How to Manage Facial Hair
By Dr. Kate Dudek
One of the main symptoms of PCOS is hyperandrogenism, which is more commonly known as an excess of male hormones. Between 60% and 80% of women with PCOS are thought to be hyperandrogenic. Biochemically the condition is typically confirmed by the presence of circulating testosterone or androstenedione in the blood serum. Alongside this are dermatological characteristics frequently seen in women with higher than average levels of male hormones; these include acne, alopecia (male pattern baldness) and hirsutism (excess hair growth).
Hirsutism usually involves unwanted hair growth on the face or body. Women who have very obvious facial hair across their upper lip or chin are likely to be self-conscious and look for ways to remove it. The optimum way of managing any PCOS symptom is to identify the underlying causes of the condition and make lifestyle and dietary changes to reverse its effects. Once resolved, the results will probably be permanent, but it can take time to see an improvement in the visible signs of the condition. More temporary options to consider are hair removal or medications.
Hair can be removed by shaving, waxing, threading and depilation. These techniques produce an instantaneous result, but can be painful, are relatively short-lasting and leave the delicate skin of the face vulnerable to scarring or reactive dermatitis. Alternative hair removal techniques are electrolysis and laser therapy. These methods are both considered permanent, however, electrolysis is painful and time-consuming and laser treatment is expensive.
For women who are not attempting to conceive, the combined oral contraceptive pill can combat some of the signs of hyperandrogenism, including hirsutism. However, it is certainly not a long-term solution and does bring with it health risks of its own and withdrawal can even cause a specific type of PCOS called pill-induced PCOS.
Antiandrogen medication can be effective. One example is spironolactone, which has been shown to reduce the extent of hirsutism when compared to a placebo. It should not be used during pregnancy, due to the risk of feminisation of male foetuses.
Metformin, which is commonly used to reduce insulin levels in women with PCOS, has not been shown to have any beneficial effects with regards to hirsutism.
Eflornithine, which is applied topically to the affected areas, is another option. This will reduce hair growth, but results are transient and hair will regrow once treatment ceases.
- Bode, D, et al. “Hirsutism in Women.” American Family Physician, vol. 85, no. 4, 15 Feb. 2012, pp. 373–380., www.aafp.org/afp/2012/0215/p373.html.
- Brown, J, et al. “Spironolactone versus Placebo or in Combination with Steroids for Hirsutism and/or Acne.” The Cochrane Database of Systematic Reviews, no. 2, 15 May 2009, CD000194., doi:10.1002/14651858.CD000194.pub2.
- Rathnayake, D, and R Sinclair. “Use of Spironolactone in Dermatology.” Skinmed, vol. 8, no. 6, 2010, pp. 328–332.
- Roth, E, and A Gotter. “Excessive or Unwanted Hair in Women.” Healthline, www.healthline.com/health/excessive-or-unwanted-hair-in-women. Medically reviewed by Deborah Weatherspoon, PhD, RN, CRNA, COI on October 11, 2016.