Can contraception help Hirsutism or PCOS hair growth?

Watching any razor or hair removal advert would have you believe that we should exist with Barbie doll smooth skin, where any hint of stubble calls for imminent removal faster than you can shout ‘Brazilian Wax.’ 

We still remember the PE room chatter, feeling mortified at a frighteningly young age about leg hair, or god forbid some armpit fuzz. Growing up against this backdrop, it’s hard to see what is normal and what isn’t…

In this piece we explore hirsutism and the various treatment options, including the combined pill.

Hirsutism: what is it?

Hirsutism affects around 5-10% of women. Hirsutism is where coarse “terminal hairs” appear in a male-type distribution (like the face, back or stomach). Terminal hairs are thick and dark like pubic hairs or eyebrows and are different to the softer, shorter hairs that appear over the rest of the body.

Hypertrichosis is generalised hair increase, but we don’t cover that in this article.

How to diagnose hirsutism

Hirsutism can be diagnosed by a healthcare professional examining your body for the typical thick hairs and where they appear.  

The Ferriman-Gallwey scoring system is a classification system for hirsutism. Here you healthcare professional will look at 9 areas on your body and score each from 0 to 4 based on excessive hair growth.

A total score of 8 or more is used to determine hirsutism in Black or Caucasian women of reproductive age. This score can be lower for some Asian and South American populations and higher for some Mediterrean, Middle Eastern or Hispanic populations. The sscoring system can also be used to classify hirsutism as mild, moderate or severe.

Your doctor may also do blood tests to assess your androgen levels (e.g. testosterone), as higher androgen levels may cause hirsutism.

What causes hirsutism?

Polycystic Ovary Syndrome (PCOS)

Hirsutism is most commonly associated with PCOS. Studies suggest 72-82% of all hirsutism cases are due to PCOS. This is due to the high levels of testosterone and androgens in the bloodstream associated with PCOS.

Idiopathic Hirsutism (IH)

Sometimes hormone levels and ovarian function (e.g. ovulation and menstrual cycles) can be completely normal, this is known as Idiopathic Hirsutism with no other underlying cause identified. Less than 20% of cases of hirsutism are down to IH, but interestingly one half of women with mild hirsutism have IH. 

Other causes: 

• Androgen secreting tumour: produces hormones such as testosterone
• Adrenal hyperplasia: enlarged adrenal glands
• Cushing’s syndrome: an excess of the hormone cortisol
• Thyroid dysfunction: underactive thyroid gland
• Certain medications: including sodium valproate and anabolic steroids

Okay, some of the above sound pretty sinister but just to reassure you that these are much less common – the most likely causes are PCOS or IH. 

Some people may also experience hirsutism due to hormonal changes around the menopause. After the menopause, oestrogen levels fall to undetectable levels. The small amount of testosterone in the female body may therefore predispose some people to androgenic symptoms, especially acne, increased facial hair growth and male pattern baldness. 

What’s the deal: PCOS and body/facial hair growth

So, to understand this connection we need to think about normal hair growth. Our bodies are covered with hair follicles, containing vellus or terminal hairs. In women, vellus areas are the fine, soft hairs on your face or back. You might not be able to see them unless you look closely. Terminal hairs are darker and thicker (typically covering the face and body in men), but in women cover the scalp, pubic areas and armpits. 

Androgens (produced by the ovaries) can be elevated in women with PCOS causing excessive hair growth. This makes sense as men have a higher level of androgens and much more terminal hair spread throughout their bodies. 

Your hair follicles may be sensitive to increased androgens which can be present with PCOS – this can cause the softer vellus hairs to change to thicker, faster growing terminal hairs. Usually, once a vellus hair has changed to a terminal hair it will not change back again. 

Contraception for excess hair or hirsutism

Contraceptives which could help hirsutism include:

1. The combined pill
2. The patch
3. The vaginal ring
4. The progestogen-only pill brand Slynd

The pill and hair growth

The oestrogen found in the combined pill, patch and ring increases a protein in your body called sex hormone binding globulin. This protein binds to testosterone, mopping up excess levels in your bloodstream. As it is excess testosterone that causes hirsutism, by reducing the levels, hirsutism can improve. We also have a fab article specifically on how the pill can affect growth or loss.

The progestogen in the combined pill, patch or ring may also reduce the amount of androgens released by your ovaries.

Some brands of the combined pill contain anti-androgenic progestogens, which are even better at reducing testosterone levels in the body, so may be preferable if you aren’t seeing any improvements on standard brands.

Anti-androgenic brands combined pill include Yasmin, Lucette, Eloine, Yacella or Dianette. These contain the anti-androgenic progestogen drospirenone.

Slynd is a progestogen-only pill which just contains drospirenone.

Remember to share a review if you see any changes to body or facial hair growth whilst on different forms of hormonal contraception! 

Does PCOS hair disappear?

As PCOS is linked to excess androgens, if you take action (including lifestyle changes) to normalise testosterone levels, it’s more likely for hirsutism to improve. Medications such as the combined pill or topical creams can be super effective in managing excess hair. And if your BMI is over 30, losing weight can help as the hormonal imbalance in PCOS improves. 

Does chin hair mean PCOS? 

Plucking the odd straggly chin hair is normal and nothing to worry about – particularly if it’s finer hair. However, if you notice that there are repeated, thick, dark hairs, this could be due to the hormone imbalances seen in PCOS. However, diagnosing PCOS requires other tests and hallmarks. Remember some hair growth can be unexplained (evidence suggests it is genetic), so chin hairs alone are not enough to diagnose PCOS. 

Natural treatments for excess hair

It is perfectly fine to use regular hair removal methods such as shaving and bleaching to manage excess hair. Waxing is not recommended as it can cause skin damage and ingrown hairs. However, a few longer-lasting non-medical solutions are:

• Laser hair removal. This inhibits hair follicle growth. It is most effective with dark hair and fair skin – but repeated sessions are needed. Also, it can cause terminal hairs to minimise into vellus hairs, so any hair within that site should appear thinner and lighter. Plus, it’s less painful than electrolysis!
• Electrolysis disrupts hair growth using heat or chemical energy. It is usually more effective than laser hair removal but can cause scarring.

Medical treatments for excess hair 

• Eflornithine: This prescription cream can be applied to the skin twice a day and works best on facial hair growth.
• Anti-androgen medications:
  • Spironolactone: This blocks androgen receptors and may be used alongside the combined pill.
  • Finasteride: This drug influences enzymes that affect testosterone. However, it cannot be used for women who may want to get pregnant.