Hirsutism in PCOS

hirsutism in pcos

Hirsutism is the most common cause of PCOS. However, there are many more potential reasons, like the Oversensitivity of the hair follicles to androgens, increased male hormone in the body, and more, leading to hirsutism.

So, let’s deep dive and see all the aspects of it.

What is PCOS & Hirsutism?

Today we will be talking about Hirsutism in PCOS but first, let’s understand them separately. Hirsutism is a condition found in females where the hair growth increases and reaches up to a level that starts growing coarse hair like in a male. The areas affected by hirsutism are the face, abdomen, sideburn area, around the nipples, chest, inner thighs, and back. It is a common symptom of PCOS.

If hirsutism hits someone before puberty, it might lead to a deeper voice. Well, it can be because of the tumor.

Males and females both have male and female hormones, but in females, when the male hormone is more instead of female, it leads to hirsutism. The imbalance of hormones happens due to an increase in male hormone(androgens), mainly testosterone.

PCOS is also known as Polycystic ovary syndrome. Found in females as this condition is related to ovaries. In PCOS, the hormone balance in an individual is not as it should be because the body produces more male hormones than individuals who don’t have PCOS.

Many small follicles get mature in the ovaries that appear in the cyst. Well, these cysts are immature ovarian follicles that fail to mature and ovulate.

PCOS is a syndrome that affects the ovaries and ovulation as it leads to cysts in the ovaries, high levels of male hormones, and irregular or skipped periods.

Symptoms of PCOS

Hormonal imbalance in the body brings a lot of changes in the body. Moreover, if the hormones are of different sex, then the symptoms can be strange and shocking. An increase in androgen leads to PCOS, and PCOS accompanies many more things. Well, I have listed some for you:-

  • Hirsutism is one of the most common symptoms of PCOS. More than 70% of the women with this condition found an increase in hair on their face and body. It also causes hair growth on their belly, chest, and back.
  • Irregular periods, as PCOS affects ovulation, it prevents the uterine lining from shedding every month. The frequency may vary between 8 times a year to none.
  •  Heavy bleeding, as periods don’t happen often, the lining becomes thicker, which leads to heavy bleeding than usual.
  • Acne, a male hormone, may lead to oilier skin and breakouts on areas like the face, chest, and upper back, leading to acne.
  • Cardiovascular diseases, too low or too high androgen level leads to Cardiovascular diseases. 
  • Weight gain is the most common symptom. More than 80% of women gain weight.
  • Difficulty in Pregnancy
  • Head hair loss
  • Infertility
  • PCOS has a variable nature reason being it is diagnosed based upon the combination of clinical, ultrasound, and laboratory features

Causes of hirsutism

Well, PCOS is not the only reason for hirsutism; there are numerous reasons behind hirsutism. Let’s understand them.

  • Hormonesmale hormone (androgen) increase in the body also leads to hirsutism.
  • An increase in androgen also leads to increased body size and pigmentation of hair.
  • Oversensitivity of the hair follicles to androgens is also a reason.
  • PCOS leads to small cysts which get formed on your ovaries. It affects 5-10% of women.
  • Insulin, when the insulin level is high in that scenario, hormones that usually help absorb energy from sugars then might start contributing to the development of hirsutism.
  • Such a situation is possible with a person with type 2 diabetes or an insulin resistance individual.
  • Tumor on an individual’s adrenal gland or ovaries
  • Cushing’s syndrome, an individual gets into that situation when one has high-level stress hormone cortisol for an extended period. Women on chronic steroid therapy usually get such features as a round face, muscle weakness, and diabetes.
  • Medicines, some medicines might imbalance the level of hormones in the body.
  • Unknown hirsutism, in few individuals, their follicles are found unusually sensitive to androgens. Those women have controlled levels of androgen, and even menstrual cycles occur regularly. The exact reason is not known, but it gets developed because of genetics.
  • NCAA (Non-classical Adrenal Hyperplasia) is an abnormality of the adrenal glands, leading to hirsutism and an inherited disorder.

There is a possibility that a female individual might have hair growth at a rapid rate and still have an average androgen level; this condition is called idiopathic hirsutism. Idiopathic hirsutism states that there is no effect of the disorder.

Diagnosis

An increase in the hair growth on the face, abdomen, sideburn area, around the nipples, chest, inner thighs, and back doesn’t need to mean that an individual has hirsutism. Henceforth, it is very crucial to check and be sure before proceeding further. We can not make assumptions and move forward on that basis.

The tests and diagnosis depend upon the medical history of the patient’s history and physical findings.

