Dr Nitasha Gupta
Facial hair is a situation of embarrassment and distress for any women and many studies and researches suggest that over 20 million women have hirsutism (excess hair on female body). Apart from affecting their looks and beauty, this condition is also an indication of several other ailments including infertility. This condition is a signal of any hormonal imbalance or growing tumor due to excess hormone production.
Hirsutism is attributed to excess production of male hormone, testosterone. Though presence of light and soft facial hair may be common in females, but when the hairs are coarser and thicker indicates hormonal imbalance which may lead to complications.
Woman with hair on chin, abdomen or back is a clear indication of excess male hormones androgen which is produced by the adrenals or due to some ovarian disease. Such conditions have been shown to cause obesity and diminished fertility that often hinders with ovulation. Polycystic ovarian syndrome (PCOS) is one such condition that is highly linked to facial hair growth in females and poses major risk for diabetes and cardiac ailments as well. PCOS is a sub category of excess androgens, which is the most common cause of hormonal disorder in females and affects about 10% of the females according to the research done at Georgia Health Sciences University.
Hirsutism is such an important marker in determining that excess hair growth in women has a higher link to metabolic dysfunction, insulin resistance and heart diseases. The ovarian causes of hyperandrogenism are PCOS, congenital adrenal hyperplasia (CAH) and ovarian tumors. In most of the cases the causes are unknown and progresses slowly after puberty due to reduction in estrogen secretion and excess production of testosterone.
What are the causes?
Adrenals and both the ovaries produce Androgens. To some level, female hormones estrogen’s and progesterone subsides the effect of androgens. Following factors can lead to high androgen levels, that causes Hirsutism –
Genetics – family history of this condition poses higher risk. Skin sensitivity is another genetic factor which even with lower levels of testosterone can lead to coarse and thicker hair growth.
Polycystic ovarian syndrome (PCOS) – Women with PCOS are found to have excess facial hair growth and it can be the most common reason and indication of onset of declining reproductive health. PCOS causes the ovaries to develop many small cysts and overproduce male hormones causing irregular ovulation, menstrual disturbances and obesity.
Ovarian Tumours – In some cases androgen-producing ovarian tumours cause hirsutism and leads to rapid progression of the tumor. This leads to development of masculine characteristics with deep voice and enlarged clitoris among females.
Adrenal disorders – The adrenal glands, which are present just above each kidney, also produces androgens. Improper functioning of these glands can result in hirsutism and can also result in an inherited disorder known as Congenital adrenal hyperplasia (CAH).
Facial hair growth in females is an indication of complications in their reproductive system like PCOS, CAH, Uterine polyps which are one of the major risk factors in preventing pregnancy.
How does the doctor analyze?
If female presents herself with the chief complaints of increased hair growth it is necessary to analyse the hair distribution and growth trend. The doctor will perform the following evaluations to confirm the related complications.
Family history of the condition – the doctor will check for the age of onset of puberty, rate of growth pattern (sudden or gradual), other symptoms like irregular menstruation, loss of tissues in breast, increased libido, history of weight gain and diabetes. Examination may also be done to check for palpitation of abdomen for ovarian mass.
Several serum marker tests may be performed –
Testosterone – if the levels are slightly increased than the normal, benign pathology indicates PCOS or CAH. If the variation is too high than normal, it is an indication of malignant ovarian tumor.
Progesterone – This test is done during the early follicular phase of menstruation to mark for CAH.
LH/FSH – higher levels of the hormones indicate PCOS.
Prolactin – If the levels of the hormone are found to be raised, the patient may be suffering from hyperprolactinemia.
Serum TSH – Low amounts of the thyroid stimulating hormone leads to hypothyroidism and can cause fertility issues in females.
Treatment of Hirsutism and thus infertility
Medications – The priority lies in treating the reproductive health and hence the focus of the treatment lies in the underlying condition. If the problem is due to PCOS, then the primary goal is to induce ovulation through medication.
In case of women planning to conceive, oral medication to reduce aldosterone levels are prescribed on a daily basis. This helps in reducing testosterone levels and restoring fertility.
For women, treating hypothyroidism is an important part of any effort to correct infertility. If infertility remains after hypothyroidism has been corrected, other interventions to treat infertility may be needed.
(The author is a Gynaecologist & IVF Specialist)
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