Short answer: Hirsutism is a symptom: coarse, dark hair growing in a male-type pattern in women. PMOS, previously called polycystic ovary syndrome (PCOS), is a hormonal and metabolic condition and the most common cause of hirsutism. About 70-80% of women with hirsutism have PMOS. But you can have hirsutism without PMOS, and PMOS without hirsutism. Getting the right diagnosis matters, because PMOS also affects your periods, fertility and long-term health.
More on PMOS: PMOS facial hair: why it happens and what helps, PMOS hair removal and what the new name PMOS means.
Hirsutism and PCOS are often mentioned in the same breath, and many women are told they have “PCOS hair”. The two are closely linked but are not the same thing. This article explains what each one is, how they are connected, how doctors tell them apart, and what that means for treatment.
What is hirsutism?
Hirsutism means excess terminal hair, the coarse, dark kind, in women in areas where men typically grow hair, such as the upper lip, chin, chest, abdomen, back and thighs.[1] It happens when androgens, hormones such as testosterone, act on hair follicles that are sensitive to them. Doctors measure it with the modified Ferriman-Gallwey (mFG) score, which rates nine body areas from 0 to 4.[1] You can learn more in what is hirsutism? or try our hirsutism self-check.
Hirsutism is a sign that something is going on with your hormones or your hair follicles’ sensitivity to them. It is not a diagnosis of the cause.
What is PMOS (formerly PCOS)?
In May 2026, polycystic ovary syndrome was officially renamed polyendocrine metabolic ovarian syndrome (PMOS) after a global consensus process involving 56 organizations and more than 14,000 survey responses from patients and health professionals. The old name suggested the condition was about ovarian cysts, which is misleading. The new name reflects that it involves several hormone systems, metabolism and the ovaries. PMOS affects about 1 in 8 women.[2] The change is being phased in, so you will still see “PCOS” on many websites and in older studies.
The 2023 international guideline estimates that 10-13% of women worldwide have the condition.[3] It can involve:[3], [4], [5]
- Irregular or missing periods, because ovulation does not happen regularly
- Signs of high androgens, such as hirsutism or acne
- Many small follicles on the ovaries on ultrasound, or a high anti-Müllerian hormone (AMH) level
- Insulin resistance and a higher risk of type 2 diabetes
- A higher risk of depression and anxiety
How PMOS is diagnosed
In adults, PMOS is diagnosed when at least two of these three are present, after other causes have been ruled out:[4]
- Clinical or biochemical hyperandrogenism, meaning hirsutism or acne, or high androgen levels on a blood test
- Ovulatory dysfunction or irregular cycles
- Polycystic ovarian morphology on ultrasound, or a high AMH level
Some details that often confuse people:[3]
- You do not need “cysts” on your ovaries to have PMOS. If you have irregular cycles and signs of high androgens, an ultrasound or AMH test is not needed for diagnosis.
- For adults, polycystic ovarian morphology now means 20 or more follicles in at least one ovary. Older criteria used a lower count of 12.
- Ultrasound is not recommended for diagnosing PMOS in adolescents.
How are hirsutism and PMOS connected?
Many women with PMOS have raised androgen levels.[3] Insulin resistance, which is common in PMOS, is linked to hirsutism too.[6] The extra androgens reach androgen-sensitive hair follicles and turn fine vellus hair into coarse terminal hair.[1]
The link is strong in both directions. The Endocrine Society estimates that 70-80% of women with hirsutism have PMOS.[1] In a study of 950 women referred to Italian endocrine clinics for signs of androgen excess, 72.1% had PCOS.[7] And the 2023 international guideline says hirsutism on its own should be considered a sign of high androgen levels and possible PMOS in adults.[3]
Different score cutoffs
The 2023 PCOS guideline uses an mFG score of 4-6 or more, depending on ethnicity, to define hirsutism.[3] The Endocrine Society hirsutism guideline uses 8 or more for Black and White women in the US and UK, with other cutoffs for other groups.[1] The Endocrine Society adds that unwanted hair of any amount deserves attention if it bothers you. Our guide to the Ferriman-Gallwey score explains this in more detail.
Hirsutism vs PMOS at a glance
| Hirsutism | PMOS (formerly PCOS) | |
|---|---|---|
| What it is | A symptom: male-pattern terminal hair in women | A hormonal and metabolic condition (a syndrome) |
| How common | About 10% of women[6] | 10-13% of women[3] |
| How it is assessed | Hair score (mFG), then blood tests for the cause[1] | At least 2 of 3 criteria: high androgens, irregular cycles, ovarian findings[4] |
| Possible causes | PMOS, idiopathic hirsutism, adrenal conditions, medicines, rare tumors[7], [5] | Not fully understood. Strong genetic and metabolic factors.[8], [2] |
| Affects | Mainly skin and hair, and how you feel | Periods, fertility, metabolism, heart health, mood and skin[3] |
Can you have hirsutism without PMOS?
Yes. In the Italian clinic study, about 28% of women with signs of androgen excess had something other than PCOS:[7]
- Idiopathic hyperandrogenism (15.8%): high androgens with regular cycles and normal ovaries
- Idiopathic hirsutism (7.6%): hirsutism with normal androgen levels and regular cycles
- Non-classic congenital adrenal hyperplasia (4.3%): an inherited adrenal condition
- Androgen-secreting tumors (0.2%): rare, but important not to miss
Some medicines, such as anabolic steroids and valproic acid, can also cause hirsutism.[1] Read more about all the causes of hirsutism.
Can you have PMOS without hirsutism?
