Hairiness

Hairiness in women
Excess hair (hirsutism) in women often appears in the places where men have body hair, such as the upper lip and chin, the chest (including around the nipples), the tops of the shoulders and the lower abdomen. The excess hair is usually coarse and dark (different from the fine hair that some women have on their upper lip, chin, breasts and stomach). The hairs also grow longer than normal so, for example, hairs on the upper lip may grow to 1 cm long instead of remaining short, fine and fair.

Reasons for excess hair
Extra-responsiveness to hormones. Women often worry that hairiness means that they have male hormones and are not fully female. In fact, all women have a small amount of the ‘male’ hormone, testosterone, circulating in their bodies. It is produced mainly by the adrenal glands, which are situated over the kidneys. If the skin is extra-responsive to it, testosterone encourages hair growth on the upper lip, chin, chest, lower abdomen. The hormone levels are normal; the problem is that the skin is too responsive to testosterone. Women with this problem gradually develop more body hair from puberty until the menopause, after which the amount of body hair slowly lessens – except for facial hair, which continues to increase.

There are many reasons for this extra-responsiveness to normal amounts of testosterone.

Polycystic ovary syndrome is the cause of hairiness in some women. This syndrome is usually caused by an imbalance between the pituitary and adrenal glands with cysts on the ovary. As a result, the level of male hormone rises. It usually develops in the late teens or early 20s and there are usually other symptoms as well as excess hair. Polycystic ovary syndrome sometimes runs in families. It is diagnosed by blood tests and, usually, an ultrasound scan of the ovaries. It can be treated with medication. Women with polycystic ovary syndrome are often obese, and the hirsutism (hairiness) improves if they lose weight.

Tumour. Very occasionally, a tumour of the ovaries or an adrenal gland can be responsible for the excess male hormones, but this is very rare.

What you can do
Lose weight if you are overweight. This may greatly improve the problem.

Bleaching is a good way of disguising upper lip hairs or ‘sideburns’ unless your skin is dark. Hydrogen peroxide cream for bleaching is available from pharmacists, but it can cause severe skin irritation.

Depilatories (hair-removing creams) do not leave stubble, but can irritate the skin. Test beforehand by applying a small amount to the inside of your wrist. If there is no reaction the next day, it is probably safe to use the cream. Weaker creams for use on the face are available.

Plucking, waxing, sugaring or threading will deal with the problem temporarily. These all work by pulling out the hairs. If you pull out a hair, a new hair immediately starts to grow in that follicle. (If you shave a hair, it may be in its resting phase and will not grow for some time.) So plucking, waxing and sugaring may have to be repeated quite frequently.

Plucking can be used to remove a few long hairs on the chin, but in general it is not a good idea for the face because it can easily cause scarring. Never pluck hairs on the nipple or the surrounding pink area (areola), or on a mole. In waxing, strips of hot wax are placed over the hairy area and pulled off, taking the hairs with them. This is painful, and difficult to use on the face. Sugaring is similar, but uses a special sugar paste obtainable from pharmacies.

Shaving will need to be done every day. In spite of the old wives’ tale, it does not make the hairs grow back more quickly (British Medical Journal 2007;335:1289). However, shaved hairs will be stubbly, so they may be noticeable if shaving is not repeated daily.

Laser treatment is quicker and less painful than electrolysis. It works best on dark hair with pale skin, because the dark pigment helps to transmit the laser energy down the hair shaft to the bottom of the hair follicle, where it damages the lining of the follicle so the hair cannot grow properly. The results can be very good, but there are also a few problems.

Electrolysis is probably the best method of getting rid of the unwanted hair long term (possibly permanently). Electrolysis is a slow process, because each hair is dealt with separately and it may take months or years of treatment before all the unwanted hairs disappear.

A fine needle is inserted into the hair root, which is then destroyed by a chemical reaction and by heat.

Try spearmint tea. A research study has suggested that drinking 2 cups of spearmint tea daily can reduce levels of testosterone in women, and might reduce hairiness (British Medical Journal 2007;334:482). This research involved only a small number of women, so its results need to be confirmed.

How your doctor can help. See your doctor if any of the following apply:

Polycystic ovary syndrome. If this is a possibility, your doctor will refer you to an endocrinologist (hormone specialist). The endocrinologist will check for other problems, such as diabetes, that can sometimes accompany polycystic ovary syndrome. The medication used to treat polycystic ovary syndrome is effective, especially if you also lose weight; greasy skin and acne clear up in about 6 weeks, but it can take 12–18 months for maximum improvement in the hirsutism (hairiness).

No hormone abnormality. If there is no hormone abnormality, and the hirsutism (hairiness) happens simply because your skin is especially responsive to testosterone, your doctor may prescribe the combined oral contraceptive pill containing the progestogens desogestrel, gestodene or norgestimate. Both the oestrogen and progestogen in the combined pill have an effect, so the progesterone-only pill would not be as effective in reducing hair. About 1 in 10 women will see an improvement, but it may take 12–18 months.

If this does not help, your doctor may decide to try a combination of ethinyloestradiol and cyproterone acetate (Dianette) or drospirenone (Yasmin), which stop testosterone having an effect on the skin. It will take about 3 months before there is any improvement, and 12 months to achieve the full effect. After this, the drug is stopped. Hair may regrow about 6 months later, in which case another course of the drug can be given.

If none of these treatments work, your doctor can refer you to a hospital dermatologist or endocrinologist who could suggest other medication.

Laser treatment and electrolysis. In the UK, some hospital dermatology departments provide laser or electrolysis treatment under the NHS, but this is usually available only for individuals with a great deal of excess hair, or who are particularly distressed by it.

Eflornithine (Vaniqa) is a cream that slows hair growth. Applied twice a day, it reduces hair growth in about 60% of people who use it (American Journal of Clinical Dermatology 2001;2a:197–201). It contains a chemical called eflornithine, which blocks a key enzyme in the hair follicle. Because it does not destroy existing hairs, it may take several weeks (or even months) before you see any result. It is probably best used after hair has been removed by another method (such as laser), to slow down the return of unwanted hair (American Family Physician 2002;66:1907–11). Eflornithine is not a permanent method of hair removal; when you stop using it, the hair will regrow, usually within about 8 weeks. The cream can cause a burning or stinging sensation and acne. It is not suitable if you are pregnant or breastfeeding.