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What is hirsutism?

Hirsutism is not a separate pathology, but rather a syndrome that can be caused by various disorders in the body. The main manifestation of this syndrome is intense hair growth in women, which occurs in the male pattern. In other words, hair begins to grow in places unusual for women - on the face, in the sternum, on the back. It should be noted that the term "hirsutism" applies only to women. It should be distinguished from a number of other hair growth pathologies that can occur in both women and men.

Hirsutism is most often an endocrinological problem. The main cause of hirsutism is an excess of male sex hormones in a woman's body. However, it is rather a mechanism of hair growth. The very imbalance between female and male sex hormones can be triggered by a variety of pathologies. In some cases, this phenomenon is temporary and is not considered a disease.

Hirsutism can have varying degrees of severity. It depends on how quickly the hair grows. Moderate manifestations of this syndrome are found, according to various sources, in 3-5% of the female population. Belonging to different races and peoples plays a certain role. It is also noted that women with dark hair and dark eye color have this syndrome much more often than blondes.

In some cases, patients may confuse hirsutism with the following medical terms:

• Virilism. This term characterizes the appearance of secondary sexual characteristics of the male type. Unlike hirsutism, it does not at all imply obligatory hair growth. High concentrations of androgens ( male sex hormones) in the body, however, the manifestations can be different. In women with virilism, not only male-type hair grows, but also the menstrual cycle is disrupted, the timbre of the voice decreases, and facial features change. Even male pattern baldness ( raised hairline on the forehead or hair loss on the crown, in the parietal region) can also be one of the manifestations of virilism. Therefore, this term is more extensive. Virilism can be seen as one of the causes of hirsutism, and hirsutism as a possible symptom of virilism.
• Hypertrichosis. This disease is also characterized by excessive hair growth, but the reasons may be not only hormonal disorders. It is statistically more common in women, but cases in men are also known. The disease consists in excess hair growth in those areas of the skin where they normally do not exist. The disease is often caused by genetic disorders. There is also local hypertrichosis ( only on a small area of ​​the skin). In this case, we can talk about a local pathological process ( birthmarks, exposure to physical factors - friction, ultraviolet radiation, etc.).

Since hirsutism, virilism, and hypertrichosis are often associated with excess hair growth, these concepts are often confused. From a medical point of view, there is a connection between them, but the causes and, accordingly, the treatment will be different.

By itself, hirsutism is not a medical problem, but rather a cosmetic problem. For most patients, hair removal is a necessary treatment. In many cases, this phenomenon is temporary and after removal the hair does not grow back. Nevertheless, one must reckon with the fact that hirsutism can be a manifestation of other, more serious pathologies. That is why, with increased hair growth, it is imperative to consult a doctor. Pathologies causing excess growth hair, are not very common, but some of them can seriously threaten the patient's life. It is precisely such cases that require qualified treatment that will be considered further.

Causes of hirsutism

There are many different reasons that can, in one way or another, provoke excess hair growth in women. These reasons are not always a serious medical problem. Hormonal disorders, which are manifested by hirsutism, can be caused by the use of certain medications or improper use of contraceptives. In rare cases, hirsutism can appear without concomitant hormonal disorders, within the framework of other pathologies.

When treating a patient with hirsutism, the doctor may consider the following causes of this syndrome:

• Genetic predisposition. Genetic predisposition leads to the development of the so-called constitutional form of the disease. Excessive hair growth in this case is at the genetic level. The main feature of this form of the disease is that there is no concomitant hormonal imbalance that would explain the development of the disease.
• Climax. During menopause, the production of estrogens and female sex hormones decreases in women. The proportional relationship between female and male sex hormones changes, and a woman may begin to develop secondary male sex characteristics ( virilism).
• Ovarian disease. There are many different diseases and syndromes that can affect the ovaries and seriously disrupt their hormonal function. These include, for example, polycystic ovary disease, benign and malignant neoplasms ( arrhenoblastoma, adrenal ovarian tumor, masculinizing tumor of lipoid cells, luteoma, etc.). In all these cases, hirsutism is not necessary, but only a possible manifestation of the disease.
• Diseases of the adrenal glands. Male sex hormones and a number of other hormones that affect hair growth are synthesized in the adrenal glands. Any pathology affecting the work of this organ can manifest itself as hirsutism. The most common of these are Cushing's syndrome, adrenal hyperplasia, benign and malignant adrenal tumors, Addison's disease.
• Diabetes. Diabetes itself does not directly affect hair growth. However, in medicine, there is the concept of "diabetes of bearded women", it is also the Ashar-Thier syndrome. It is associated with abnormalities in insulin production that can occur during menopause. Also, this syndrome can appear within the framework of another syndrome - Morgagni-Stewart-Morel. In this case, endocrine disorders are associated with the pathology of the pituitary gland.
• Diseases of the pituitary gland. The work of the endocrine glands, which produce various hormones, is coordinated by the pineal gland or the pituitary gland. It is located at the base of the brain. Tumors of this organ or some functional disorder lead to the release of too much of any hormones. In the female body, these can be androgens. Then virilism develops and, as a result, hirsutism.
• Medication reasons. There are a fairly large number of different medications that, in one way or another, affect hormonal levels, estrogen and androgen levels. Not only their wrong reception, but sometimes just long-term treatment in small doses can lead to the development of hirsutism. The most common drugs leading to masculinization are streptomycin, cortisone, prednisone, diphenylhydantoin, interferon, cyclosporin, etc. The same effect has the intake of certain sex hormones - estrogens, progesterone. In a number of pathologies, patients may be prescribed treatment with androgenic drugs. Then a large amount of male sex hormones enters the bloodstream at once. Hirsutism in this case will be called exogenous, since male hormones enter the body from the outside, and are not synthesized in the adrenal cortex.

There are other possible reasons and mechanisms for the development of hirsutism, which are much less common. There are also cases when doctors cannot find the cause of the disease and explain the excess hair growth.

The mechanism of the onset of hirsutism

Hirsutism as a disease is directly related to the mechanisms of hair growth and hormonal processes in a woman's body. First of all, it should be noted that hair growth itself is largely related to gender. Men have more hair and grow faster. This is due to the presence in their body of a high concentration of androgens, male sex hormones. Basically, the more this hormone, the more body hair appears. In men, hair growth on the face, arms, legs, trunk, and back is the norm. Speaking about the intensity of hair growth, their types should also be taken into account.

In general, the following hair types are distinguished:

• Long. Long hair grows on the head, on the chin ( in men), in the armpits, in the area of ​​the external genitalia. The appearance of long hair elsewhere in men or women speaks of pathology.
• Cannon. Fluffy hairs are called soft, short, unpigmented hairs that cover the surface of the skin of the arms, trunk, and legs. They are also called primary, since they are the first to form on the body of the fetus during intrauterine development. Before birth, some of these primary hairs are replaced by pigmented ones ( painted). In infancy, this type of scalp hair is replaced with intermediate hair.
• Intermediate. This type of hair is somewhat thicker and darker than vellus hair. After the onset of puberty, the intermediate hairs, in turn, are replaced by the terminal ones. The color and density of terminal and intermediate hairs most often do not match. Typically, terminal hairs are characterized by the fact that they have dark color and denser to the touch.
• Bristly. The bristly type includes eyelashes and eyebrows. This is pigmented, coarse, short hair.

With hirsutism, most often the problem lies in the more intense growth of terminal and long hair in women. For example, hair from the genital area rises along the white line of the abdomen ( median line) almost to the navel. The appearance of terminal hairs on the chest, back, thighs, or face in women also indicates the development of hirsutism.