  • The first step would be to get a blood test to check the hormone levels (testosterone and like hormones) in the blood. The blood test would give clarity that is increased androgen level a level of hirsutism or not.
  • To test insulin, as that is also a reason, you might have to get a glucose and C-peptide test done.
  • There is no such test to diagnose PCOS; the doctor might have to take symptoms, blood tests, physical exams. In some cases, you might have to get a pelvic ultrasound test done to detect PCOS.
  • To detect an Adrenal Gland Tumor, one may have to go through many tests, as with one trial, one can not conclude. Henceforth a person might have to get:-
    • Blood and urine test
    • Biopsy
    • CT or CAT scan
    • MRI
    • Metaiodobenzylguanidine scan
    • Adrenal Vein Sampling
  • To check if someone is suffering from Cushing’s syndrome or not, then there are some series of tests one has to go through:-
    • Urine and blood test
    • Saliva test
    • Imaging tests, CT, or MRI, can provide images of your pituitary and adrenal gland to detect
    • Petrosal sinus test

These were few standard tests one has to go through depending upon your doctors’ symptoms.

Treatments

Now, we are aware of the diagnosis procedure; let’s see which methods and ways to treat it. If you have tried cosmetics and hair removal and are still not satisfied with the results, you may consider talking to your doctor.

The tenure of the treatment will depend upon the age. Moreover, and the secretion of androgen Well, some of the ways which your doctor might as well recommend are:-

remove hair

Temporary hair removal

  • Shaving is the most common method of hair removal. It is fast, safe, and convenient, but one has to shave regularly
  • Reducing weight will also lower the androgen level helping in reducing unwanted hair.
  • Bleaching helps to lighten the tone of unwanted hair. Note that some bleaches may lead to irritation
  • Waxing and plucking is another way to remove hair, but it can be a bit painful, and it may also irritate the hair follicle
  • Depilatory products are a great way to dissolve hair. These products may irritate sensitive areas.

Contraceptives

Birth control pills or any other pill will help control hirsutism caused by excess androgen production as it restricts the excretion of estrogen and progestin. Oral contraceptives are a widespread and famous treatment chosen by women who don’t want to be pregnant.

Side effects- Nausea, headache, breast tenderness, GI stress and might lead to intolerance to contact lenses.

Drug- Ethinylestradiol with norgestimate, desogestrel, norethindrone, ethynodiol diacetate

Consumption– 1 pill/tablet per 21 days followed by 7days pill-free interval

Price range– Pills are available at INR.50/pack, and IUDs range between 300-500 in private setups. Well, the Indian government provides it for free at family planning centers. Levonorgestrel is the only emergency contraceptive approved in India.

Drugs

Apart from contraceptives, many drugs block and prevent androgens from mediating their biological effects in the body.

Anti- Androgens

They block androgens from getting attached to our body receptors. Therefore, anti-androgens usually are advised after oral contraceptives are not compelling enough.

DrugSpironolactone (Aldactone)Flutamide (Eulexin)Finasteride (Proscar)
Intake50-200mg/day250mg. twice a day5mg/day
Side effectsGynecomastia and theoretic feminization of the male fetusKeep a check on liver functionKeep a check on liver function
Price RangeIt ranges between INR250-800/boxRanges between INR90-600/boxRanges between INR37-200
Prices may vary as these are the prices as per May 2021

Topical hair growth retardant

Hair growth inhibitors are applied over the skin as this is a hair growth removal method to reduce excess body hair. Growth retardants are preferred to use after removing skin hair, and they work better on light hair over dark hair. In addition, they work best in the facial area as the hair there is short and more delicate.

They deplete the supply of nutrients to the hair follicles, which results in reduced hair growth.

laser treatment

Long-Lasting procedures

The methods mentioned above may last for few months, but the undermentioned therapies would last even longer.

Laser Treatment

A laser beam passes over your skin to damage the hair follicles, preventing hair growth on that area further. How many times one has to go through this treatment depends. Laser treatment gives the best results to people with black or brown hair color.

People with tanned/ dark complexion have a higher risk of side effects from certain types of lasers, including darkening or lightening their actual skin tone. Henceforth, one should consult his/her doctor about the possible side effects of it.

Electrolysis

In this method, a tiny needle is inserted into each follicle as that needle emits a pulse of electric current which damages the follicle. As the follicle gets damaged, then hair growth will stop. It is an effective method, but it can be painful.

Even in Electrolysis, you might need few sittings depending upon various factors. Electrolysis results are best seen in people with white or blond hair color.

Electrolysis is somewhat time-consuming, painful, and expensive.

Conclusion

Hirsutism is one of the most common reasons for PCOS. However, if treated well, hirsutism can get better up to a level where except you, no one will be aware that you have hirsutism. Therefore, you need to find the best and the most suitable way according to your body type and nature.