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Family Health Magazine - WOMEN'S HEALTH

Hirsutism
When extra hair growth is a concern

If you are a woman and find yourself developing dark hair on your upper lip, chin, chest, abdomen or back, you may have a condition called hirsutism. (This is pronounced: her-shoot-ism.) In many women, dark or heavy hair growth is perfectly normal and related to ethnic background. However, it may also signal a medical condition. In the vast majority of cases, these conditions are not life threatening. However, because they indicate too much male hormone, you should discuss the hair growth with your doctor.

There are differences in the types of hair we grow on our body. Newborns are covered with a very soft lanugo hair. In childhood, this is replaced by vellum hair that is fine and colorless. At puberty, a girl’s hormone system starts to make greater quantities of female hormones. It also produces small amounts of male hormones, known as androgens. Androgens stimulate the growth of coarser, curlier hair, known as terminal hair, in the pubic area and armpits. This continues through a woman’s life. It stays somewhat constant, unless a condition develops that increases the amount of androgen. If this happens, coarse dark hair will grow in areas similar to those of a male. These areas are on the upper lip, chin, chest, abdomen, back and inner thighs. In more severe cases, excess androgen also contributes to other symptoms like increased acne, deepening voice, and enlarged clitoris (part of the female genitals, found at the anterior end of the vulva).

In many women some facial hair growth is normal, and is related to ethnic background. This hair is often dark but not coarse (vellum hair). It appears in women with a family heritage from South Asia, the Middle East or Mediterranean countries. These women often have darker hair on their upper lip, between their eyebrows (as seen on Frida Kahlo, a Mexican artist of Spanish descent), and around the areola (the ring of colored skin around the nipple of the breasts). On the other hand, this is not usual in women of East Asian or Native American heritage.

If you notice a new male hair growth pattern, it is important to seek medical advice to determine the cause, and pursue treatment where necessary. This is especially true if the hair growth:

• is rapid and progressive
• is associated with irregular menstrual periods
• is made worse by a medication
• is accompanied by an enlarging clitoris, and male features like deepening voice or balding on the front or top of the scalp.

In 75 to 80 per cent of hirsutism cases, a condition called polycystic ovary syndrome (PCOS) is the cause. It is somewhat misnamed, as about a third of women with this condition do not have cysts in their ovaries. However, there is a common mechanism. The ovaries and adrenal glands, through a series of complex hormone interactions, make excessive amounts of androgens. As a result, the woman will not ovulate (release an egg from her ovary) during her menstrual cycle. This contributes to irregular menstrual periods, and often infertility. A young woman with PCOS also usually has quite severe acne along with increased hair growth. PCOS is associated with obesity, a much higher risk of diabetes, sleep apnea, and possibly heart disease – though there is not a clear cause-and-effect relationship. Medical treatment and lifestyle guidance reduce the risks of this condition.

Other disorders that disrupt the body’s hormone system can cause androgen excess. They include thyroid conditions, Cushing’s syndrome, eating disorders, and an inherited condition known as congenital adrenal hyperplasia that appears later in life. Many medications can also contribute, especially anabolic steroids, danazol (used to treat endometriosis), and a number of medications used to treat epilepsy. Several other medications also need to be considered.

In the most severe (but rare) situation, the androgen excess may come from a tumor in the ovaries or the adrenal gland. Only 0.3 per cent of hirsutism is caused by such tumors. In some cases, this type of tumor can be malignant.

A number of blood tests and occasionally further testing with ultrasound or CT scan will usually diagnose the cause.

Treatment

Treatment of hirsutism is aimed at controlling the underlying cause. It includes therapies like:

• oral contraceptives to control the hormones made by the ovaries
• anti-androgen medications to block the effects of androgen
• weight loss to control the balance of androgen and estrogen.

Though this is a very individual preference, many women wish to remove the hair. There are many ways to do so. However, understand that if a medical condition exists, until it is treated the hair will simply regrow. At the same time, treating the underlying condition will not eliminate hair that is already there.

Hair removal takes two general forms: temporary and possibly permanent. Temporary removal includes waxing or plucking the hair to remove it, including the root, from the hair follicle. Shaving or chemical depilatories removes the hair at the skin surface. All of these methods can irritate the skin. This is especially true with depilatory chemicals, so test on a small area of skin first to see how your body responds.

A new and very expensive treatment is the medication Vaniqa® (eflornithine). This prescription cream blocks an enzyme needed for cells to produce hair. Vaniqa® helps slow the growth of new hair, but does not remove existing hair. It must be used constantly to suppress hair growth.

More permanent solutions include electrolysis and laser. Electrolysis has been used for some time, and is generally very effective. However, it is time consuming and can scar. Laser has become the most popular new way to remove unwanted hair. A number of different types of lasers can be used depending on the circumstances. Discuss this option with a reputable medical laser therapist. In general, laser hair removal is effective after the first laser treatment, but is not permanent. It may cause scarring, and works best on dark hair.

If you notice more hair on your body, especially if it is coarse and darker than expected, you may have hirsutism. Talk to your doctor to determine the cause. Any medical condition should be treated to prevent complications or more hair growth. Many cosmetic options are now available to remove unwanted hair. If you are interested in a more permanent solution, seek a doctor or medically trained and supervised cosmetic therapist.

FAMILY HEALTH is written with the assistance of

While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specified medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physician promptly. © Copyright 2018, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 0S1    [WH_FHa13]