The mechanism of development of this disease can be different, but it is almost always associated with disorders at one of the steps in the hair growth regulation scheme. This system as a whole has common features in both men and women.

Hair growth regulation occurs at the following levels:

• Pituitary. The pituitary gland is an appendage of the brain that controls the endocrine glands. It produces hormones that act on the corresponding gland and enhance its work. For example, adrenocorticotropic hormone ( ACTH) stimulates the adrenal glands, gonadotropic hormones affect the sex glands, and growth hormone - on the metabolism and growth of the body as a whole. Often the root of the problem with virilism is precisely the increased production of one of these hormones ( especially ACTH).
• Endocrine glands. The greatest role in the regulation of hair growth is played by the adrenal glands, sex glands and, in part, the thyroid gland. In the adrenal cortex, under the influence of ACTH, androgens are produced, the excess of which causes virilism in women. Lack of gonadotropic hormones can lead to inadequate production of estrogen by the ovaries. Thus, there will be more androgens proportionally.
• Hair follicles. Hair follicles are located practically on the entire surface of the human body, but not all of them are active. Under the influence of androgens, hair follicles can be activated in unusual places, which causes increased hair growth. Thus, in this chain, hair follicles are the final working mechanism, which is influenced by the above hormones. Also, the hair follicles may be defective and not react ( or react inappropriately) on the effect of hormones. The frequency and location of hair follicles in the skin is also an individual feature of the body.

In general, the mechanisms that regulate hair growth are much more complex. The above chain links can be exposed to various influences from other organs, hormones or substances in the body. A complex system arises, in which even leading specialists cannot take into account all the factors. And yet, the most important condition for the provision of qualified care to patients with hirsutism is to identify the approximate mechanism of the pathology.

What hormone is responsible for hirsutism in women?

Male sex hormones are directly responsible for the appearance of hirsutism in almost all cases. Despite the fact that this disease occurs in women, a certain amount of male hormones in their body is also present. However, while in men the testes are a powerful source of androgens, in women these hormones are produced only in very small quantities by other organs.

The following androgens are normally found in small amounts:

• androstenedione;
• dehydroepiandrosterone;
• dehydroepiandrosterone sulfate.

All these hormones have similar functions, and in the body they are often transformed into the same substances. The most important source of androgens in a woman's body are the adrenal glands, or rather, their cortex. A small amount of male sex hormones are normally produced here, which partly affect the metabolism and some other processes in the body. The ovaries ( a small number of special cells).

In tissues that are sensitive to androgens ( target cells) most androgens are converted to the hormone dihydrotestosterone. In hair follicles ( bulbs) it stimulates hair growth. In this case, the follicles that formed the vellus hair begin to form terminal, coarse hair. An excess of androgens leads to the activation of follicles in places unusual for women, and hair growth begins there. This is how hirsutism develops.

The degree of cell sensitivity to androgens is an individual characteristic of the organism. For some women, a very small increase in androgen levels is sufficient for hair growth. In other patients, hoarseness appears, facial features change, other signs of virilism develop, but hirsutism itself, excessive hair growth, is barely noticeable. This is due to the low sensitivity of target cells to androgens. Some races ( mostly white women with dark skin and dark hair) sensitivity to androgens is high due to genetic predisposition.

It should be noted that an excess of dihydrotestosterone causes not only excess hair growth, but is also directly related to baldness. In this case, hair loss will occur between the ages of 50 and 55. Baldness under the influence of androgens occurs in the male pattern. Sometimes it starts with a patch of hair loss at the crown of the head ( in the area of ​​the crown), in other cases, there is an increase in the forehead line ( bitemporal baldness). Thus, women with hirsutism often grow bald faster with age ( androgenic alopecia).

Hirsutism in girls and adolescents

In principle, hirsutism can occur in women of almost any age. For obvious reasons, this problem peaks between the ages of 45 and 50, when menopause occurs. This problem is much less common among girls and women. Of the reasons at this age, various problems with the ovaries are most common. In little girls, various congenital problems are possible, which in one way or another affected the production of androgens.

The main problem in adolescent girls with hirsutism is psychological complexes due to cosmetic problems and concomitant disorders. At this age, the body is actively developing, puberty occurs, and the body should develop according to the female type. An excess of androgens in the body at this stage can lead to very serious problems.

The following associated problems are most common in girls with hirsutism:

• delayed development of the mammary glands;
• dysmenorrhea ( irregular menstrual cycle) or amenorrhea ( lack of menstruation);
• disproportionate increase in the clitoris;
• accelerated set of muscle mass;
• shape changes ( adipose tissue is not deposited in the thighs, but on the abdomen).

At this stage, hirsutism is often associated with polycystic ovary disease. If you do not take quick measures to fully diagnose and treat this problem, the consequences can be very serious. The body grows and develops up to 20 - 25 years. And if at this time male hormones dominate in the female body, then many changes will be very difficult to correct in the future.

Hereditary hirsutism

The hereditary form of hirsutism is often regarded not as a pathology, but as one of the variants of the norm. It is especially common in women from the Mediterranean and Middle East. Among the peoples of northern Europe, this form is rare. The cause of hereditary hirsutism is considered to be an increased sensitivity of hair follicles to dihydrotestosterone. Even a small amount of androgens, which is normal for women, leads to faster and more abundant hair growth. Since this form begins to manifest itself from childhood and reaches a peak to adolescence, many girls refer to it as a cosmetic problem.

In fact, this form of hirsutism really does not pose any serious threat. We are not talking about a malfunction of the endocrine glands, but signs of masculinization ( virilism) are absent. Girls do not have problems with changes in voice, appearance, or with the menstrual cycle, as with other forms of hirsutism. In case of excessive hair growth, conventional epilation and consultation with a dermatologist or beautician are recommended. Drug treatment is usually not prescribed because the risk of side effects is higher than the expected benefit.

Hirsutism with menopause

Climax ( menopause) is the period in which the ovarian function in women decays. This stops the menstrual cycle, and the female sex hormones are produced in smaller quantities. In general, menopause is a complex process of rebuilding the body, which takes place against the background of serious hormonal changes. The manifestations can be different. In some women, during this period, more active male-pattern hair growth begins. This phenomenon is usually called hirsutism with menopause.

This form of hirsutism is most often accompanied by the following disorders:

• dysmenorrhea or amenorrhea;
• feeling hot at rest;
• decrease in skin elasticity;
• sleep disturbances;
• increased sweating.

In this case, it is possible to maintain the level of estrogen in the body at a sufficient level with the help of medications. This will reduce the appearance of hirsutism, retard hair growth or stop it completely.

Idiopathic hirsutism

Idiopathic hirsutism in its manifestations and mechanism of development is very close to the hereditary form of this disease. This diagnosis is made when doctors cannot find any pathological cause of excess hair growth. Patients with idiopathic hirsutism, as a rule, do not have any complaints associated with the menstrual cycle ( a frequent symptom in pathological forms of hirsutism). Unlike hereditary hirsutism, the disease can manifest itself not in childhood, but after 20 - 30 years. The mechanisms that influence the sensitivity of hair follicles to androgens have not been elucidated.

From a medical point of view, it is quite difficult to help patients with idiopathic hirsutism. A special course of treatment using hormonal drugs may be prescribed in cases where the tests reveal a high level of androgens. However, in practice, such cases are quite rare.

