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Treating hirsutism

Weight Loss:

The majority of women with excessive body hair will be so because of polycystic ovarian syndrome (PCOS). The commonest hallmark of PCOS is excessive weight. Many are surprised and some can be quite sceptical when advised that losing weight to as close to the ideal body weight tends to have dramatic effect on the excessive hair as well. However, this is certainly true and the one measure that is within the individual woman’s power to directly influence. There is a reduction of around 50% of the excess hair within months of achieving a normal body mass index (BMI). It is therefore the single most effective remedial measure for women with polycystic ovaries and hirsutism. This is, apart from the other long term health benefits of shedding the excess weight.

Medication for hirsutism

The Combined Pill: The standard oral contraceptive pill is beneficial in this regard. It tends to stop further hair growth but hair that is already present is not affected. The benefit will be noted if this is combined with cosmetic measures used for hair removal. These are discussed below. There are a number of contraceptive pill types which are specifically aimed at individuals with hirsutism and/or other hyperandrogenic skin problems such as severe acne or a greasy skin. These include Dianette and the relatively new Yasmin. Dianette contains Cyproterone which has anti-androgenic effect. It therefore has the effect of blocking the effect of androgens on hair follicles. Yasmin contains Drospirenone which too has anti-androgenic effect. The pill is ideal for women requiring acontraception and those who may want to have regular periods.

Cyproterone: As mentioned above, this is an anti-androgen. In fact, it reduces the production of androgens such as Testosterone and also antagonises their effect on, among others, the hair follicles. It is a constituent of the pill Dianette but it can also be used in isolation at a higher dose of 50 mg per day. Its effect is modest and response varies among women. There is also the issue of potential side-effects which include weight gain, the last thing a woman with polycystic ovaries would want to contend with. Other potential side effects include feeling lethargic, loss of libido and mood changes. It also increases the risk of thrombo-embolism similar to the second generation contraceptive pill.

Metformin: This is an insulin sensitizer which has been used in Type 2 diabetes for many years. It reduces the level of circulating insulin by increasing the number of insulin receptors and inhibiting liver production of glucose. The reduction in insulin concentration has a knock on effect of reduced androgen production by the ovaries.

Finasteride: This is an enzyme inhibitor which has similar effectiveness to Cyproterone (discussed above). It has very few side effects but a woman taking this medication should ensure she has reliable contraception in place. Conception during the use of Finasteride could lead to feminization of a male fetus.

Vaniqa cream: This relatively new product consists of Eflornithine as the active ingredient. Eflonirthine is an enzyme inhibitor which has the effect of arresting hair growth. The effect continues for as long as it is used. Application is twice a day and results can be seen within a few months of starting the application. It is currently licensed for use on the face only.

Spironolactone: This can be employed to combat hirsutism because of its anti-androgenic effect. Whilst it is mainly used as a diuretic especially for patients with heart failure, it has been shown to have a good effect when used to combat hirsutism and may even be superior to Finasteride and Cyproterone (discussed above). A woman should avoid pregnancy during its use.

Cosmetic measures for hirsutism:

Waxing: Useful for short term control of excessive hair. However, this does not reduce rate of hair growth and long-term use not advised as skin damage can result.

Shaving: May be effective for short term cosmetic purposes but long term use of this method especially for facial hair is not advised as it can be associated with problems similar to those encountered with waxing (above). However, it is important to point out that shaving does not increase hair growth as many tend to believe.

Depilatory creams: Hair removal creams are also only effective as a short term measure. The rate of hair growth is unaffected, can lead to skin irritation with repeated use and results for facial hair may be disappointing for some women.

Bleaching: This does not remove the hair and is therefore not very effective when there is a significant amount of hair. It is also unsuitable for dark-skinned women.

Electrolysis: This is a method where each individual hair follicle is destroyed using a measured amount of electric current. It is quite laborious and really impractical where large parts of the body are affected by the excessive body hair as can be the case in PCOS. It is also painful and some individuals may find the pain unbearable. Repeat treatments are necessary and the whole course can take up to two years, even longer, to complete. Apart from pain, extensive electrolysis can cause burns and skin depigmentation. This treatment is usually available in skin clinic even though portable DIY electrolysis machines are also available in the market place.

Laser therapy: This is arguably the best and most effective cosmetic treatment for excessive body hair currently available. It works on similar principles to electrolysis but is quicker and easier to tolerate. Permanent reduction of hair density is achieved but a number of treatments ranging from 3 or 4 to more than a dozen are typically required. It remains relatively expensive. Skin depigmentation can occur especially with dark-skinned women. As the technology has been refined further, this problem has also receded.

Important Points on hirsutism:

Hirsutism or excessive body hair affects up to 15% of women
Many cases of Hirsutism are due to hormonal problems with polycystic ovaries being the leading cause
Sudden or rapid appearance of excessive body hair needs to be investigated quickly
Losing weight and achieving an ideal BMI can result in a dramatic reduction in the excessive hair in polycystic ovaries
Medication can help control rate of hair growth but effect is modest at best
Cosmetic measures such as shaving, depilatory creams and waxing have limited value and only recommended for short term use.
Electrolysis is effective but treatment of large areas is impractical. It can also be quite painful
Laser photothermolysis is the most effective hair removal method currently available. Several treatments are usually required. Cost may make it unavailable for some.

Last update: June 20, 2011