Hirsutism is known as increased hair growth in women. It is a disorder that follows a pattern called “androgen-dependent”, that is, it occurs in areas where hair is common in males but not in females, such as the back, groin, chest, face or hairline. It is a type of hair that can be generated by an increase in androgens which, under normal conditions, are present in all women.
Hirsutism must be distinguished from hypertrichosis, which refers to the presence of increased hair in thickness and quantity in normal areas for female distribution, such as the forearm, for example. In addition, the phenotypic characteristics of the patient’s skin color must be taken into account.
How do I know if I suffer from hirsutism?
Hirsutism is usually identified if an increase in hair is observed, as mentioned above, in androgen-dependent regions. In the Endocrinology consultation, it is quantified and assessed whether or not the patient has hirsutism, based on quantification scales, the most commonly used being the Ferriman-Galwey scale. Scores above 8-10 points are generally considered pathological.
Why does hirsutism occur?
Hirsutism is due to an increase in androgens, which are male hormones. In women they are also generated but in smaller quantities in the ovaries and adrenal glands.
In most cases, around 75%, it is due to the so-called “polycystic ovary syndrome”, which is usually accompanied by delayed or lack of menstruation, acne and insulin resistance.
In about 20% of cases the cause is unknown. Environmental factors, drugs, pregnancy or menopause itself may be in this group.
Less than 5% may hide serious pathologies, such as an excess of cortisol, growth hormone, adrenal or ovarian tumors, congenital alterations in hormonal pathways (such as congenital adrenal hyperplasia), etc.
When should I worry if I suffer from hirsutism?
The symptoms that should alert us and that should lead us to request an appointment with a specialist are usually cases of sudden onset of hirsutism (onset within months) and very larvae. In addition, if the hair is accompanied by “masculinization” in the form of a hoarser voice, clitoromegaly or alopecia, the study by the specialist should not be delayed. Likewise, it should also be consulted if it is accompanied by other symptoms, such as acne or menstrual delays.
What tests will be performed in consultation to assess whether I have hirsutism?
The first thing the specialist will do in consultation is a physical examination, as well as assessing the presence of symptoms associated with the pathology: intake of drugs, evolution of symptoms, etc.
It will also be essential to perform a blood test, 3-7 days after the onset of menstruation, to check androgen levels and other hormonal parameters.
Depending on the results, an imaging test may be required, such as an abdominal MRI, although in most cases, the above is usually sufficient to obtain the diagnosis.
What treatments exist for hirsutism?
Once hirsutism has been classified as non-pathological (if it is not, the appropriate therapeutic options should be applied), there are several alternatives depending on the severity of the symptoms and the discomfort that hirsutism may generate in the patient.
The first step would be aesthetic treatments: laser therapy, waxing… The second step would be pharmacological therapies.
There are also topical treatments that induce improvement in 70% of patients with continuous application. But, undoubtedly, the cornerstone is oral contraceptives which, in addition, can improve acne, if the patient has it, and regularize menstrual cycles.
Finally, drugs with an “anti-androgenic” effect can be associated with the above, which are also effective, but require close medical follow-up.