Hirsutism and the menstrual cycle

Top things to know:

• Hirsutism refers to excessive hairiness, particularly in male-typical areas like the face, chest, and back.
• Most often hirsutism is a symptom of extra androgens (like testosterone) in the blood.
• It’s most often – though not always – an indicator of polycystic ovary syndrome.
• There is a wide range of treatments available for managing hirsutism, including both hormonal and aesthetic treatments. Talk to your healthcare provider to determine the best option for you.

What is hirsutism?

Hirsutism is the medical term for growing more dark, coarse hair in areas like the face, back, and stomach than is typically expected in women (1). Though the medical explanation may seem daunting, as many as 8-10% of women and people with cycles are affected by hirsutism, excluding far-east Asian populations (2,3).

Sometimes hirsutism can be a side effect of medication (4,5), but more often it is a symptom of a hormonal imbalance caused by extra androgens (a type of hormone including testosterone) present in the blood. There are a few reasons why someone might have the kind of hormonal imbalance that can lead to hirsutism, but hirsutism is often seen as a clue that someone might have polycystic ovary syndrome (PCOS). Roughly 70% of people with hirsutism end up with a PCOS diagnosis (3), though extra hair growth alone is not enough to diagnose the disorder (6). If excess hair growth is a concern, a good place to start might be talking to trusted family members and bringing it up with a healthcare provider.

How do hormones affect hair growth?

There are three different types of hair in the human body: lanugo hairs (the fuzz babies are born with, which falls off shortly after birth), vellus hairs (the shorter, softer hair found on the face and body; “peach fuzz”), and terminal hairs (dark, coarse hairs, including pubic hair, eyebrow hair, and eyelashes) (3).

Androgens are responsible for changing many aspects of hair growth, including the size of the hair follicle (the cells that connect the root of the hair to your skin) and the size of the hair fiber (7). These same hormones are responsible for hair growth in many animals, from lion manes to the coats of deer (7). Androgens cause a few things to happen during hair development, but their primary role is in converting vellus hairs into terminal hairs (5,8)—this is why hair that is pale and soft in children becomes dark and coarse after puberty. In addition to changing the appearance, androgens also extend the growth phase for body hair, meaning that these hairs may be longer and darker than other hairs on your body (5,8).

Interestingly, it seems like androgens cause a different response in different parts of the body: while androgens work to increase the size and coarseness of hairs on the face and torso, they are also responsible for hair loss on the top of the head (think: male-patterned baldness) (7).

How is hirsutism assessed and diagnosed?

Hirsutism is usually graded on a scale called the “modified Ferriman-Gallwey” (mFG) score (8). A healthcare provider will examine nine areas of the body and give each one a score from 0-4 based on how much hair growth they see (8). Modified Ferriman-Gallwey scores range from zero to 36 (adding the score from each of the nine areas examined).

Mild hirsutism is considered a score below 15, while severe hirsutism describes individuals who score above 25 (3). However, standards are changing around the world as health practitioners begin to consider cultural and population differences when assessing hirsutism.

Among people with PCOS, hirsutism is more common in people of Hispanic, Middle Eastern, South Asian, and Mediterranean descent (9,10). But recent studies suggest that how we assess hirsutism varies considerably between ethnic groups (11). Researchers have recommended lowering the hirsutism cut-off for people of Chinese, Japanese, and Thai descent since people from these backgrounds tend to have less body hair in general (9,12). Medical standards for diagnosis and treatment are always changing as more research develops. Also, if aesthetic hair removal is being used (e.g. waxing, plucking or shaving), a healthcare provider might not notice any additional hair growth. It’s always recommended to check in with healthcare providers about your concerns.

How is hirsutism treated?

Healthcare providers can offer a few options for treating hirsutism (5,13). The treatments available will depend partly on the cause of the hair growth, and partly on the impact it has on a person’s life.

A healthcare provider might request a blood test in order to test hormone levels and determine whether a hormonal imbalance exists. Sometimes people with hirsutism are given medications like the birth control pill to help stabilize their hormones; sometimes healthcare provider will treat the hormonal imbalance directly with androgen blockers (13). Terminal hairs grow for about three to four months in the body (5), so there’s no need to worry if hormonal therapy takes a little longer to produce the intended results. Most anti-androgen treatments will show an effect within six months (14), but healthcare providers usually wait nine to twelve months before deciding if treatment has been effective for their patient (8). Healthcare providers might also check their patient’s medication list to see if changing some of their medications will help reduce any unwanted hair growth (4). Weight loss may help reduce hair growth as well, though this should be discussed with a healthcare provider (13). Aesthetic solutions are also available: some people choose to remove the excess body hair through waxing, electrolysis, shaving, or laser hair removal (13).

If facial and body hair is unwanted, some people may also struggle with social and emotional difficulties. For some people, hair growth outside of cultural expectations can be distressing; as a group, people diagnosed with hirsutism tend to struggle with anxiety, depression, and body discomfort at higher rates than other folks (15,16). Make sure you’re feeling supported as you consider your options. Finding friends or family you can talk with, seeking out therapy or psychiatric help, and having a solid self-care routine can really help you through these feelings.

There is no one “normal” way to grow body hair. Nipple hair, lip hair, and chin hairs grow in all kinds of ways on all kinds of people! And how people choose to work with it – from Brazilian waxes to dyed armpit hair—is a personal decision. Whether or not you opt for pharmacological treatments, aesthetic solutions, or to let your hair grow freely, spend some time experimenting to figure out what feels right for you. The internet can be a great place to see how other people are expressing themselves through their hairstyles. Here are a few awesome folks showing how so-called “abnormal” hair growth can be embraced:

Musician & artist JD Samson (Profiled in Marie Claire)
Model, activist Harnaam Kaur (on Instagram @harnaamkaur)
Opera singer Little Bear Schwarz

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