Hirsutism as a Symptom of PCOS

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 and the condition often runs in families.

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, which normally develop during puberty. However, if a woman's 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, may include the following conditions: 

• PCOS
• A tumor or cancer of the adrenal gland
• A tumor or cancer of the ovary
• Thyroid disease
• Cushings syndrome
• Congenital adrenal hyperplasia
• Hyperthecosis (a condition in which the ovaries produce too many male hormones)
• Use of certain medicines, such as and not limited to: 
  • Testosterone
  • Danazol
  • Anabolic steroids
  • DHEA
  • Glucocorticoids

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

• Irregular or absent menstrual periods
• Signs of hyperandrogenism—like facial hair, hair loss, and acne—without another medical cause.
• Trouble losing weight and/or diabetes

To distinguish PCOS from other conditions, a doctor will take your 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, your doctor will also order a blood test to measure the following hormone levels:

• Thyroid function test to determine 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 vaginal ultrasound which allows your gynecologist to create real-time images of your reproductive organs.
• A pelvic laparoscopy (a surgical procedure) allows your doctor to check for growths on your ovaries using a small camera.
• If growths on your ovaries are present, a small tissue sample (a biopsy) may be required for further examination.

Once all of the prescribed testing is completed, the doctor will look at all of the results and clinical information to come to a medical diagnosis. If you think your PCOS may be the cause of your hirsutism, you should see your physician about your symptoms.

Since hair grows in different phases, in long 6-month cycles, hirsutism is generally a long-term condition. There are multiple treatment methods for unwanted hair and some treatments last longer than others. Some examples include:

• Medication such as birth control pills and anti-androgen drugs (spironolactone)
• Electrolysis used to permanently damage individual hair follicles. Expensive as multiple treatments are needed and risks include swelling, scarring, and redness of the skin.
• Laser energy directed at the melanin hair. This method works best with very dark hair.
• Shaving
• Chemicals, plucking, and waxing.
• For overweight or obese women, weight loss may help reduce excess hair growth.