Hirsutism in Women - Latest Womens' Hirsutism Information
Hirsutism in woman





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Hirsutism in Woman

Polycystic Ovaries or PCOS is a common cause of hirsutism in women. The exact cause of PCOS is unknown, however, PCOS is believed to develop when the ovaries overproduce testosterone. This iscaused by the overproduction of luteinizing hormone (LH), which is produced by the pituitary gland.

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Hirsutism (Unwanted Facial Hair In Women) Information
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Hirsutism is the development of androgen-dependent terminal body hair (dark course pigmented hair normally seen on the face, underarms, scalp, eyebrows and pubis) in a woman and in other places where this type of hair is not normally found in women.

Remember a woman's definition of hirsutism may differ secondary to her ethnic background. Any definition of normal body hair should consider both race and ethnicity. For example, most Asian and/or Native American women have little body hair, while most women from the Mediterranean have moderately heavy body hair. However, the most important consideration in diagnosing hirsutism is the extent to which a woman's normal pattern of hair growth has changed. Although hirsutism can occur in both men and women, it is usually only a problem for women.

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Causes of Hirsuitism

The most common causes of hirsuitism are idiopathic hirsutism and polycystic ovary syndrome:

Idiopathic hirsutism is the diagnosis given to women with hirsutism and no other presenting clinical abnormalities. Women with idiopathic hirsutism generally present with normal levels of serum androgen concentrations.

Polycystic ovary syndrome is the most common cause of androgen excess in women. Polycystic ovary syndrome (PCOS) is a common disease affecting 3-5% of women of reproductive age. PCOS usually presents with the following symptoms:

  • Menstrual abnormalities - PCOS is often diagnosed during puberty secondary to menstrual irregularities. Infrequent, irregular or absent menstrual cycles are common. Once the period does arrive they are often uncharacteristically heavy. This abnormal menstrual cycle is an indication that there may be a problem with ovulation. The use of oral contraceptives can often delay the presentation of PCOS.
     
  • Androgenic symptoms - androgens are a group of hormones, such as testosterone, found predominantly in men, however, they are also present in women in lower levels. Woman with PCOS have considerably higher than normal levels of androgens which causes the characteristic excessive hair growth. Some woman also experience acne and male pattern hair loss.
     
  • Infertility - secondary to the disruption in the menstrual cycle many women are infertile. However, some women with PCOS will ovulate normally, some will ovulate less frequently and some will fail to ovulate.
     
  • Obesity - some 40% of woman with PCOS are considered to be obese. Unfortunately, the obesity will exacerbate the symptoms associated with PCOS. The hormone changes associated with PCOS make weight loss difficult.

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Other less frequent causes of hirsutism include the following:

  • Medications - Danazol and the androgenic progestins present in some oral contraceptives such as norgestrel can result in hirsutism.
     
  • Hyperprolactinemia - should be ruled out in patients with hirsuitism, ameorrhea and a breast discharge.
     
  • Congenital adrenal hyperplasia - affected girls will generally present around puberty with hirsutism and menstrual irregularity or primary amenorrhea. Excess androgen production is a key feature of most forms of congenital adrenal hyperplasia. Congenital adrenal hyperplasia is usually recognized at birth or early in infancy.
     
  • Hyperthecosis - is a nonmalignant ovarian condition resulting in increased serum testosterone concentrations. Women with hyperthecosis are generally obese and have a long history of sever hirsutism. Unlike PCOS, which occurs only during the reproductive years, hyperthecosis of the ovaries can occur in postmenopausal women.
  • Ovarian tumors - hirsutism caused by an androgen-secreting tumor generally occurs later in life and progresses very rapidly.
     
  • Adrenal tumors - adrenal tumors are a rare cause of hirsutism.
     
  • Severe insulin resistance syndromes - hirsutism is also associated with women who have a severe insulin resistance marked by hyperinsulinemia.

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You should note there are two conditions characterized by generalized hair growth that do not represent true hirsutism:

  • Hypertrichosis - which refers to diffusely increased total body hair. This is a rare condition that is usually caused by a systemic illnesses or a medication.
  • Androgen-independent hair - which is the soft, vellus, unpigmented hair that covers the entire body. In infants, this hair is called lanugo.
Symptoms of Hirsutism

Hirsutism can present with a broad spectrum of symptoms including the following:

  • Excessive hair growth - individuals with hirsutism will often present with excess hair on areas of the body where hair follicles are sensitive to androgens including: face, chest, breast, lower back, midline region of the lower abdomen, inner thigh, arms, legs, etc.
     