Yes. You can be diagnosed with PMOS based on irregular cycles and ovarian findings alone, without any signs of high androgens.[4] And even women with very high androgen levels may not develop hirsutism, because follicle sensitivity varies.[6] Hirsutism is also less common in women of East Asian descent.[6] So “I don’t have excess hair” does not rule out PMOS.
Why telling them apart matters
If your hirsutism is caused by PMOS, the hair is only one part of the picture. The international guideline recommends that women with PMOS are:[3]
- Considered at higher risk of heart disease, with blood pressure checked every year
- Checked for diabetes risk at diagnosis, ideally with an oral glucose tolerance test
- Screened for depression and anxiety
- Made aware of their higher risk of endometrial hyperplasia and cancer
None of this applies to idiopathic hirsutism. On the other hand, if your hirsutism is caused by an adrenal condition or a medicine, the treatment is different.[1]
Treatment: where hirsutism and PMOS overlap
Many treatments help both. Our hirsutism medication guide has more detail.
Combined birth control pills
Evidence: Strong The 2023 PCOS guideline recommends combined oral contraceptive pills for hirsutism and irregular cycles in adults with PMOS. Low-dose pills work as well as higher-dose ones for hirsutism.[3] The Endocrine Society also recommends them as first-line treatment for most women with hirsutism.[1]
Anti-androgens
Evidence: Strong If hirsutism is still bothersome after at least 6 months of the pill or cosmetic treatment, an anti-androgen such as spironolactone can be considered. Because these medicines can harm a developing male baby, effective contraception is essential.[3]
Laser hair removal
Evidence: Strong The guideline says laser and light treatments should be considered for facial hirsutism. Women with PMOS may need more sessions than women with idiopathic hirsutism, and laser works poorly on blond, grey or white hair.[3] See our guide to laser, IPL and electrolysis.
Metformin and lifestyle
Evidence: Limited Metformin helps with metabolic aspects of PMOS, but the guideline prefers the pill over metformin for hirsutism.[3] A Cochrane review found no benefit of metformin over placebo on hirsutism scores, and low-calorie diets lowered weight but not hirsutism scores.[9] A healthy lifestyle is still recommended for all women with PMOS for their long-term health, with or without weight loss.[3]
When to see a doctor
See a doctor if you have unwanted thick, dark hair, especially with irregular or missing periods, so the cause can be found.[5] Ask for an urgent appointment if hair growth starts suddenly or worsens quickly, your voice deepens, your muscles get bigger or your clitoris enlarges. These can be signs of a rare androgen-secreting tumor rather than PMOS.[1], [5]
Frequently asked questions
Is hirsutism always a sign of PCOS (PMOS)?
No. It is the most common cause, at about 70-80% of cases, but idiopathic hirsutism, adrenal conditions, medicines and rare tumors can also cause it.[1], [7]
Do all women with PMOS have hirsutism?
No. PMOS can be diagnosed without any signs of high androgens, and some women with high androgens do not develop excess hair.[4], [6]
Why was PCOS renamed PMOS?
Because “polycystic ovary” wrongly suggests the condition is about cysts. The new name, polyendocrine metabolic ovarian syndrome, reflects its effects on several hormone systems and metabolism.[2]
Will treating PMOS get rid of my hirsutism?
Treatment can slow and reduce hair growth, but it takes about 6 months to see results, and existing hair often needs removing too.[1] See can hirsutism be cured permanently?.
Key takeaways
- Hirsutism is a symptom. PMOS (formerly PCOS) is a condition that commonly causes it.
- About 70-80% of women with hirsutism have PMOS, but not all women with PMOS have hirsutism.
- PMOS is diagnosed when at least 2 of 3 criteria are met: high androgens, irregular cycles, and ovarian findings on ultrasound or AMH.
- PMOS also affects metabolism, heart health and mood, so the right diagnosis matters beyond hair.
- The pill, anti-androgens and laser are the main treatments for hirsutism in PMOS.
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Sources
- Martin KA, Anderson RR, Chang RJ, et al. Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(4):1233-1257. PubMed 29522147
- Teede HJ, Bahri Khomami M, Morman R, et al. Polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome: a multistep global consensus process. Lancet. 2026;407(10545):2329-2339. PubMed 42119588
- Teede HJ, Tay CT, Laven JJE, et al. Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2023;108(10):2447-2469. PubMed 37580314
- Teede HJ, Mousa A, Tay CT, et al. Summary of the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome: an Australian perspective. Med J Aust. 2024;221(7). Link
- NHS. Excessive hair growth (hirsutism). Accessed October 2026. Link
- Escobar-Morreale HF, Carmina E, Dewailly D, et al. Epidemiology, diagnosis and management of hirsutism: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society. Hum Reprod Update. 2012;18(2):146-170. PubMed 22064667
- Carmina E, Rosato F, Jannì A, Rizzo M, Longo RA. Extensive clinical experience: relative prevalence of different androgen excess disorders in 950 women referred because of clinical hyperandrogenism. J Clin Endocrinol Metab. 2006;91(1):2-6. PubMed 16263820
- Vink JM, Sadrzadeh S, Lambalk CB, Boomsma DI. Heritability of polycystic ovary syndrome in a Dutch twin-family study. J Clin Endocrinol Metab. 2006;91(6):2100-2104. Link
- van Zuuren EJ, Fedorowicz Z, Carter B, Pandis N. Interventions for hirsutism (excluding laser and photoepilation therapy alone). Cochrane Database Syst Rev. 2015;(4):CD010334. Link
This article is for education and is not medical advice. Talk to a doctor about diagnosis and treatment.