skin.

For women who are overweight, weight loss may be able to help reduce hair growth.

Hair follicles grow for about 6 months before falling out. Therefore, it takes many months of taking medicine before you will notice a decrease in hair growth.
Many women get good results with temporary steps to remove hair or lighten it.

Most of the time, hirsutism does not cause health problems. But many women find it bothersome or embarrassing.

Call your doctor if:
The hair grows rapidly.
You also have male features such as acne, deepening voice, increased muscle mass, male pattern thinning of your hair, and decreased breast size.
You are concerned that medicine you're taking may be making the growth of unwanted hair worse.

References

Camacho-Martinez FM. Hypertrichosis and hirsuitism. In: Bolognia JL, Jorizzo JL, Schaffer JV, et al, eds. Dermatology. 3rd ed. Philadelphia, PA: Mosby Elsevier; 2012:chap 70.

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.