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Excessive or unwanted hair in women

 

Definition

The normal amount of body hair varies widely among women. Usually, a woman will only grow fine hair (peach fuzz) on her lips, chin, chest, abdomen, or back. When women grow coarse, dark hairs in these areas, the condition is called hirsutism. This pattern of hair growth is more typical of men.

Alternative Names

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

Common Causes

All women normally produce low levels of male hormones (androgens). Unwanted hair growth (hirsutism) in women may occur when the body makes too much male hormone.

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 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, a deeper voice similar to that of men, and diabetes. If these symptoms start suddenly, there may be a tumor that releases male hormones.

The following other causes of unwanted hair growth are rare:

  • Tumor or cancer of the adrenal gland
  • Tumor or cancer of the ovary
  • Cushing's syndrome
  • Congenital adrenal hyperplasia
  • Hyperthecosis (a condition in which the ovaries produce too much male hormones)
  • Medications (testosterone, danazol, anabolic steroids, glucocorticoids, cyclosporine, minoxidil, 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.

Laser hair removal (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.

Call your health care provider if

Call your doctor if:

  • The hair grows rapidly.
  • The hair growth is associated with 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 doctor will perform a physical examination, including a pelvic examination if appropriate. The doctor will ask questions such as:

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

Your doctor may measure different hormone levels if you have moderate or severe hirsutism or you have other symptoms:

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.
  • Hair removal using laser and nonlaser light sources damage individual hair follicles so they do not grow back. This is expensive and multiple treatments are needed. You may get a topical (applied to the skin) medicine called eflomithine during these treatments.
Considerations

Prevention

References

Martin KA, Chang RJ, Shrmann DA, Ibanez L, Lobo RA, Rosenfield RL, et al. Evaluation and treatment of hirsutism in premenopausal women: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2008;93:1105-1120.

Lobo RA. Hyperandrogenism: Physiology, etiology, differential diagnosis, management. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier;2007:chap 40.


Review Date: 9/2/2009
Reviewed By: Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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