What is the Difference between Hirsutism and PCOS? 

how are pcos and hirsutism related

Polycystic ovarian syndrome (PCOS) and hirsutism are words that are used interchangeably. The term hirsutism can be both a medical diagnosis and a symptom. For example, a woman

might be diagnosed with hirsutism (a medical condition) which is caused by a hormonal problem. But it’s equally correct for someone with polycystic ovarian syndrome to complain about hirsutism, as a symptom. Use of the term hirsutism can be confusing but the context that it is used in is what matters. 

Hirsutism as a medical condition

Hirsutism is the growth of excess body hair in women in areas such as the face, back or chest. And like any other medical condition, the cause of hirsutism needs to be found. This will allow for appropriate treatment to be started. Some factors that promote excessive hair growth in women are: 

  • A hormonal imbalance within the body
  • Certain medications or supplements
  • Problems with the adrenal gland (a part of the body that secretes hormones)
  • Genetics

However, the number one cause of hirsutism is polycystic ovarian syndrome. In fact, according to some studies, polycystic ovary syndrome accounts for 72 to 82 percent of all hirsutism cases

Hirsutism as a symptom (of Polycystic ovarian syndrome)

Hirsutism is not just a medical condition. It can also be a symptom. Hirsutism may be a symptom of an adrenal problem or of polycystic ovarian syndrome (PCOS). In this context, PCOS is the medical condition and hirsutism is just one of its symptoms.

To further differentiate between PCOS and hirsutism, PCOS is known as an endocrinological disorder. It is caused by the excess production of male hormones within the female body. Every woman produces a small amount of male hormones like testosterone but women with polycystic ovarian syndrome produce an excessive amount. 

The three main features of PCOS are: cysts in the ovaries, high levels of male hormones and irregular or skipped periods

Women with PCOS may experience symptoms such as:

  • Weight gain
  • Male-pattern baldness or alopecia
  • An irregular period
  • Acne 
  • Darkening of the skin (dark patches of skin form in body creases like those on the neck, in the groin, and under the breasts)

Diagnosing polycystic ovarian syndrome or hirsutism 

The diagnosis of both polycystic ovarian syndrome (PCOS) and hirsutism will differ.

The diagnosis of PCOS can be made relatively easily with a blood test and an ultrasound scan. Doctors will look for a blood test that has a high level of male hormones. They might also carry out an ultrasound scan to look for the growth of tiny cysts on the ovaries –the hallmark of PCOS.

The diagnosis of hirsutism requires a little more work. It involves a more comprehensive look at your personal medical history, past medical history, family history and of course any medications that you might be taking. Doctors will still carry out a physical examination and conduct tests but these can be more extensive in nature and scope. A blood test will look for the presence of excess male hormones within the body. Following this, an imaging test (ultrasound scan, CT or MRI) might be used to further evaluate the cause of hirsutism. 

Other causes of hirsutism 

Apart from Polycystic ovarian syndrome, your doctor will search for other causes of hirsutism such as:

  • Cushing syndrome (excess production of a hormone known as cortisol)
  • Adrenal hyperplasia (overproduction of the cortisol hormone by the adrenal glands)
  • Medications (such as women taking long-term oral steroids, androgenic medications)
  • Ovarian or adrenal tumors (on rare occasions, an androgen-producing tumor may develop in the ovaries or adrenal glands)
  • Genetics (Excessive hair growth may run in the family. A mother, sister or grandmother who suffered from hirsutism makes you more susceptible to developing it yourself )

Treatment of polycystic ovarian syndrome and hirsutism

The treatment of polycystic ovarian syndrome and hirsutism are similar yet different. In both cases, women attempt to address the cause of excess hair growth. 

PCOS is caused by high levels of male hormones circulating within the body. So the full array of treatment includes the use of medications like oral contraceptive pills, metformin (a drug used to treat type 2 diabetes) or clomifene citrate (a fertility drug that helps women with PCOS get pregnant). All are common treatment options. 

If hirsutism is the medical diagnosis, then treating the primary cause is most important. Doctors must first carry out a number of tests to determine what is behind the excess hair growth. Following this, different options may be appropriate. 

Treatment of excess hair 

Treatment of hirsutism can broadly be broken down into these different categories:

Physical treatments – such as shaving, waxing or plucking. These are relatively cheap options that offer immediate results. However, hair regrows within a short period of time. Side effects include irritation of the skin, folliculitis and redness.

Face creams- like Vaniqa are applied directly to the face. Results are usually seen after a few weeks of routine treatment. However, once stopped, hair growth will revert. 

Medications -like Spironolactone, flutamide or birth control pills. These may be used in the treatment of PCOS or if the adrenal gland produces too much male hormone

Electrolysis –this is considered the only permanent way to remove hair. However, because it is dependent on the skill of the electrologist, results may vary. A fine needle is inserted near the base of the hair shaft where heat or an electrical current is applied. This allows the hair to be removed. The technique is repeated over the course of a few sessions before permanent hair removal will be seen.

Laser treatments/IPL– are popular hair removal techniques. Lasers are used to destroy the hair follicle at the source. Their ease of use, long term results and good side effect profile have given these techniques widespread acceptance 

With the exception of electrolysis, all other methods of hair removal only provide temporary reduction of hair. And electrolysis itself has is limited by the skill of the operator. IPL and laser treatments appear to offer the most success at significantly slowing down hair growth or reducing its presence. 

Depending on whether you’ve been diagnosed with hirsutism or if hirsutism is just a symptom of PCOS, your treatment options will depend on what the true cause of excess hair growth is. So a trip to see your doctor is the best place to start.

References

1) American Family Physician (AAFP). Am Fam Physician. 2012 Feb 15;85(4):373-380.

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