Polycystic ovary

Polycystic ovary disease is a relatively common pathology, which is the appearance of multiple cysts in the ovary. Currently, doctors associate the development of this disease with endocrine disorders in a woman's body. The cause may be malfunctioning of the pancreas, thyroid gland, pituitary gland or hypothalamus. With polycystic ovary, hirsutism is only one of the possible ( but not mandatory) manifestations of the so-called polycystic ovary syndrome.

Polycystic ovary syndrome can include the following disorders:

• menstrual irregularities;
• acne;
• increased secretion of sebum ( oily skin);

All these manifestations, one way or another, are associated with a hormonal imbalance that occurs in a woman's body. Polycystic ovary syndrome requires serious treatment. At the initial stages, hormone therapy is prescribed to patients. If the effect of this method is insufficient, surgical treatment is prescribed.

Signs and symptoms of hirsutism

Since hirsutism itself is most often a symptom of other disorders in a woman's body, it is not entirely correct to talk about its own symptoms. In fact, there is only one symptom in this case - excessive hair growth in places unusual for women. However, as noted above, hirsutism is often associated with other disorders. Common cause these disorders are changes in the amount and proportion of sex hormones in the body. However, each of these violations can occur separately.

The most common symptoms that accompany hirsutism in various pathologies are:

• acne;
• obesity;
• menstrual irregularities.

A similar combination of symptoms for no apparent reason ( menopause) usually speaks of serious pathologies. In these cases, you should immediately consult a doctor to rule out the most serious and dangerous causes.

Acne ( acne) with hirsutism

Acne is a very common problem in girls during puberty, but it can also occur at other ages. In principle, this problem has many different reasons, but hormonal imbalances are one of the most serious. If a woman has hirsutism at the same time as acne, then the reason is most likely a common one. Pathology should be looked for at the ovarian level, since it is estrogens that are directly related to skin health. The combination of acne with abnormal hair growth is often found with polycystic ovary disease, ovarian tumors, misuse of hormonal drugs ( including contraceptive).

Obesity with hirsutism

The absorption of nutrients and their deposition as adipose tissue are regulated by many different mechanisms. The hormones of the adrenal glands, pancreas and thyroid gland play a very important role. There are other factors contributing to weight gain. Hirsutism is often combined with obesity in case of disturbances in the hypothalamus or adrenal glands. In this case, the deposition of adipose tissue can occur in different ways.

The reason for the simultaneous appearance of hirsutism and obesity can be long-term use of hormonal drugs, Itsenko-Cushing's disease, adrenal tumors. In principle, these symptoms are not directly related to each other, but are usually a simultaneous manifestation of the same pathological process.

Dysmenorrhea with hirsutism

Menstrual irregularities in combination with hirsutism speak volumes about hormonal problems. This is often associated with various pathologies of the adrenal glands and ovaries. Dysmenorrhea in this case can manifest itself in different ways. However, most often we are talking about virilism, in which the level of androgens is greatly increased. In this case, there is stimulation of hair growth with dihydrotestosterone and inhibition of egg maturation. Thus, hirsutism is most often combined with a delay in menstruation.

Such a combination of symptoms should alert the patient, since it speaks of a very serious disorder in the body. Difficulties with the onset of pregnancy, fatigue, headaches, poor general health are possible. As a rule, both symptoms are successfully treated with a properly selected course of hormone therapy.

Is it possible to get pregnant with hirsutism?

Hirsutism itself does not affect a woman's reproductive function in any way and cannot interfere with fertilization. But if hirsutism is a manifestation of a pathological process in the body ( pathological forms), then difficulties with pregnancy are very common. The mechanism of this violation is quite easy to understand. Reproductive function is a distinctive feature of the female body and is largely regulated by female sex hormones - estrogens. If there is a lack of estrogen, or there is an excessive production of androgens, a number of changes occur in the body that prevent pregnancy.

The pathologies that cause hirsutism can interfere with pregnancy as follows:

• endometrial changes ( the inner layer of the uterus, to which the fertilized egg is to be attached);
• amenorrhea or dysmenorrhea, since no eggs are produced;
• weak viability of the eggs produced by the ovaries;
• decrease in vaginal lubrication;
• decreased libido ( sex drive);
• modification of the external genital organs that interferes with normal fertilization.

If an excess of androgens appears during pregnancy ( for example, with the growth of a hormone-producing adrenal tumor), then various violations of the course of pregnancy, up to spontaneous abortion, are not excluded. Such cases are rare in medical practice. Most often, a timely visit to a doctor allows you to prescribe the correct hormonal treatment and bring the pregnancy to a successful birth. With a normal gestation period, this, as a rule, does not affect the child's health.

Thus, pregnancy has nothing to do with hirsutism itself. If the patient has hereditary ( constitutional) the form of this disease, then, in principle, there are no obstacles to pregnancy. When it comes to the idiopathic form, the level of androgens in the blood is important. The normal level, again, indicates that there are no obstacles to conception. Only in pathological forms of hirsutism, when it comes to specific diseases of the adrenal glands, pituitary gland, thyroid gland ( rarely) or ovaries ( most often) the probability of conception decreases. In all these cases, the chance of getting pregnant, as a rule, remains, but the prognosis in each case is different. For more detailed information, the patient needs to contact a specialist and pass the appropriate tests.

Why is hirsutism dangerous?

By itself, hirsutism is rather a cosmetic problem that does not imply any serious danger to the patient's health or life. Abnormal hair growth can be controlled by periodic hair removal in various ways. However, if you experience this symptom, it is highly recommended to see a doctor. This is because hirsutism may be the first symptom of other, more serious pathologies. It is they who, in the absence of proper treatment, can pose a threat to the patient.

For patients with hirsutism, the following diseases and their complications are the most serious and dangerous:

• Ovarian tumors. Ovarian neoplasms in the early stages may manifest as hirsutism due to hormonal disorders. However, even benign tumors large sizes can disrupt the work of the pelvic organs. Malignant neoplasms easily affect neighboring organs, can metastasize and threaten the patient's life.
• Inflammation of the ovaries. Hormonal disruptions, manifested by hirsutism, can develop in some other diseases of the ovaries. With large single cysts or polycystic ovary, there is a risk of inflammation. This gives severe pain lower abdomen on the right ( appendicitis-like) or to the left. The inflammation can spread to the peritoneum and adjacent pelvic organs. At this stage, the only effective treatment is surgery.
• Tumors of the adrenal glands. Adrenal neoplasms can produce ( work out) androgens, which cause excess hair growth. However, the main problem is the tumor itself. Along with androgens, other adrenal hormones can be produced that regulate various functions in the body. Perhaps a strong decrease in immunity, surges in blood pressure. Malignant neoplasms are dangerous in themselves, as they lead to the destruction of the organ and damage to adjacent anatomical structures.
• Diabetes. Sometimes hormonal disruptions leading to hirsutism are one of the first harbingers of pancreatic malfunction. Some patients develop diabetes mellitus. This disease is very dangerous, since high glucose levels ( Sahara) in the blood has a detrimental effect on many organs and tissues. First of all, this concerns the retina of the eye, the walls of blood vessels, the nervous and immune systems. In principle, over time, pathological changes develop in almost all organs and tissues.
• Infertility. Infertility can be a consequence of ovarian pathology. In any case, patients with hirsutism often face this problem. Level changes reproductive system are almost always reversible in the early stages, but late initiation of treatment can lead to the fact that the woman will no longer be able to have children.
• Uterine bleeding. Uterine bleeding can complicate menstruation or open suddenly during other phases of the menstrual cycle. They are explained by changes in the inner layer of the uterus, which occur under the influence of sex hormones.
• Mental disorders. Hormonal disruptions sometimes affect mental processes. It can be depression or even bouts of aggression. Only a psychologist's help ( as with complexes caused by changes in appearance) won't always help. Mood changes can be directly triggered by the release of hormones.

