One of the main symptoms of PCOS is hyperandrogenism, which is more commonly known as an excess of male hormones. Hyperandrogenism affects between 60% and 80% of women with PCOS. Biochemically, the condition is confirmed by the presence of circulating testosterone or dehydroepiandrosterone (DHEA) in the blood serum. However, hyperandrogenism can also manifest as physical symptoms, such as acne, alopecia (male pattern baldness) and hirsutism (excess hair growth).
What is hirsutism?
Hirsutism is characterised as excessive hair growth across the face or body that appears in a male pattern. It is a common symptom of PCOS, with 65-75% of women who are diagnosed with the condition experiencing unwanted hair growth. 70-80% of women with hirsutism will be diagnosed with PCOS.
Managing excess hair growth
Women who experience noticeable hair growth across the upper lip and chin may be more self-conscious and suffer from a lack of confidence. There are various options for hair removal, some of which can be effective and provide short-term relief. However, the ideal solution is to identify and manage the underlying cause of excess hair growth.
Women with PCOS will usually find that they can alleviate many of their symptoms by implementing lifestyle adjustments, such as losing weight. The downside to this is that it can take time to see an improvement in the visible manifestations of the condition.
If you are experiencing unwanted hair growth and want a faster solution, the two main options to consider are hair removal and medication. The relief that both of these options provide is temporary, so it is important to consider a longer-term strategy too; consult your doctor for advice on identifying and managing the underlying cause.
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 should not be relied upon as a long-term solution.
Anti-androgen medication can also be effective, but is rarely given as a first line approach. It is sometimes given in combination with the pill, if the pill is ineffective in isolation. The anti-androgen spironolactone 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.
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- 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.
- Martin, Kathryn A, et al. “Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society* Clinical Practice Guideline.” The Journal of Clinical Endocrinology & Metabolism, vol. 103, no. 4, 7 Apr. 2018, pp. 1233–1257., doi:10.1210/jc.2018-00241.
- Rathnayake, D, and R Sinclair. “Use of Spironolactone in Dermatology.” Skinmed, vol. 8, no. 6, 2010, pp. 328–332.