  • Acne - excess androgen associated with hirsutism can also contribute to the development of acne, which may occur on the face, chest and/or upper-back.
     
  • Irregular menstrual cycle - increased androgen levels can also disrupt the normal menstrual cycles. In severe cases may cause women to be anovulatory.

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Diagnosis of Hirsutism

The diagnosis of hirsutism is based on a family history of hirsutism, a personal history of menstrual irregularities, and the presentation of masculine traits. The patients medical history can often reveal enough information were no other diagnostic testing is needed.

However, if a physician deems that further testing is needed the following represent the most common diagnostic procedures:

  • Ovarian ultrasound - represents most consistent investigation in PCOS is ovarian ultrasound, although a skilled ultrasound technician is necessary. The typical ultrasonic presentation are those of a thickened capsule, multiple 3-5mm cysts and hyperechogenic stroma. In addition, it should also be noted that prolonged hyper androgenization from any cause may result in polycystic changes in the ovary. The use of ultrasound may also show virilization ovarian tumors.
     
  • 17-x-Hydroxyprogesterone - is elevated in classical congential adrenal hyperplasia (CAH), but may be apparent in late-onset CAH only after stimulation.
     
  • Gonadotrophin levels - LH hypersecretion is a consistent feature of PCOS, but the pulsatile nature of secretion of this hormone means that an increased LH/FSH ratio is not always observed on a random sample.

    Serum testosterone levels
    - may be elevated in PCOS and is invariably substantially raised in virilization tumours. Patients with hisutism and normal testosterone level frequently have low levels of sex hormone binding globulin (SHBG), leading to high free androgen levels.
     
  • Additional androgens - androstenedione and DHEA sulphate are frequently elevated in PCOS, and even more elevated in congenital adrenal hyperplasia including virilizing tumours.
     
  • Serum prolactin - mild hyperprolactinaemia is common in PCOS.

In addition, If a virilization tumor is suspected clinically or after investigation, then more complex tests may include dexamethosone suppression tests, MRI, CT, etc.

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Treatment of Hirsutism

There are various treatment options which should be discussed with the patient:

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Oral contraceptives - combination (estrogen and progesterone) oral contraceptives are indicated for women with idiopathic, familial hirsutism and PCOS. Women with hypertension, bleeding or clotting disorders, migraines, smoker or a family history of breast and/or uterine cancer, should not use oral contraceptives to treat hirsutism.

Oral contraceptive or Depo-Provera injections establish a regular menstrual cycle but do not restore ovulation. Oral contraceptives also suppress the ovarian production of androgens, which is why they are to improve the symptoms of hirsutism and acne.

Diabetes medications - glucophage an insulin sensitizer used primarily in the treatment of diabetes, may decrease insulin resistance and promote ovulation in women with PCOS. This oral medication is not approved by the U.S. Food and Drug Administration (FDA) for this indication, nor is it appropriate for those who have kidney or liver disease.

Blood pressure medication - spironolactone is prescribed primarily as an oral blood pressure medication. However, the medication is also a synthetic steroid with an aldosterone-like structure that acts as a competitive antagonist at aldosterone receptors. Thus, the medication blocks androgens from binding to their receptor reducing the effects of hirsutism. Spironolactone is not FDA approved for the treatment of hirsutism (may cause birth defects).

Male pattern baldness medication - the commonly used medication for male pattern baldness, finasteride brand name Propecia has been shown to improve the effects of hirsutism. Once again, this medication is not FDA approved for the treatment of hirsutism (may cause birth defects).

Mechanical hair removal -remains one of the most popular treatment options for the treatment of hirsutism. Mechanical treatment involves bleaching or physically removing unwanted hair: Shaving, plucking, waxing, electrolysis, laser hair removal, bleaching, depilatories, etc.


Hirsutism vs. Virilization

Virilization is esentailly hirsutism with signs of masculinization in a woman. Virilization may include an increase in body hair, facial hair, deepening of the voice, male pattern baldness, clitoral enlargement and the cessation of the menstrual cycle. Virilization is not as common as hirsutism, the physical changes associated with virilization is indicative of androgen levels that are extremely high. Virilization may be caused by either an adrenal or ovarian tumor which may be malignant. Individuals who suspect virilization should urgently visit an endocrinologist to undergo a thorough workup.

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