In all of the above cases, hirsutism usually appears in the earlier stages of the disease, when qualified help can prevent serious complications. That is why, at the first signs of abnormal hair growth, women are advised to consult a specialist to determine the specific cause of this symptom.

The hereditary and idiopathic form of the disease, as a rule, is not accompanied by pathological changes in other organs. The only real complication can be psychological complexes that often appear in girls and women with this problem.

Diagnosis of hirsutism

The initial diagnosis of hirsutism is not particularly difficult, since abnormal hair growth is usually noticed by the patients themselves. When contacting a doctor, it is important not to establish the very fact of hirsutism, but to find out the reasons for this violation. To do this, it is necessary to collect as complete anamnesis as possible ( case history according to the patient) and carry out a series of analyzes. In hirsutism, the diagnostic process is directed by an endocrinologist.

When collecting anamnesis, be sure to pay attention to the following points:

• location and rate of hair growth;
• time from the onset of the disease ( some patients come only after 1 - 2 years or more after the onset of this symptom);

• information about the menstrual cycle ( regularity, duration, past violations);
• medications that the patient was taking before the onset of symptoms ( some of them can cause virilism);
• past diseases and surgical interventions;
• the presence of already diagnosed chronic diseases.

As a rule, finding out these subtleties helps to draw up a plan for taking tests. If tumors are suspected, various examinations are prescribed to visualize them. The main organs examined are the pituitary gland, adrenal glands, and ovaries.

The following methods can be used to visualize tumors or other pathological processes:

• Ultrasonography ( Ultrasound). It is an affordable, fast and safe method for examining the ovaries and adrenal glands. Unfortunately, this method can only detect rather large neoplasms.
• Radiography. An X-ray is usually orientational in nature, since even a very high-quality image is unlikely to reveal a small tumor.
• CT scan ( CT scan). This method is also based on the use of X-rays, but its possibilities are much wider. Even small tumors and organ damage are detected.
• Magnetic resonance imaging ( MRI). This method can sometimes detect formations less than 1 mm in size. It does not use X-rays and is safer for the patient.

However, even these highly accurate methods do not completely exclude the possibility of neoplasms. Hormone-producing tumors are sometimes so small that they cannot be visualized. It's just a collection of cells that uncontrollably produce active substances and throw them into the blood. In these cases, the presence of a tumor is indirectly confirmed, excluding other possible causes of the disease.

What tests to take with hirsutism?

Laboratory tests are the main method in the diagnosis of hirsutism. It is with their help that it is possible to establish the concentration of various hormones in the blood and determine which disorders have caused the disease. In most cases, the concentration of hormones in the patient's blood is measured, but sometimes urine is also examined. The urine contains a number of hormone breakdown products and substances into which hormones are transformed. They can also be used to indirectly judge the hormonal background of the patient.

With hirsutism, it is necessary to pass tests to determine the following hormones:

• total testosterone;
• dehydroepiandrosterone sulfate;
• androstenedione;
• 17-hydroxyprogesterone;
• adrenocorticotropic hormone ( ACTH);
• luteinizing hormone;
• follicle-stimulating hormone.

Other hormones may be tested at the discretion of the doctor. In addition, there are a number of special tests that make it possible to judge the body's sensitivity to a particular hormone. For example, the release of ketosteroids ( androgen breakdown intermediate) with urine indicates the amount of androgens produced in the body. However, this process can be influenced in various ways. For example, after the introduction of ACTH, normally more adrenal hormones should be produced, and after the introduction of dexamethasone, less. Such studies are called ACTH and dexamethasone tests, respectively. They are only performed in a hospital setting to avoid any side effects or reactions.

Diagnosis of various causes of hirsutism based on basic test results

Cause	Analysis for the content of ketosteroids in urine				Studies to confirm the diagnosis
	Selection under normal conditions	With dexamethasone suppression	When stimulated with ACTH
Idiopathic form
Congenital adrenal hyperplasia	norm, sometimes - increased		increased	increased	increased)
Adrenal hyperplasia androgenic	norm or increased		increased	increased	Analysis for the release of pregnanthriol ( normal)
Hirsutism in Cushing's syndrome	norm or increased	reduced	increased	increased	The release of ketogenic steroids is enhanced, there is no change in cortisol levels during the day
Adrenal neoplasms	increased	reduced	reduced	increased	Tumor imaging techniques ( X-ray, MRI, etc.)
Ovarian neoplasms	increased, sometimes normal	decreased, rarely - normal		norm or increased	Gynecologist's consultation, visualization methods
Stein-Leventhal syndrome	norm or increased	not carried out	not carried out	norm or increased	There is no specific analysis

This table provides indicative results. In any case, a doctor's consultation is mandatory, since concomitant diseases and disorders are possible that may affect the research results.

Thus, analyzes in most cases help to understand the nature of hormonal disorders in the body that led to hirsutism. In the case of, for example, hereditary or idiomatic hirsutism, there may not be any abnormalities in the analyzes. That is why these forms of the disease are the hardest to diagnose and treat.

Hirsutism treatment

Treatment of hirsutism in each case may have its own characteristics. This is due to the fact that hirsutism itself is usually only a manifestation of other pathologies that have to be cured. It is very important to correctly determine the nature of excess hair growth. The diagnosis and treatment of patients with hirsutism is usually carried out by an endocrinologist. If there are obvious violations at the level of the ovaries, a gynecologist can also act as the attending physician.

In the course of treatment, the help of the following specialists may also be required:

• dermatologist- to determine the nature of hair growth and exclude some skin pathologies;
• therapist- for the management of patients with concomitant chronic diseases;
• surgeon or oncologist- for the treatment of tumor processes that could cause hormonal imbalance;
• cosmetologist- to select the optimal method for removing existing hair.

When a tumor of the ovary or adrenal gland is detected, it is assumed that it is she who secretes excess hormones. Therefore, its removal is usually recommended as a treatment. With large tumors, the question of the complete removal of these organs may arise. Sometimes this is done if the tumor cannot be detected ( presumably too small), and hirsutism and accompanying manifestations of virilism seriously threaten the health of a woman.

Surgery on the ovaries and adrenal glands is usually successful and rarely complicated. After removal of a tumor or an entire organ, patients may have hormonal disruptions associated with the adaptation of the body to new conditions. During this period, it is necessary to take hormonal drugs, which the doctor selects on the basis of tests. Sometimes hormone therapy ( especially after removal of the adrenal glands) lasts until the end of life. The correct dose and its regular adjustment allow patients to lead a fulfilling life.

Most patients with hirsutism receive the main course of treatment at home, since the disease does not pose a serious danger to life. After the diagnosis is made, the attending physician simply prescribes the course of treatment, which the patient takes on her own. After its end ( and sometimes during treatment) may require re-delivery of some tests.

Hospitalization of patients with hirsutism may be required in the following cases:

• sometimes - for conducting diagnostic tests and tests;
• with a strong hormonal imbalance and pronounced manifestations of virilism ( to quickly correct the problem);
• at the time of surgery to remove tumors that produce hormones;
• periodically - during pregnancy, since a high concentration of androgens threatens spontaneous abortion;
• after severe manifestations of virilism ( uterine bleeding, acute psychosis), but such manifestations are extremely rare.

