The Link Between PCOS and Excess Facial Hair

Facial hair growth by itself does not indicate that you have polycystic ovary syndrome (PCOS), though hirsutism—unwanted or excess body hair—is one of the most distressing symptoms of PCOS. 

In some cases, the exact cause of facial hair in women is never known, although it often runs in families.

Symptoms of Hirsutism

Most women have fine, light-colored, and barely noticeable thin hairs (called vellus hairs) that grow above the lips, on the chin, chest, abdomen, or back. This is usually referred to as "peach fuzz" and is normally developed in childhood.

When women have coarse, visible, dark hairs growing in the place of the vellus hairs in these areas, the condition is called hirsutism. These coarse hairs are referred to as terminal or androgenic hairs, and they normally develop during puberty.

Causes

If your body makes too many androgens or male hormones, like testosterone, you may experience unwanted hair growth, especially in the central part of your body (between your breasts, belly button, inner thighs). 

Some causes of excess androgen productions, and thus hirsutism, include the following conditions: 

• PCOS
• A tumor or cancer of the adrenal gland
• A tumor or cancer of the ovary
• Thyroid disease
• Cushing syndrome
• Congenital adrenal hyperplasia
• Hyperthecosis, a condition in which the ovaries produce too many male hormones)
• Excess growth hormone
• Insulin resistance

When PCOS Is to Blame

If you think your PCOS may be the cause of your hirsutism, you should see your healthcare provider about your symptoms.

Though there is no definitive test for PCOS, a diagnosis is usually made after your healthcare provider conducts an extensive review of your medical history and confirms the presence of symptoms such as: 

• Irregular or absent menstrual periods
• Signs of hyperandrogenism—like facial hair, hair loss, and acne—without another medical cause
• Weight gain or trouble losing weight and/or diabetes
• Skin tags in the armpit or neck area
• Darkening skin, especially along the neck, groin, or underneath breasts

To distinguish PCOS from other conditions, your healthcare provider will likely take a full medical history and perform a physical and pelvic examination to look for signs of PCOS (such as swollen ovaries or a swollen clitoris).

Usually, they'll also order blood tests to measure the following hormone levels:

• Thyroid function test to evaluate thyroid hormones produced by the body
• Fasting glucose test to measure blood sugar levels
• Lipid level tests to assess blood cholesterol

Other tests may also be ordered, such as:

• A pelvic ultrasound (sonogram): This creates real-time images of your reproductive organs so a healthcare provider can check for ovarian cysts and look at the endometrium (lining of uterus).
• A pelvic laparoscopy: This surgical procedure allows your healthcare provider to check for growths on your ovaries using a small camera.
• A tissue biopsy, if growths on your ovaries are present

Once all of the prescribed tests are performed, the healthcare provider will look at all of the results and clinical information to come to a medical diagnosis. 

Treatment Options

Since hair grows in different phases, in six-month cycles, hirsutism is generally a long-term condition. There are multiple treatment methods for unwanted hair, some of which are more effective than others.

Some examples include:

• Medication, such as birth control pills and anti-androgen drugs, such as Aldactone (spironolactone)
• Electrolysis, which has risks including swelling, scarring, and redness of the skin
• Laser hair reduction (this method works best on fair-skinned people with very dark hair)
• Shaving
• Chemicals, plucking, and waxing

For overweight or obese women, weight loss may help reduce excess hair growth.