What is the Difference between Hirsutism and PCOS?
Polycystic Ovary Syndrome (PCOS) is a chronic condition that affects 10% of women of reproductive age. It leads to symptoms such as weight gain, acne, hair loss, irregular menstruation, anxiety, depression, and also hirsutism, the presence of excess hair growth. And unlike its name, having polycystic ovaries, meaning a large number of follicles in the ovaries, actually doesn’t necessarily has to be the case to be diagnosed with it.
72 – 82% of women with PCOS are experiencing hirsutism, or excess hair growth. Hirsutism also can have other underlying causes such as Cushing syndrome, tumors, or medications, but in many cases, PCOS is the culprit.
But how are PCOS and Hirsutism connected?
What is PCOS?
PCOS is a chronic hormonal condition, meaning that it affects the hormonal system. Although many of the symptoms of PCOS are connected to the reproductive system and female hormones, researchers have now understood that it is not only a gynecological issue, but a metabolic syndrome that affects the whole body. PCOS is characterized by the presence of irregular menstruation, high androgen levels and insulin resistance.
Many symptoms of PCOS overlap with other conditions, which is why it’s important that your doctor performs a careful and in-depth diagnostic process. They may look for symptoms that are present, but also look to exclude other conditions that can cause the same symptoms.
Some of the symptoms of PCOS are:
- Weight gain or difficulty to lose weight
- Excess hair growth (Hirsutism)
- Moderate to severe acne
- Irregular menstruation or no menstruation
- Insulin Resistance
- Hair thinning
- Insulin Resistance
- Acanthosis nigricans (darkening and thickening of the skin)
- Mood changes
With PCOS being a metabolic condition, it can also increase the risk for long-term conditions such as:
- Diabetes Type 2
- Heart problems and high blood pressure (also called cardiovascular disease)
- Endometrial cancer
If you are experiencing some of the symptoms above, it’s important to discuss them with your doctor, as they can start the diagnostic process and discuss treatment options with you. As you can see, PCOS can lead to some serious long-term complications if it’s left unmanaged, which is why it’s important to raise the topic with your doctor. But what will happen then, and how is PCOS diagnosed?
For the diagnosis of PCOS, the Rotterdam Criteria are used, a set of diagnostic criteria to determine if it’s PCOS or not. For the diagnosis of PCOS, two out of these three criteria need to be present:
- Irregular menstruation, or absent menstruation
- Increased androgen levels; measured with a blood test but also looked for signs of it such as hirsutism and acne
- Polycystic ovaries: 12 or more follicles per ovary, or >10ml of ovarian volume
A series of tests will be done by your doctor to determine if you have PCOS, or if there’s another medical condition for which the symptoms look similar. These tests can include:
- Medical history and family history
- Physical examination
- Blood tests
- Ultrasound to check your ovaries
Also, other conditions that may mimic the symptoms have to be ruled out. They include conditions such as thyroid dysfunction, tumors of the adrenal gland and Cushing syndrome.
If your doctor has made a diagnosis of PCOS, they can then discuss the possible treatment options for you. Although there currently is no cure for PCOS, there are treatment options such as medication, lifestyle interventions and other therapies. Based on your goals and situation, you will then work on a treatment plan together with your doctor.
Treatment options for PCOS include:
- Lifestyle modifications
Lifestyle modification is the first line treatment for PCOS. Which changes you will want to implement depends on your specific situation. If you have gained weight or are obese, you may want to look into weight loss, as even a small weight loss of 5 – 10% of the body weight can improve ovulation and metabolic dysfunction. Exercising is encouraged, which can also help to improve the mood. For many women with PCOS, talking to a dietitian also helps to find a diet that works for you long-term.
There’s also a number of medications available that might be worth looking into with your doctor. Which medications are recommended depends on your specific situation and also your treatment goal, for example if you want to get pregnant or not. They can include medications such as the birth control pill, anti-androgens, anti-diabetic medications and fertility medication. Your doctor will discuss them in more details with you.
- Cosmetic Methods
For many of the physical symptoms, there are cosmetic methods that may be helpful. For example, hirsutism can be handled with physical hair removal (e.g. shaving, waxing). Acne can be treated with the help of a dermatologist, and baldness/hair loss can be treated with specialized hair loss shampoo. It’s best to connect with a dermatologist about all these methods.
Whichever method you may decide on, make sure to listen and follow your doctor’s advice, and if you have any questions about them, check back in with them or your healthcare team.
The Connection with Hirsutism
As mentioned above, one of the symptoms of PCOS is hyperandrogenism, meaning that the androgen levels in the body are too high. Androgens are male hormones, of which testosterone is the most well known one. It’s still not fully clear what causes PCOS, but researchers are working on it to understand the condition in more depth. But the androgen excess is one of the effects that it has on the body.
In 72% – 82% of women with PCOS, the androgen excess can lead to Hirsutism, the growth of excess body hair. This means that there is the growth of the darker, coarser hair type called terminal hair growing instead of the fine, lighter vellus hair. This happens because your hair follicles are sensitive to androgen, and too high levels of androgens can cause this switch. This mainly affects areas that have a high sensitivity to androgens such as the chin, chest, arms and legs, back and buttocks.
However, if you’re experiencing hirsutism, it doesn’t necessarily have to be because of PCOS. There are also other causes for hirsutism, such as:
- Cushing syndrome (excess production of a hormone known as cortisol)
- Adrenal hyperplasia (overproduction of the cortisol 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 )
If you experience hirsutism, make sure to discuss your symptoms with your doctor. They can then identify the underlying cause, may it be PCOS or another cause, and discuss the best treatment options with you.
Other than medical treatment, women who are affected by hirsutism can also choose to use several methods of hair removal:
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.
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. If you’re interested, you can learn more about semi-permanent or permanent hair removal here.
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.
Polycystic Ovary Syndrome (PCOS) is a chronic hormonal condition that affects 10% of women of reproductive age. It also has effects on the metabolism and increases the risk for long-term conditions such as diabetes. Hirsutism, or the growth of excess hair, is one of the symptoms of PCOS and is caused by the excess androgen levels of PCOS. If you experience the symptoms of hirsutism and/or of PCOS, it’s important to contact your doctor and go in for a doctor’s appointment. They can then identify the underlying cause and discuss the possible treatment options with you.