Antiandrogenic drugs for hirsutism

Medical treatment of patients with hirsutism usually comes down to the use of several groups of drugs that can affect the production of male and female sex hormones. When tumors are found, they are first removed, and only then a drug correction of the hormonal background is prescribed.

One of the options for drug treatment is the appointment of dexamethasone. This drug can inhibit the function of the adrenal cortex and thus the production of androgens. The dose of the drug is selected individually and, if necessary, changed slowly to avoid possible complications.

There is also a fairly large group of drugs that have their own antiandrogenic effect. Their mechanism of action is to block the enzymes responsible for the biochemical conversion of testosterone in the body. In most cases, taking them prevents testosterone from transforming into its active form - 5-dihydrotestosterone. Thus, androgens can be released, and their concentration in the blood remains elevated, but the consequences of their release ( hirsutism, male pattern hair loss, coarsening of the voice, etc.) do not appear.

Antiandrogenic drugs used in virilism and hirsutism

Drug name	Active substances	Doses and regimen	special instructions
Diane-35	Ethinylestradiol, cyproterone	1 tablet a day, course 21 days.	Drink with a little water, take at the same time of day.
Buserelin	Buserelin	0.1 - 0.5 mg / day 1 time as a subcutaneous injection. The duration of the course is determined by the doctor.	The beginning of the course of treatment must be correlated with the phase of the menstrual cycle.
Byzanne	Dienogest	1 tablet, usually over several months.	Treatment can be started on any day of the cycle.

Almost all of these drugs can bring down the menstrual cycle somewhat, cause intermenstrual bleeding. In patients with migraines, they can provoke an attack of severe headaches. Also, during the course, libido may decrease and there is a tendency to depression. In this regard, treatment with antiandrogenic drugs requires mandatory consultation with a doctor. They are not prescribed in all cases of hirsutism. The dose is almost always selected individually and adjusted during the course of treatment.

Antiandrogenic drugs can decrease the activity of testosterone in the body, but it is still recommended to remove the tumors that are causing the secretion of this hormone. For pathologies that are not accompanied by an increase in testosterone, but leading to hirsutism, other drugs may be prescribed.

Contraceptives for hirsutism

Many women nowadays use COC ( combined oral contraceptives) to prevent pregnancy. These products contain a large amount of estrogens and progestins, which cause corresponding changes at the level of the reproductive system. However, the doses selected by the doctor are designed for healthy women. With hirsutism, there is a high probability that hormonal disruptions have already occurred at the level of the ovaries or other endocrine glands. The intake of sex hormones from the outside while taking COCs can have different effects on the body. In principle, these hormones will compensate for the lack of estrogen or excess of androgens, which are often the cause of hirsutism. However, it is very difficult to calculate a safe and effective dose without a thorough diagnosis.

Thus, hirsutism, while not being a direct contraindication for the use of COCs, still speaks of possible complications. First of all, they are manifested by serious menstrual irregularities, the formation of cysts in the ovaries, pathological changes at the level of the uterus and severe uterine bleeding. When choosing contraceptive methods for women with hirsutism, condoms are always preferred. In this case, this is the most safe way prevent pregnancy, as it does not affect hormones in any way.

If a woman still wants to use COCs, then first it is necessary to consult with an endocrinologist. Tests are pre-assigned to identify the cause of hirsutism and determine the level of various hormones in the blood. Only after that, an effective and safe dose is gradually selected. However, even after this, a woman needs to regularly consult with a specialist and periodically take tests for preventive purposes.

Do folk remedies help with hirsutism?

In most cases, hirsutism in women is associated with hormonal disorders that are difficult to correct even with modern medicines. Medicinal plants that are used in traditional medicine, in this case, will be even less effective. Nevertheless, temporary violations can be partially corrected with their help. The main condition for this is contacting a specialist. Most doctors do not prohibit patients from using folk remedies. However, you still need to try to identify the cause of hirsutism, and this can only be done by an experienced doctor.

As an addition to the main course of treatment for hirsutism, the following folk remedies can be used:

• Datura decoction. Several plants ( can be used whole, with roots, but you need to rinse them well) pour 1 l boiled water... After that, the water is brought to a boil and kept on low heat for 40 - 60 minutes, without adding more water. The broth then slowly cools down to room temperature and the plants are removed. The liquid is rubbed onto the skin after depilation 1 - 2 times a day. In no case should the agent be taken internally! If you experience skin irritation or signs of allergies, it is better to stop using Datura.
• Walnut juice. Peel off the green walnuts and squeeze the juice out of it. This juice is applied to cotton swabs or gauze, which is placed on the hair growth area for 5 minutes. 1 to 2 sessions a day will usually cause hair to stop growing. If the effect does not appear after 5 - 7 days of procedures, then in this case, nut juice, most likely, will not help.
• Lemon juice. Squeeze half a lemon into 200 ml of water and add 20 - 25 g of sugar. The mixture is cooked over low heat until about half of the liquid has boiled away. After that, it is cooled and applied to the skin with excess hair growth. After 1 - 2 minutes, this place is washed well with boiled water.
• Sugar. 20 g of sugar is dissolved in hot water (20 - 25 ml) and add a pinch of citric acid. The mixture is cooked over low heat until it acquires a yellowish tint and slightly thickens. After the mixture has cooled down a little, it is used for depilation.

In all of the above cases, folk remedies are designed to affect the skin itself and hair follicles. Thus, these remedies are symptomatic. Even if hair growth slows down, this will not solve the underlying problem. As noted above, morbid obesity, changes in facial features, changes in voice timbre, and other serious symptoms are common in patients with hirsutism. That is why traditional medicine should be combined with hormonal therapy, which will help eliminate the hormonal imbalance in the body itself.

By themselves, folk remedies can partly help with a hereditary tendency to hirsutism, when a woman does not have concomitant virilism, and the level of androgens in the blood is within normal limits. Then the use of hormonal drugs will be unreasonable. Long-term medication can help get rid of hair growth, but it can also cause side effects. In such cases, treatment with folk remedies is agreed with the doctor and used for a long time ( intermittently - months and even years).

Does the boar uterus help with hirsutism?

Borovaya uterus is a medicinal plant that is widely used in folk medicine for the treatment of "female" diseases. It is very common in the temperate zone in Europe, Asia and North America. Of all medicinal plants, the boron uterus is indeed the most effective in many diseases of the female genital area.

This plant has the following medicinal properties:

• high content of vitamins and minerals;
• the content of substances of plant origin, similar to estrogens;
• anti-inflammatory properties;
• disinfectants ( antimicrobial properties);
• stimulation of immune processes.

Under constitutional ( hereditary) in the form of hirsutism, medicinal products based on the boron uterus can really have a positive effect on the course of the disease. However, if we are talking about a serious endocrinological pathology with a pronounced hormonal imbalance, then its action will clearly not be enough. The intake of substances similar in action to estrogens, on the contrary, can aggravate the course of the disease. After all, if we are talking about excess production of androgens, then it turns out that both male and female sex hormones will be elevated in the body.

Most gynecologists are familiar with the healing properties of the borax uterus. If hirsutism is associated with the onset of menopause or a number of ovarian pathologies, then they themselves can prescribe drugs based on this plant. In this case, the drug will compensate for the lack of female sex hormones and can really help in the fight against hirsutism. The main thing is to understand the causes and mechanisms of the development of the disease, and this is impossible without conducting appropriate analyzes.

Does laser hair removal help with hirsutism?

