Hirsutism refers to excessive unwanted body hair in women. Some women also have very fine hair in their body, which is not thick and is easily bleachable. This is also called vellus hirsutism. Also, dark hair in several regions of the body which causes more discomfort is called terminal hirsutism.
Hirsutism happens generally due to either excess of androgen hormone or excessive sensitivity to androgens. Every woman has a certain level of mild hirsutism which is genetically determined. This becomes problematic or concerning over the years if it is progressive i.e increases with time or is generally severe in nature.
Hirsutism by itself is considered a symptom. Some of the symptoms include low pitch of voice, breast atrophy, development of masculine body contour etc. This usually happens in those with a severe degree of androgen excess.
Hirsutism does not always mean PCOS. If hirsutism is due to excess sensitivity of skin to androgen, then there may be no changes in fertility or cycle regularity. There are also other causes of androgen excess like adrenal tumors, cushing’s syndrome and non classical congenital adrenal hyperplasia (NCCAH)
Hirsutism of whichever cause requires one thorough evaluation by a qualified endocrinologist soon after the diagnosis. Even if you are undergoing laser hair reduction and getting a good response, it's better to have a clinical evaluation by an endocrinologist. This is mainly done to rule out if other causes like androgen producing tumors and cushing’s syndrome are not missed. The doctor will take a detailed history and compute a ferriman Gallwey score based on the distribution and intensity of body hair. The doctor will also look for other features of elevated androgens. He/She will also perform lab tests including- Total testosterone,LH,FSH,17(oh)progesterone- if indicated and ONDST cortisol (if indicated). T4 and TSH are also usually done.
While lifestyle modification is very helpful in regularizing cycles and inducing ovulation, it's not so effective for reducing hirsutism. Hirsutism, though considered a cosmetic issue, can be severe at times and cause secondary psychological effects. If there is a strong concern regarding hirsutism, patients must be offered hormonal therapy which is both safe as well as effective.
Both oral contraceptive pills (OCP) and spironolactone are highly effective for Hirsutism. Many randomized controlled trials have shown that more than 50% of patients with hirsutism do see some form of improvement with this line of therapy.Typically improvements in hirsutism are not seen very quickly after initiation of antiandrogenic therapy and persitense with therapy which goes on for 6 to 8 months and is necessary to see any improvement.