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Some women will notice the growth of extra hair in typically male patterns as they go through the menopause and afterward. What can you do about this condition, called hirsutism?

Have you noticed — probably to your horror — that you've suddenly got thick, coarse, hair growth in places typically associated with, well, men? Places like the upper lips (AKA "mustache"), chin, chest, around the navel, on your back, and even around the groin? This extra hair growth is called hirsutism, and it affects around one in 10 women, especially those with a Middle Eastern or Mediterranean background.

Excessive hair growth in male-like patterns is, unfortunately, more likely to appear around the time you go through the menopause, like so many other nasty things you'd rather do without. What do you need to know about hirsutism and its treatment?

What's hirsutism got to do with the menopause?

The cause of hirsutism can be found in higher levels of androgens, "male" hormones that women also have, just typically in lower doses. The decline in estrogen levels that you experience in the run-up to the menopause can be to blame for menopausal hirsutism, because even as you produce less and less of this typically female hormone, your testosterone levels stay more or less intact.

Hirsutism certainly isn't caused exclusively by the menopause — many women with polycystic ovary syndrome also have it, along with those who take medications like steroids and danazol. Hirsutism tends to run in families, too. In rare cases, it can also be the result of androgen-emitting tumors. 

What can you do to treat this extra hair growth?

Hirsutism can be treated with a combination of:

  • Medications
  • Hair removal methods
  • Treatment of the disorder that caused the hair growth, where applicable

Hirsutism: What can you do to eliminate those hairs?

Many women will already be familiar with all the different hair removal methods out there, but here's a comprehensive summary of options:

  • You can use tweezers to pluck the odd but stubborn hair that keeps appearing on your face. 
  • Shaving is the easiest and cheapest hair removal option for larger areas of hair growth on your body. 
  • Waxing is another viable option for the body, but generally not the best idea for the face, as it can lead to irritation.
  • Hair removal creams work well, but can again cause skin irritation — it's best to try a small patch first to see how you get on.
  • Bleaching creams don't remove the hair but do make it less visible — fair-skinned people may want to consider it for their facial hair.

Temporary hair removal methods may be the only treatment you need or want if your extra hair growth is fairly mild. For women with more severe hirsutism, there are more potent options, though.

Hirsutism: Bring out the more invasive treatment!

More permanent solutions can come to a body near you in the form of electrolysis or laser treatment. 

Electrolysis is a procedure during which small needles will indvidually be placed into your hair follicles. It sends a wave of electric energy there to take the follicle out of action. Disadvantages? Well, it hurts, and you may need a few sessions before the hair growth is dealy with. Also, it costs. Quite a bit. Upsides? The hair goes away. Forever. If you choose this option, make sure to have it done by a reputable practitioner.

Laser treatment involves lasers, concentrated beams of light, to again destroy follicles and eliminate further hair growth. The same pros and cons mostly apply. If you choose laser therapy, talk to your provider about special cautions you'll need to apply, like no sunbathing and no hair removal. Make sure to discuss possible side effects, like redness and pigment changes, and even burns.

Pharmacological approaches to hirsutism

You won't just be able to walk into your doctor's office and ask for medications — they'll want lab tests first, and will probably recommend lifestyle changes as well. However, for your information, these medications are sometimes used to treat hirsutism:

  • Birth control pills and other kinds of combined hormonal contraceptives can be used to treat hirsutism caused by excessive androgen production. They may be suitable for women going through the perimenopause, but not for post-menopausal women. 
  • Anti-androgens directly attack androgen production, and may be offered to you. Examples include spironolactone (Aldactone), which is very commonly prescribed for hirsutism, and cyproterone acetate. They are not suitable for women who are trying to get pregnant.
  • Topical creams like eflornithine (Vaniqa) are available by prescription to prevent further hair growth. These creams can also be used in conjunction with laser treatment, to make it more effective. They don't, however, eliminate hairs you already have. Eflornithine is suitable both before and after the menopause.
  • In the case of menopause-related hirsutism, estrogen replacement therapy can help out, and it is frequently offered together with the anti-androgens mentioned above. Anti-androgen treatment may be suitable as a stand-alone in women who cannot take hormone replacement therapy.
  • Gonadotrophin-releasing hormone (GnRH agonists) are for severe hirsutism with an ovarian-related cause that hasn't improved with other treatments. 
  • Metformin may be recommended to improve your insulin resistance.
  • In extreme cases, oophorectomy, a procedure in which your ovaries are removed, may be recommended. 

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