In hirsutism, medical treatment can slow down or stop hair growth in atypical areas altogether, but it does not eliminate hair that has already grown. Therefore, from a cosmetic point of view, in any case, their removal is required. Almost any method is suitable for this, but laser hair removal is still the most effective ( photoepilation). This procedure not suitable for all patients and has a number of contraindications.

The essence of the method is that the laser ( with laser hair removal) or pulsed light ( with photoepilation) sends light waves with a certain frequency and energy to the hair root. Correctly selected physical parameters allow targeted destruction of the hair root and structures around it ( vessels and nerves that feed it, sometimes the sebaceous gland). Hair without a root usually falls out after a few days, and in this place it will no longer grow. The procedure is optimal for patients with hirsutism, as in their case it allows to completely remove hair growth in an undesirable place. Usually several procedures are prescribed at intervals of several weeks.

Laser hair removal may be contraindicated for the treatment of hirsutism in the following cases:

• in the presence of hormone-producing tumors ( first, the tumor itself should be cured, and then the hair should be removed);
• diabetes;
• pregnancy;
• blonde or gray hair ( they have little melanin, which should absorb radiation).

Therefore, it is best to discuss hair removal with laser hair removal with your doctor in advance. The specialist will tell you at what stage of treatment and in what way it is better to do this procedure.

It should be noted that only laser hair removal, as a method of treating hirsutism, is not used. The hair growth in the epilation area will indeed not resume, but the elimination of the symptom does not mean the elimination of the problem. The patient should first visit an endocrinologist and outline a plan of analyzes, and then a comprehensive treatment. Otherwise, the hair will be removed, but swelling, high testosterone levels, or other possible causes will remain. Sooner or later, they will lead to more serious disorders than excess hair growth.

Diet for hirsutism

Hormonal disturbances, which in most cases cause hirsutism, are very difficult to regulate through diet. The work of the adrenal glands and ovaries is not directly related to substances that enter the body with food. Androgens are a product of repeated processing and pre-formation of nutrients in the body. However, many doctors advise adhering to specific eating habits. This is mainly due to the prevention of other associated disorders.

The diet for hirsutism should follow the following principles:

• limited intake of animal fats;
• limited use of flour products;
• avoiding pure carbohydrates - sugar, desserts high in sugar ( cream, marmalade, etc.);
• refusal from hot and spicy sauces;

Cosmetology offers different methods of dealing with unwanted vegetation. The laser method is especially popular. There are many myths about him, positive and dubious reviews. Is laser hair removal harmful to health? Let's talk about this in detail.

Positive aspects of laser hair removal:

• the beam acts directly on the pigment contained in the hairs. At the same time, fiber does not suffer, the skin does not overheat. Manipulation does not violate the integrity of the surface, does not cause irritation, rashes, wounds, scars and other unpleasant consequences;
• the stream of light does not affect the internal organs, does not have a toxic effect. Therefore, it is suitable for different categories and ages;

It just seems that you just need to correctly set the parameters and direct the beam to the problem area.

• lack of inflammation and irritation. The rays have anti-inflammatory and aseptic properties. Therefore, negative consequences after the procedure are completely excluded. Sugar or wax hair removal, shaving and other methods of dealing with unwanted vegetation cannot boast of this;
• painlessness. When the hair follicle is exposed to wax, sugar paste or a mechanical epilator, unpleasant sensations arise. The client does not feel any discomfort with the laser device. The rays penetrate deep into the dermis, but do not affect nerve endings or blood vessels. Therefore, after a session of dealing with unwanted vegetation, there is no pain, bruising and bruising;
• suitable for delicate and sensitive dermis. If any methods of removing unwanted vegetation in the bikini area, armpits, on the face (especially near the mouth) are too painful for you, then you cannot do without a laser. With it, you will forget about discomfort and fear;
• with a large number of ingrown hairs, only laser depilation can solve problems once and for all, prevent inflammation and the appearance of pustules.

Laser types

Previously, it was believed that completely stopping the growth of unwanted hair in different parts of the body is realistic only in women with a light type of dermis and dark stiff shafts. The stronger the contrast is, the more likely it is that 3-4 sessions will solve the problem once and for all. The owners of thin light hairs or dark fiber had a hard time.

Now the technique has gone ahead. And laser hair removal of different types solves the cosmetic problem of all women. The main thing is to be patient. Because even the most modern device does not fix a defect in one go.

Laser hair removal is not suitable for everyone, although reviews say that this particular service is considered the most popular

The type of laser is chosen only by a specialist, while paying attention to the color of the hairs, length, density and area of ​​influence:

• long-wave hair removal is often used by salons and beauty parlors. The rays penetrate the level of the subcutaneous tissue, destroy the pigment. After exposure to the follicle, destruction occurs, stopping the growth of unwanted vegetation;
• ruby. The oldest method of laser hair removal. Suitable for light-colored dermis with dark shafts. This contrast gives the maximum effect;
• alexandrite ray. Has the most positive reviews. An excellent result does not depend on the type of dermis, hair color and other factors. Therefore, most women use it;
• diode. It guarantees a positive result even on dark and dark dermis. If the procedure is performed by a specialist without qualifications or the duration of the session is increased, then the likelihood of burns and scars increases after the completion of regeneration.

Indications for therapy

Is the procedure dangerous? Not if the professionals are involved. Moreover, the method is safe and effective in many difficult situations:

• hypertrichosis. This is an ailment when women have increased body hair density. They are darker than expected, grow quickly, and have a large diameter. This brings a lot of psychological discomfort. A woman becomes insecure, hides, refuses to go out in public. To solve the problem, an endocrinologist is involved. After eliminating the dysfunction of the internal glands, the cosmetologist begins to work with a laser. Remove by other, mechanical or by chemical means unwanted facial hair is not recommended. Manipulations increase blood flow to the follicles, which means they stimulate growth;

It is not suitable for everyone and has a number of limitations.

• individual and ethnic characteristics. Certain nations and women often have "antennae" or dark fuzz. All this indicates increased testosterone, and hence libido. But if this interferes with the owner of this feature, then it's time to think about a laser procedure. With a light cannon, 2 sessions are enough.

Why is laser hair removal dangerous? Like any manipulation, the procedure has contraindications:

• pregnancy and breastfeeding;
• oncological diseases, the period of chemotherapy or radiation therapy. At this time, any manipulation causes an aggressive reaction on the skin. Therefore, they are waiting for the end of recovery and recovery;
• a large number of moles, papillomas and warts;
• violation of the integrity of the skin. If you have abrasions or scratches, then when asked whether the procedure is dangerous, dermatologists answer positively;
• varicose veins, thrombosis, thrombophlebitis and other circulatory pathologies.

Preparing for a beauty session

The question of laser hair removal is harm or benefit, everyone decides for himself. Doctors and cosmetologists insist that with proper preparation for a beauty session, the risk of complications decreases several times.

So:

• 3 days before laser hair removal, stop visiting the beach or solarium. Any effect on the skin of ultraviolet radiation reduces the work of local defenses, slows down the regeneration of the epidermis. If you neglect the advice, then the likelihood of the appearance of age spots and scars increases several times. This is the danger of this removal of unwanted vegetation during the warmer months. The opinion of doctors is unanimous: to carry out a session only in cold weather, when there is no effect of ultraviolet radiation on the dermis;

Ultimate success depends on how well prepared the person who will be epilating is.

