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April 13, 2022
Hirsutism (HUR-soot-iz-um) is a condition in women that results in excessive growth of dark or coarse hair in a male-like pattern—on the face, chest and back. This unwanted hair is referred to as “terminal hair” and it affects roughly 5 to 10% of women. It is a common reason why women visit the dermatologist.
Hirsutism can be emotionally distressing. And although hirsutism doesn't cause physical complications, the underlying cause, which is a hormonal imbalance, can. Facial hair growth during menopause is typically caused by an increase in the ratio of androgen (testosterone) to estrogen. This does not necessarily point to a problem, but the increase in facial hair can be bothersome.
Although hiruitsim or unwanted facial hair is usually experienced by pre-menopausal women, it can still occur in women who have gone through menopause or are going through menopause and experiencing significant hormone changes. Some of the reasons a woman may experience hirsutism before menopause include polycystic ovary syndrome, diabetes and even simply an increased sensitivity to androgens.
In post-menopausal women, the cause of facial hair is not necessarily the production of too much androgen, but instead due to the lower production of estrogen that occurs in menopausal women. If there are lower levels of estrogens, the balance between estrogens and androgens is thrown off, and there are more androgens in the blood and therefore the androgens act on hair follicles and create growth that looks similar to the effect of an overproduction of androgens. In some women, this can lead to a growth of too much facial hair. For this reason, it is not uncommon for menopausal women to notice new facial hair, such as unwanted hair in a moustache distrubition or the surprising appearance of stray coarse hair appearing as whiskers.
More often women complain about coarse chin hair that appears fairly regularly. If you are a woman that has a few chin hairs every now and then, this is very common and no reason to be alarmed. When hirsutism appears excessive and/or its onset is sudden, it is important to identify the cause of hirsutism and the excessive unwanted hair. Getting to the root of the cause of hirsutism can help in determining the best treatment. Important details to discuss with your doctor are the unwanted hair’s change in form and character, location and distribution of growth, and the rate of hair growth.
While unwanted facial hair that appears as a light upper mustache and on other areas of the face in a “male-like distribution” may be caused by high levels of androgen or other menopause-related hormone changes, it can also result from more serious causes such as disorders of the adrenal glands or ovaries.
Sometimes facial hair growth and excessive hair growth in and around the chin and cheeks and throughout the body after menopause can be caused by certain formulations of hormone therapy given to peri-menopause or menopausal women. Women on testosterone hormone therapy alone or in combination with estrogen or estrogen/progestin prescribed by a clinician can potentially deliver more testosterone than physiologically needed. Blood levels of testosterone can potentially reach serum levels as high as healthy males. Testosterone either through injections, creams or pellets placed surgically can cause unwanted hair growth, as well as the other symptoms of “virilization” such as deepening of voice, new onset of acne, reduction in breast size and balding.
Treatment of unwanted facial hair can vary, so it’s important to first determine the cause. More likely the cause of unwanted facial hair is the change of ratio of estrogen to androgens that women produce physiologically. In this circumstance, laser treatment performed and recommended by a dermatologist office is a popular mode of treatment. It is important to note that laser settings differ among women with differing pigmentation and a reputable and knowledgeable clinician should be aware of this to diminish chances of scarring or hyperpigmentation from treatment. Topical medication prescribed by clinicians can reduce unwanted hair growth by acting locally on the mechanism of hair growth within the dermis of the skin.
If you think you have too much coarse hair on your face or body, talk with your doctor about treatment options or review your current medications to see if there may be a link. Less common reasons for excessive unwanted hair growth during menopause that are serious can be due to ovarian or adrenal disorders.
To summarize, excess facial or body hair is often a symptom of an underlying medical problem. See your doctor for assessment if over a few months you experience rapid hair growth on your face or body or other signs of virilization discussed above. You may be referred to a doctor who specializes in hormone disorders (endocrinologist) or skin problems (dermatologist).
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