Excess hair (hirsutism)

What is excess hair growth?

Excess hair, or hirsutism, is where women grow thick, dark hair in a male pattern, on the face, neck, chest, tummy, lower back, buttocks or thighs. It happens because of changes in hormones called androgens, or because your body becomes more sensitive to them.

What causes excess hair growth?

The most common cause is polyendocrine metabolic ovarian syndrome (PMOS), a condition affecting the ovaries that was previously known as polycystic ovary syndrome (PCOS). It can also cause acne and irregular periods. Sometimes there's no obvious cause at all.

Less often, excess hair growth is linked to:

• the menopause
• certain medicines, such as some epilepsy medicines, steroids, or medicines like minoxidil or danazol
• other hormonal conditions, such as Cushing's syndrome or acromegaly
• congenital adrenal hyperplasia, a genetic condition affecting your adrenal glands
• a tumour affecting your hormone levels.

You're more likely to develop hirsutism if you have a family history of it, have obesity, or are of Mediterranean, Hispanic, South Asian or Middle Eastern descent.

Is all extra hair hirsutism?

Not necessarily. It's worth knowing the difference between two things:

• lighter, finer hair on your face or body is probably not hirsutism; most women get more of this as they get older, particularly after the menopause
• hirsutism itself may have an identifiable cause, such as PMOS, or no obvious cause at all, which is known as idiopathic hirsutism.

How is excess hair growth diagnosed?

Your GP will ask about your symptoms and look at where the hair is growing. They may use a scoring system called the Ferriman-Gallwey scale, which rates hair growth across different areas of your body; a combined score of 8 or more suggests hirsutism.

You may also be offered:

• a blood test, to measure your hormone levels
• a pelvic examination, to check for any growths or other changes
• imaging tests, such as an ultrasound, MRI or X-ray, to look more closely at your ovaries and adrenal glands.

How is excess hair growth treated?

There's no cure for hirsutism, but there are ways to manage it. If you're overweight, losing weight can help control your hormone levels and may ease your symptoms.

For removing or lightening the hair itself, options include:

• shaving, waxing, plucking, hair removal creams or bleaching at home
• a prescription cream (eflornithine) to slow hair growth on your face
• electrolysis or laser hair removal for longer-lasting results, though these aren't usually available on the NHS and can be expensive.

Sources differ on shaving and waxing. Some list them as safe, effective short-term options; others advise avoiding them, since repeated hair removal can sometimes irritate the skin or cause inflamed hair follicles (folliculitis).

If an underlying hormone condition is found, your GP or a specialist may also suggest:

• a contraceptive pill, to help regulate your hormone levels
• anti-androgen medication, to reduce the effect of these hormones on your hair follicles
• low-dose steroids or insulin-lowering medication, for some underlying causes.

Treatments can take weeks or months to show a difference, and none of them remove unwanted hair completely, but many people find a combination that works well for them.

When should I see a doctor?

See a GP if hirsutism is a problem for you, particularly if you also notice irregular periods, acne, oily skin or weight gain.

Ask for an urgent GP appointment if:

• new, thick, dark hair suddenly starts growing on your face and body
• your voice is getting lower
• your muscles are getting bigger.