• if you are doing the procedure for the first time, then trim the hairs. So it is easier for the laser beams to reach the follicle, destroy the pigment and stop growth;
• 3 days before the cosmetology session, any products that contain ethyl alcohol are excluded from care and decorative cosmetics. The component dries up the dermis, reduces the level of local protective forces. Also banned are antibiotics of the tetracycline series. These substances cause active peeling of the dermis, dehydration and redness after modern removal of unwanted vegetation;
• after the procedure, baths, saunas, steam rooms and other institutions with high temperatures and high humidity are strictly prohibited. Such factors slow down regeneration, create favorable conditions for the growth and development of pathological microorganisms;
• so that the dermis heals normally during the recovery period, do not experiment with care products.

The peculiarity of working with different zones

Laser hair removal reviews are different, and it all depends on which part of the skin the master works with.

The quality of hair removal is mainly influenced by the wavelength of the laser beam and the phototype of the patient's skin.

Experts advise:

• for the bikini area. If you have been shaving off unwanted vegetation in this area for a long time, then the laser in one session will not solve the problem. The follicles in the dermis lie at a depth of 1 cm. To facilitate the penetration of rays to this depth, the hairs are shaved off before going to the master. If a woman is worried and afraid of pain, then an anesthetic lotion or "Emla" ointment is applied to the skin. Due to the deep bedding of the follicles and dark pigment, for the complete removal of unwanted vegetation, women need 5 sessions with an interval of 7-10 days;
• the face does not suggest any special nuances. Dermatologists advise not to experiment with decorative cosmetics or care products before modern hair removal. After a session of combating unwanted vegetation, the dermis is treated with special creams based on panthenol;
• armpits. The site is a test site for clients. In a certain percentage of women, laser intolerance occurs when irritation or discomfort occurs on the sensitive dermis of the armpits after laser depilation;
• legs, back, chest. These large areas are easiest to deal with unwanted vegetation. Due to the large amount of work, 2-3 sessions are required for complete disposal. Due to the roughness of the dermis, no special protective agents or pain relieving lotions or sprays are required. If after the procedure there is dryness and peeling on the surface of the skin, then a strong decoction of medicinal chamomile or sage will eliminate the troubles in a couple of times. Compresses are made or the skin is irrigated. Helps to solve the problem of rubbing with cosmetic ice cubes.

Is it realistic to do the procedure yourself?

Home appliance manufacturers produce devices for self-removal of unwanted hair. Now women conduct beauty sessions at a convenient time for them at home. But is it harmful? If, in the conditions of a cosmetology office or clinic of aesthetic medicine, a trained employee with the appropriate education is watching the course of manipulation, then this will not happen at home. This means that the risk of the consequences of an incorrectly performed manipulation increases.

The cost of a laser hair removal device is not affordable for everyone. There are also certain nuances of hair removal:

• small manipulation area. It is no more than 30 square meters. mm. To completely get rid of unwanted vegetation in the deep bikini zone, you will have to spend more than 1 hour. To work with large areas (legs, back and chest in men), you need 2-3 sessions for 1 hour. So please be patient;
• narrow spectrum of action. Due to the specifics of the laser beam, the device at home removes only dark hairs on the light dermis. That is, the owners of dark skin or light hairs are forced to use sugar or wax hair removal;
• the need for skills. Working with a laser epilator requires a cosmetology or medical education. It is necessary to watch at least 2-3 lessons on the Internet.

Therefore, doctors advise to carry out laser hair removal from trusted specialists with positive reviews.

Many women are concerned about unwanted hair in the upper lip area. The reasons for this phenomenon primarily include hormonal disorders, hereditary factor, ethnicity, as well as the abuse of shaving or hair plucking in this area. There are many processes taking place in the female body that can trigger the growth of hair above the upper lip. These include: puberty, pregnancy, hormones and oral contraceptives.

The only difference from laser hair removal of other localization is that you do not need to shave your hair specially before the procedure, unless you have previously removed the hair above the upper lip by other methods (shaving, plucking, waxing, etc.)

Features of laser hair removal for upper lip:

• The hormone-dependent zone, therefore, it is difficult to correct with an increased level of testosterone and other hormonal disorders;
• It is not recommended to shave the hair before the procedure or remove it in any other way;
• It is excluded to carry out procedures in the summer, since when exposed to sunlight there is a risk of pigmentation;
• Fluffy hair is not removed by light methods of epilation;
• The number of procedures can reach 10-15 with an interval of 1 time per month and mandatory supporting sessions;

Laser hair removal is the most effective and safest method of hair removal on the upper lip

After completing the full course of procedures, you will forget about the embarrassment when they look at your face. Immediately after the session, in some cases, locally there is hyperemia (reddening of the skin). In this situation, the use of creams and ointments with a calming and regenerating effect (panthenol, bepanten, etc.) is recommended. The use of sunscreens with a high protection factor is mandatory between sessions. After all, the face is under the sun's rays more than the rest of the body.

Considering that the upper lip area is hormone-dependent, laser hair removal helps to get rid of unwanted hair, but does not eliminate the cause that caused hair growth in this area. Therefore, it is recommended to consult an endocrinologist for an integrated approach to the problem.

Concluding a series of articles on pharmacological agents that doctors can prescribe to women with hirsutism, I want to talk separately about oral contraceptives (OC) in general. When I was a teenager, they were prescribed for everything from painful periods to teenage acne. Now gynecologists began to promote the point of view that OK is also an excellent means for "preserving" one's reproductive potential, preventing cancer, fibroids and endometriosis.

The tactics of managing women with hirsutism is limited either by advice to give birth as soon as possible, or by taking OK. Doctors, in general, can also be understood: hirsutism itself, but one in 10 women. And even if it is possible to diagnose all hormonal diseases associated with hirsutism, traditional medicine not heals, but compensates by taking exogenous drugs. One pill more, one less - in the end, OK was invented in general for all women. It is difficult to resist the temptation not to consider them completely safe. However, OCs were used so massively that over 50 years, a mass of clinical data has accumulated about the health of which organs a woman pays for sex without a condom. Even the newest OK, the so-called. third-generation contraceptives or natural oral contraceptives increase the risk of thromboembolism (up to stroke).

How do contraceptives affect hairiness?

All OCs consist of two components - progestin and estradiol. Each of these components affects the amount of androgens in the female body. Estradiol(usually the potent ethyl estradiol) is able to increase the level of sex hormone binding globulin (SHBG), which decreases the concentration of free testosterone. Progestin the component lowers the luteinizing hormone (LH) in the pituitary gland, as a result, the production of androgens by the ovaries decreases. Some of the progestins used in OC can also reduce the production of androgens by the adrenal glands. However, not every progestin is equally effective at suppressing androgens. Some of them are able to bind to androgen receptors and, on the contrary, activate them so that the beard becomes even thicker.

In the treatment of hirsutism, preference is given to progestins with an antiandrogenic effect, which is realized due to:

1. Ability to bind to androgen receptors and activate them with less efficiency than androgens (,);
2. The ability to inhibit the 5α-reductase enzyme, which is involved in the conversion of free testosterone into the active form - dihydrotestosterone (the same +, 3rd generation progestins (destodene, norgestimate)).

There is a website about each of these progestins separate material, which you can read by clicking on the links. The most effective are OK based on cyproterone and drospirenone; after a year of taking OK, women scored half as many points on the Ferriman-Galloway scale. It is believed that if after a year of using OK it was not possible to achieve a noticeable effect, the diagnosis was made incorrectly. Then try to use or combine them with OK.

