All women have hair growth all over their bodies, but there are areas such as the face, chin, upper lip, chest, stomach and back where the body hair is virtually invisible – the hair is fine, short and light. Hirsutism is excessive hair growth in these areas where the hair becomes darker, coarser and thicker, to the point where it’s very noticeable.

A mild form of hirsutism may show symptoms, such as the growth of hair on the chin, upper lip, sideburn area, and around the lower abdomen or nipples. The hair grows to be of the same colour and texture as that growing on the scalp. 

An advanced form of hirsutism may show significant hair growth on the shoulders, upper abdomen, upper back, and chest. This usually begins during puberty. If hirsutism starts before or after puberty, it could be due to a hormonal imbalance, and hence the symptoms should be evaluated by a doctor.

Besides excessive hair growth, hirsutism also has the following symptoms: 

• Acne

• Oily skin

• A receding hairline

• Hair loss, known as alopecia

• A deeper voice

• An enlarged clitoris

During puberty, a girl’s body starts producing both male and female hormones. The women’s menstrual cycle keeps the levels of female hormones higher, resulting in less body hair than men. But when these hormone levels are thrown off, increasing the male hormones (androgens) that cause excessive hair growth. 

Hirsutism causes are as follows:  

• Increased sensitivity to androgen

• Polycystic ovary syndrome is the most common cause, which results in increased androgen production

• Cushing’s syndrome wherein there is an increased production of cortisol hormone

• Acromegaly is a hormonal disorder causing too much growth hormone, which affects the hair

• Certain medicines

• Using anabolic steroids

• Tumours affecting your hormone levels

• Genetics

Unfortunately, a lot of women develop hirsutism where there is no obvious cause. This is known as idiopathic hirsutism.

A physician will examine the medical history with a special focus on the menstrual cycle. If the menstrual cycle is regular, hirsutism is likely to be inherited or genetic. If menstruation has always been irregular, the likely cause is polycystic ovary syndrome (PCOS).

If the woman is missing her periods and both the hirsutism and menstrual irregularity have onset recently, the doctor may prescribe some tests to rule out some serious conditions such as tumours of the ovaries, pituitary gland or adrenal glands. The doctor will check for signs of PCOS, adrenal gland tumours, ovarian tumours by measuring the levels of testosterone and DHEA in the blood. 

The following tests help to identify tumours or physical irregularities that could have caused hirsutism:

• A CT scan of the adrenal glands

• MRI scans of the brain

• An ultrasound of the ovaries

In mild cases of hirsutism, with no other significant symptoms that suggest overproduction of androgens, the doctor may not recommend further testing.

Here are some ways to treat hirsutism or stop facial hair growth in women: 

1. Self-Care Treatments

Shaving: It is the easiest way to get rid of unwanted hair. However, regrowth can be coarse and undesirable.

Waxing: It is effective but can irritate the skin, especially if it’s done for facial hair removal. 

Depilatories: These are hair removal creams that chemically dissolve hair shafts, thereby leaving no stubble.

Vaniqa Cream and Nair Tough Hair Removal Cream are some popular hair removal creams in the UK. 

Bleaching creams: These creams make the dark hair look pale, hence less noticeable. 

2. Physical Treatments

Laser hair removal: Laser and intense pulsed light (IPL) treatments destroy the hair root permanently. They are expensive treatments and are not always available on the NHS. These treatments are done in special clinics operated by qualified professionals. 

Electrolysis: In this method, an electrical current is passed through a needle into the hair follicle to destroy the hair root permanently. 

Weight loss: Weight loss in overweight women is recommended to decrease the levels of androgens and reduce hirsutism. After weight loss, women may notice that their menstrual cycle becomes regular, and hirsutism becomes less. 

3. Medical Treatments

Birth control pills: Birth control pills reduce the levels of androgens and establish regular menstrual cycles in women who have irregular cycles or who do not menstruate at all.

Anti-androgens: Anti-androgens such as spironolactone and finasteride directly decrease androgen production or block the action of androgens on the hair follicle. These medications can cause birth defects, and therefore they are prescribed with an effective form of birth control (birth control pills) in sexually active premenopausal women. Popular anti-androgen brands in the UK are Dianette and Clairette. 

Combination therapy:  Over time, many women adopt a multipronged approach that is a combination therapy of direct hair removal (such as a laser), suppression of androgen production with estrogen-progestin birth control pills, and blocking of androgen with an anti-androgen for maximal reduction of hair growth.

How much facial hair is normal in women?

Having body hair is completely normal in women; however, there are some cases in which hair growth is excessive, and it is present in areas where excessive hair growth is not normal, such as on the face, chest, upper lip and lower back. This hair growth can negatively affect the woman visually, socially, or emotionally.

Will birth control pills help with facial hair? 

Birth control pills lower the levels of androgens and can reduce facial hair. 

How long does laser hair removal last?

Once you are done with all the sessions, laser hair removal lasts for at least two years. However, maintenance sessions may be needed to keep the area without hair forever. 

What causes hirsutism in PCOS?

There are several conditions that are known to cause hirsutism. These conditions include:

• High level of male hormone – androgensin PCOS can turn the very fine hair into thick, dark hair.

• High insulin levels in PCOS, stimulate the ovaries to produce more androgens. 

Treating the root cause of hirsutism is the most important step in the management of hirsutism in PCOS women.

Can hirsutism be cured permanently?

Hirsutism can be treated successfully with medication. Following the medical treatment, laser treatment or electrolysis can be used for permanent hair removal of unwanted hair. 

Which hormone is responsible for hirsutism?

An excess amount of androgen hormones is responsible for hirsutism. 

Can losing weight reverse hirsutism?

Obesity increases androgen production, which can worsen hirsutism. Losing weight (even as little as 5%) can help lower androgen levels and decrease unwanted hair. 

Does hirsutism always mean PCOS?

Although hirsutism is one of the most distressing symptoms of PCOS, it by itself does not indicate polycystic ovary syndrome (PCOS). There could be many other causes of hirsutism.  

Does exercise reduce hirsutism?

A nutritious, balanced diet and regular exercise can help control your weight, which can, in turn, help control hirsutism. 

Is hirsutism a sign of infertility?

If you have irregular periods and hirsutism, you may be suffering from polycystic ovary syndrome, which can inhibit fertility.