Hirsutism and Menopause
Hirsutism is a common medical condition seen in women of all ages. It describes the presence of excess hair on areas such as the chin, chest, arms and legs, back and buttocks. Although Hirsutism is usually experienced by pre-menopausal women, hirsutism can still occur in those who have gone through menopause or are going through menopause.
Fifty-one is the average age that most women experience menopause. During this time a woman’s body will undergo a significant number of hormonal changes. The most significant amongst them is the reduction of estrogen, the primary female sex hormone. The reduction of estrogen has wide-ranging effects on the body. One such effect is the possible growth of excess hair.
Estrogen and Menopause
Changes such as a loss of bone density, thinning of the skin and hot flashes are experienced when estrogen levels decline. As this continues, it leaves the body more susceptible to the effects of male hormones such as testosterone. A woman’s body normally secretes a small amount of male hormones, but the effects are usually held in check by the presence of estrogen. With a decline in estrogen, male hormones begin to have an outsized effect on the body.
A high level of male hormones (androgens) within the female body will produce the same effects that are seen in men: hair growth on the face, chest and stomach, a deepened voice and hair loss. This effect is known as hyperandrogenism and it is the primary cause of hirsutism in post-menopausal women.
The Biology behind Hirsutism in Women after Menopause
Hirsutism shares many commonalities across women of all ages. But a key difference is the cause behind it. In pre-menopausal women, Hirsutism is mostly defined by the production of too much androgen. This is most often caused by a chronic hormonal condition called Polycystic Ovary Syndrome (PCOS).
In post-menopausal women, it is not necessarily the production of too much androgen, but due to the lower production of estrogen. If there’s lower levels of estrogens, the balance between estrogens and androgens is thrown off, and there are more androgens in the blood, which has an effect on the body similar to an overproduction of androgens. In some women, this can lead to a growth of too much facial hair. For this reason, it is not uncommon for menopausal women to notice new facial hair, such as a moustache, whiskers or mild balding.
Symptoms of Hirsutism
Postmenopausal women with excess hair growth may notice:
- Excess hair on the face and/or body
- Alopecia (balding or dramatic thinning of the hair)
Other symptoms of male hormone excess include:
- Deepening of the voice
- Clitoromegaly (an enlarged clitoris)
If hirsutism is accompanied by signs of virilization (e.g. balding, deepening of the voice, or clitoromegaly), an underlying androgen-secreting tumour may be the cause.
Causes of Hirsutism in Postmenopausal Women
Other than the hormonal levels being thrown out of balance, there are a couple of other causes that can lead to an excess of male hormones in the body, such as:
- Polycystic ovarian syndrome (PCOS)
The excess production of male hormones may still occur in post-menopausal women, if they are affected by the polycystic ovary syndrome (PCOS)
There are some medications that alter androgen/estrogen levels, or certain supplements may also contribute to postmenopausal hirsutism.
- Tumors of the ovary or adrenal glands
In very rare cases, hirsutism may be a sign of a serious condition. A combination of history, physical exam and diagnostic tests will allow your doctor to distinguish between benign causes or something more serious.
- Adrenal hyperplasia
Depending on the ethnic background of the patient, congenital adrenal hyperplasia (CAH) may be the cause of postmenopausal androgen excess
As it’s important to understand if there is an underlying cause to the excess hair growth, making an appointment with your doctor is crucial. They can then look into the issue and suggest treatment options for you. The diagnosis of hirsutism follows a number of steps. A blood test is the first, followed by imaging scans. In rare cases other tests may be needed. Should these be required, your doctor will guide you through the process.
The hormones testosterone and dehydroepiandrosterone sulfate (DHEA-S) are male hormones. Normally, these hormones are found in very low amounts in women. In hirsutism, their levels might be elevated.
Pelvic ultrasonography — A pelvic ultrasound scan is used in patients with suspected polycystic ovarian syndrome or with extremely high levels of testosterone. For example, if an androgen-secreting tumor is suspected. Imaging allows the doctor to get a closer look at the organs within the pelvic cavity.
Adrenal imaging — Adrenal imaging is indicated if the doctor has reason to suspect that an adrenal mass is present.
CT or MRI – both CT scan and MRI are non-invasive imaging tests that offer a more detailed view of the organs. If your doctor suspects that there may be a more complex reason behind the hirsutism, these scans may be carried out.
Treatment and Hair Removal
Treatment options depend on the cause of hirsutism, and your doctor will discuss the treatment options with you. But for the removal of hair, the methods below are the most popular and offer the best chance of success.
Physical removal techniques (waxing, plucking, tweezing)
These techniques are essentially the same idea — pulling the hair out at the root. Contrary to popular belief, plucking, waxing or tweezing will not make the hair grow back thicker. These techniques are temporary and hair usually grows back in a few days to weeks.
A topical cream that is applied to the face or area of unwanted body hair. Applied twice daily, the cream works by blocking a natural substance (an enzyme) that is needed for hair growth. Vaniqa slows hair growth and may also make the hair finer and lighter. However, results may not be seen for at least 4 weeks and only last as long as the cream is continuously used.
Electrolysis (or epilation) uses a direct electric current to kill the hair follicle at the root. If done properly (by a trained operator), it is recognized as the only true method of permanent hair removal. This technique requires a number of sessions to get rid of the hair permanently.
Laser treatment / Intense Pulsed light therapy (IPL)
A growing and more successful technique for hair reduction is the use of lasers or Intense Pulse light therapy (IPL). The key difference between laser and IPL is the type of light that the device uses. In terms of effectiveness, with a few caveats, both are thought to be equally effective.
Hirsutism in menopause should always be investigated by your doctor before treatment is started. Although the hair growth is likely due to a benign cause, it is best to get a full work-up to rule out anything more serious.
1) Management of Postmenopausal Virilization. Macarena Alpañés, José M. González-Casbas, Juan Sánchez, Héctor Pián Héctor F., Escobar-Morreale. The Journal of Clinical Endocrinology & Metabolism, Volume 97, Issue 8, 1 August 2012, Pages 2584–2588.