If hirsutism is combined with obesity, OC ceases to be so effective: the level of free testosterone decreases slightly, and the level of sex hormone binding globulin (SHBG) does not change at all compared to women without metabolic abnormalities. According to the guidelines for the management of women with PCOS (usually associated with obesity), only 10% of women notice reduced hair growth as a result of taking OC. Some studies, however, refute this point of view, showing that OCs work in obesity as well.

In studies of the effectiveness of OC in the treatment of hirsutism, a noticeable effect occurs after six months of continuous use. This is due to: hair is sensitive to androgens in the stage of active growth (anagen), therefore, it is possible to judge about the changes only after the hair that has grown before the start of taking OK falls out. The cycle length is also different in different parts of the body. There is not a single study where women have been followed for over a year. After the abolition of OK, the androgen level begins to gradually recover.

Pharmacological therapy for hirsutism is not always preferred. Both laser hair removal works only with those hairs that are in the stage of active growth, so if you start to suppress the secretion of androgens with OK, then you will need more time to process all the follicles.

Problems with taking oral contraceptives

The first six months after the start of taking OK from the point of view of the occurrence of side effects are the most dangerous. The worst side effects of contraceptives are the development of thromboembolism (and concomitant stroke, heart attack) and toxic effects on the liver (including death).

Doctors say that since the first deaths due to the use of OK were recorded, everything has changed - new compounds are used, almost natural. In fact, now the pills are more technological- Concentrations of active substances are observed more clearly and doses are adjusted to the minimum effective. In the instructions for the use of OK, they still warn about the possible development of side effects, especially if there is a predisposition (which you are most likely not aware of at all). Remember that a weak link in your health can arise spontaneously, be the result of a flu or treatment during childhood. If your parents and other ancestors, as it seems to you, were not sick with anything, this does not exclude at all that the OK reception for you will be, let's say, not useful.

Messages about side effects OK reception in the medical literature continues to appear [for example, Domecq], but this does not stop gynecologists, dermatologists and endocrinologists from prescribing OK for any reason and even recommending them as a means of preserving your body for the future. To illustrate this opinion, I will cite excerpts from an interview with Svetlana Yureneva, Doctor of Medical Sciences, a leading researcher at the Department of Gynecological Endocrinology at the V.I.Kulakov Scientific Center for Obstetrics, Gynecology and Perinatology of the Ministry of Health of the Russian Federation:

Women began to care more about their education, about their careers, later marry and, accordingly, the question of the implementation of the reproductive function is postponed until the age of 30–35 and older. But from the point of view of biology, nothing has changed in the female body (evolution does not happen so quickly) and the best age for the birth of the first child is still 20–25 years (up to 30). Therefore, when a woman puts off a decision for late dates, we have to deal with the problems that a woman has accumulated during her life.<..>

At the beginning of the menstrual cycle, the follicle matures, estrogens are produced, after which the follicle ruptures, an egg comes out of it, which travels to abdominal cavity... If it meets with a sperm, then it enters the uterus through the tubes and there, fertilized, attaches itself. In the place where the egg came from in the ovary, a corpus luteum is formed, which produces the hormone progesterone. It transforms the lining of the uterus and prepares it for pregnancy. If pregnancy does not occur, this endometrium is rejected and menstruation occurs. This is a normal cycle. If a woman is pregnant, there are no conditions for the maturation of the next follicle, the ovaries rest and therefore are not injured. The fact is that the rupture of the egg and its release into the abdominal cavity is always an injury to the ovaries, which increases the risk of endometriosis and ovarian cancer... This is not useful. Nature has not foreseen monthly ovulation for many years (from 20 to 30 years, for example). Menstruation is not always desirable at all: due to trauma to the ovary, and due to the fact that menstrual blood may flow through the tubes into the abdominal cavity and theoretically increases the risk of developing endometriosis. As a result of such work of the ovaries without "rest", disorders can occur, for example, functional ovarian cysts, which not only cause pain, but also apoplexy, and then women with severe pain are admitted to hospitals<..>

In general, you understand: the female body is imprisoned for the cycle "girl - pregnant - grandmother" and in the absence of a series of pregnancies already at 30 is preparing to switch to the "grandmother with endometriosis and fibroids" mode. Well, read on:

We understand that life has changed: we can urge women to give birth young, but if a woman postpones the birth of her first child, then the most correct thing is to use contraception, which will turn off ovulation. From the point of view of the physiology of the female body, this is perhaps the most correct approach. Combined oral contraceptives block the maturation of the egg and prevent the follicle from growing. And this is a real prevention of functional cysts. Secondly, these contraceptives allow the ovaries to rest. This, of course, is not a chemical pregnancy, but the closest condition to this situation. Therefore, the recommended duration of taking contraceptives is at least one and a half years, because it is nine months that pregnancy lasts and about nine months - lactation<..>There is another important point: we are all born with a different ovarian reserve (the number of eggs in the ovaries). [Someone] is already exhausted at the age of 30. Then there is nothing we can do<..>

Very figurative, agree? Actually, I read the same thing about the sterilization of pets. Like, sterilized pussy live happily ever after.

There are many problems besides contraception that we can help solve [with oral contraceptives]. For example, painful or heavy periods, migraines during menstruation, acne, hair loss or excessive hair growth. There is a contraceptive that can be used to treat profuse bleeding that contains ... identical estradiol [estradiol valerate]<..>

Love yourself and be healthy!

Sources of

• Vrbíková J & Cibula D. Combined oral contraceptives in the treatment of polycystic ovary syndrome. Human Reproduction Update 2005 11 277-291.
• De Leo V, Morgante G, Piomboni P, Musacchio MC, Petraglia F & Cianci A. Evaluation of effects of an oral contraceptive containing ethinylestradiol combined with drospirenone on adrenal steroidogenesis in hyperandrogenic women with polycystic ovary syndrome. Fertility and Sterility 2007 88 113-117.
• Batukan C, Muderris II, Ozcelik B & Ozturk A. Comparison of two oral contraceptives containing either drospirenone or cyproterone acetate in the treatment of hirsutism. Gynecological Endocrinology 2007 23 38-44.
• Futterweit, W. A Patient's Guide to PCOS: Understanding and Reversing Polycystic Ovary Syndrome / Walter Futterweit, George Ryan; nutrition editor, Martha McKittrick. - 2006 .-- Holt Paperbacks. 251 pages.
• Cibula D, Hill M, Fanta M, Sindelka G & Zivny J. Does obesity diminish the positive effect of oral contraceptive treatment on hyperandrogenism in women with polycystic ovarian syndrome? Human Reproduction 2001 16 940–944.
• Hoeger K, Davidson K, Kochman L, Cherry T, Kopin L & Guzick DS. The impact of metformin, oral contraceptives, and lifestyle modification on polycystic ovary syndrome in obese adolescent women in two randomized, placebo-controlled clinical trials. Journal of Clinical Endocrinology and Metabolism 2008 93 4299–4306
• Domecq JP, Prutsky G, Mullan RJ, Sundaresh V, Wang AT, Erwin PJ, Welt C, Ehrmann D, Montori VM & Murad MH. Adverse effects of the common treatments for polycystic ovary syndrome: a systematic review and meta-analysis. Journal of Clinical Endocrinology and Metabolism 2013 98 4646-4654.

SOURCES

• Atmaca, M., İ. Seven, R. Üçler, M. Alay, V. Barut, Y. Dirik, and Y. Sezgin. "An Interesting Cause of Hyperandrogenemic Hirsutism." Case Reports in Endocrinology, 2014, 1-4. doi: 10.1155 / 2014/987272.
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