Hirsutism

Signs and Symptoms

The main symptom of hirsutism is hair growing on the abdomen, breasts, and upper lip (male-pattern hair growth in women). If hirsutism is caused by high levels of male hormones, symptoms may also include:

• Irregular menstrual periods
• Acne
• Loss of feminine body shape
• Signs of masculinity, deepening voice, male pattern baldness, enlarged clitoris, enlarged shoulder muscles

If hirsutism is caused by Cushing syndrome, signs and symptoms can include:

• Obesity, especially around the middle section
• High blood pressure (hypertension)
• Diabetes
• Thinning skin

Causes

About half of women with hirsutism have high levels of male sex hormones, called androgens. Those high levels can be caused by:

• Polycystic ovarian syndrome (PCOS), which may also cause infertility
• Tumors on the adrenal glands or ovaries
• Cushing syndrome
• Medications that can cause hair growth, such as phenytoin (Dilantin), minoxidil (Rogaine), diazoxide (Proglycem), and cyclosporine
• Anabolic steroids
• Danazol (Danocrine), used to treat endometriosis

Sometimes, women with hirsutism may have normal levels of male hormones. If there is no underlying condition, doctors may not be able to determine what causes hirsutism.

Risk Factors

The following factors may increase your risk of hirsutism:

• Genetics, some conditions that cause hirsutism may be inherited.
• Race and ethnicity, women of European, Middle Eastern, and South Asian ancestry are more likely to develop the condition

Diagnosis

Your doctor will examine you and take a medical history. You may be asked about your menstrual cycle, what medications you take, and your family history. Your doctor will check you for hair growth and also may do a pelvic examination to check for tumors or cysts on the ovaries. After doing the physical exam, your doctor may order one of the following tests:

• Blood tests, may show high androgen levels
• Imaging tests, including CT scan, MRI, pelvic ultrasound, used to find cysts or tumors on the ovaries or adrenal glands

Preventive Care

Preventing hirsutism depends on the cause. For women with polycystic ovary syndrome (PCOS), for example, losing weight through diet and exercise may help. Studies suggest that obese women with PCOS may be less likely to develop hirsutism if they eat a low-calorie diet.

Treatment

Treatment for hirsutism depends on whether there is an underlying cause, and how severe the hair growth is. For example, if medications are making it worse, you can ask your doctor if you can switch medications. A tumor on the ovaries or adrenal glands can be removed surgically. Overweight women with hirsutism may want to lose weight so their bodies will make less testosterone.

If your doctor cannot find a cause, you can try a combination of self care and hair-removal techniques. Psychological support may also help because hirsutism is often a frustrating and embarrassing condition.

Lifestyle

Being overweight may contribute to hirsutism. Eating a balanced diet and getting enough exercise can help control weight.

Medications

The U.S. Food and Drug Administration (FDA) has not approved any medications to treat hirsutism. However, some drugs may lower androgen production and reduce hair growth. It can take 6 months or longer for the medications to produce noticeable changes in hair growth. They must be taken long term to keep symptoms under control. These medications include:

• Birth control pills. Some birth control pills can lower the amount of androgens your body makes.
• Spironolactone (Aldactone) blocks androgen from being used in the body
• Eflorinithine (Vaniqa) is a prescription cream for unwanted facial hair. It slows new hair growth but does not get rid of existing hair. Hair comes back if you stop using the cream.

Surgery and Other Procedures

If a tumor on the ovaries or adrenal glands is causing hirsutism, you may need surgery to remove it.

Laser therapy can remove unwanted hair for some women. The laser destroys hair follicles and stops hair from growing. You will need several sessions to reduce hair growth in specific areas, and you may need touch-ups afterward. Laser therapy works best on women with dark hair and light skin.

Nutrition and Dietary Supplements

Ask your health care provider how to use complementary and alternative therapies (CAM) in your overall treatment plan. Always tell your provider about the herbs and supplements you are using or considering using.

These nutritional tips may help women stay at a good weight, which may help lower androgens in the body:

• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash and bell peppers).
• Avoid refined foods, such as white breads, pastas, and especially sugar.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy), or beans for protein.
• Use healthy oils in foods, such as olive oil or vegetable oil.
• Reduce or eliminate trans fat, found in commercially-baked goods, such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and some margarines.
• Avoid alcohol and tobacco.
• Drink 6 to 8 glasses of filtered water daily.
• Exercise at least 30 minutes daily, 5 days a week.

Herbs

Herbs may strengthen and tone the body's systems. As with any therapy, you should work with your health care provider before starting treatment. You may use herbs as dried extracts (capsules, powders, or teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots.

These herbs are sometimes suggested to treat hirsutism, but most have not been studied by scientists. Always talk to your doctor before taking any herb that can affect hormones. DO NOT take these supplements if you are pregnant or breast feeding, or planning to become pregnant. Women who have a history of breast, uterine, or ovarian cancer, or other hormone-related conditions, should not take these supplements except under their doctor's supervision.

• Saw palmetto (Serenoa repens) has anti-androgenic effects, meaning it lowers levels of male hormones in the body. It is sometimes suggested for treating PCOS, although there is no scientific evidence whether it works or not. Saw palmetto may increase the risk of bleeding. If you have a history of hormone-sensitive illness or take hormone medications, including birth control, ask your doctor before taking saw palmetto. If you take blood thinners such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin, or hormone medications, ask your doctor before taking saw palmetto.
• Chaste tree (Vitex agnus castus) standardized extract also has anti-androgenic effects. If you have a history of hormone-sensitve illness or take hormone medications, including birth control, ask your doctor before taking chaste tree. Chaste tree can interfere with some antipsychotic drugs as well as some Parkinson medicines.
• Black cohosh (Actaea racemosa) is another herb with anti-androgenic effects. DO NOT take black cohosh if you have liver disease. If you have a history of hormone-sensitive illness or take hormone medications, including birth control, ask your doctor before taking black cohosh. Black cohosh may increase the risk of blood clots, so DO NOT take it if you have a clotting disorder.
• Spearmint tea (Mentha spicata), 1 cup, 2 times per day. A preliminary study found that women with hirsutism who drank spearmint tea had less free testosterone (a male hormone) in their blood. The researchers thought the tea might reduce symptoms of mild hirsutism. Another study found that spearmint tea lowered androgen levels in women who had PCOS.
• Lavender and tea tree oils may reduce mild hirsuitism without a known cause. One preliminary study found that applying lavender and tea tree oils locally on the skin could improve the condition. These oils are for topical use only.

Acupuncture

One small study of women with hirsutism found that acupuncture reduced both hair density and hair length. It also reduced levels of the male hormone testosterone. More research is needed.

Other Considerations

Pregnancy

If you are pregnant, you should not take medications, herbs, or supplements that change hormone levels. Talk to your doctor if you are pregnant, breastfeeding, or plan to become pregnant.

Pregnant women may notice more hair growth during the third trimester, especially on the face, arms and legs, and breasts. This is normal and is not a sign of hirsutism.

Prognosis and Complications

Treating the underlying cause of hirsutism can improve your symptoms. Long-term medication may slow hair growth, but it usually will not get rid of existing hair on the face and body. Some cosmetic techniques, laser hair removal and waxing, can reduce unwanted hair. Women who are embarrassed by their condition might consider seeing a trained counselor.

Supporting Research

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