Advice for Facial Hair
Female facial hair (also known as facial hirsutism) is when a woman gets excessive growth of thick, dark hair on areas of the face such as the upper lip and chin. Excess female facial hair is though to affect anything from 5 – 10% of women who have not experienced the menopause, increasing to up to 75% after menopause.
Unwanted facial hair is more common in women with dark hair, particularly those from Southern Asia and Europe, and can run in the family. Causes of female facial hair can include hormonal changes (such as the menopause), polycystic ovaries, and side effects of medicines.
Facial hirsutism is normally caused by an excess of, or increased sensitivity to, androgens (male sex hormones) in premenopausal women. In the majority of cases this is caused by polycystic ovary syndrome (PCOS), which causes symptoms of irregular periods, weight gain and acne. In less than a quarter of women, the cause of excess unwanted facial hair the cause of hirsutism is unclear. This is known as idiopathic hirsutism.
Women who have experienced the menopause are more likely to experience unwanted facial hair due to changing hormones. Oestrogen levels can decrease during this time and testosterone (an androgen) can increase causing growth of facial hair.
Most people have a fine layer of small, light hairs that cover the body. In hirsutism, these hairs become noticeably thicker, darker and coarser. This excessive growth of hair occurs most commonly on the face, however it can also occur on the neck, chest, stomach and buttocks. This can be distressing for some women and if this is the case it is important to seek treatment.
Unwanted female facial hair can often occur alongside other symptoms such as:
- Oily skin
- Deepening voice
- Receding hair line
Polycystic ovary syndrome will also cause symptoms of:
- Weight gain
- Irregular periods
Excessive female facial hair does not need to be diagnosed by your GP, it is a very subjective and personal condition – what is considered excessive will vary from person to person, as will their attitude to it. It is important however to discuss newly occurring hirsutism with your GP to investigate the cause. If you have an underlying cause such as PCOS, this can be treated alongside your facial hair with the aim to control both conditions.
If hirsutism is causing you to experience psychological problems such as a loss of confidence, embarrassment or even depression, it is important to consult your GP for treatment. You should also consult your GP if your hirsutism has come on suddenly.
Hirsutism can be diagnosed by visually inspecting and grading the hair growth on 9 different areas on your body. Each area will be graded from 0 to 4, with 0 meaning no hair growth and 4 meaning heavy, dark hair growth. Generally, if you have a score of 15 or above this is considered moderate to severe hirsutism.
If you have had hirsutism (unwanted facial hair) diagnosed by your GP and you have idiopathic hirsutism (facial hair of unknown cause), or your are treating the underlying condition, you may wish to begin treating your unwanted facial hair. If you are treating unwanted facial hair yourself, we always recommend having a check-up from your GP before starting any treatment to ensure there are no underlying causes, such as PCOS.
There are a number of ways to remove, ease or disguise excess facial hair however because they are considered to be cosmetic many are not available on the NHS.
If you suffer with mild hirsutism, you may only require hair removal techniques with no medical intervention. All of these techniques can be effective and improve the appearance of excessive hair. The suitability of each treatment is down to each individual.
- Shaving – Quick & easy method however can cause irritation and leave stubble.
- Bleaching – Can effectively lighten hair and make it less noticeable. It works best with pale skin and can cause irritation.
- Waxing, plucking or threading – Can help to reduce hair regrowth however can be painful and cause inflamed hair follicles.
- Electrolysis – Can remove hair permanently however it may take a long time, be expensive and can cause scarring or changes in skin colour.
- Laser Hair Removal - Can remove hair permanently however it may take a long time and be expensive. It works best on women with pale skin and dark hair.
Vaniqa (eflornithine 11.5%) cream is applied to areas of the face where there is excessive hair growth. It acts to reduce hair growth by blocking an enzyme responsible for hair growth in the hair follicle. Vaniqa has been shown produce an improvement (reduction) in facial hair growth in 70% of patients in clinical trials. Vaniqa is equally as effective in all skin types and shades. Vaniqa is not a hair removal cream, it helps to slow the growth of hair, as well as making it shorter, finer, lighter and ultimately less visible.
Vaniqa can be used alongside other treatments such as hormone tablets or other forms of hair removal such as plucking, waxing, threading or laser hair removal. Vaniqa should be used regularly; if it is discontinued normal hair growth will resume within 8 weeks.
If you suffer with moderate to severe hirsutism that requires medical treatment, your GP may prescribe you certain oral contraceptives to treat the condition. These will only be effective in pre-menopausal women. Oral contraceptive pills such as Yasmin or Dianette (co-cyprindiol) can be prescribed for their anti-androgen effects. By blocking the effects of the male hormones they can help to treat hormone-related hirsutism. Oral contraceptives can be effective at treating excess facial hair in women however they can take up to 6 months to be effective.
Other treatment methods
Unwanted female facial hair can be caused by excess weight. Losing weight to get to a healthy BMI can help to prevent hirsutism in some women.
There are a few Non-Prescription alternatives for Facial Hair removal.
- Laser And Electrolysis treatments
Remember that Laser and Electrolysis treatments should always be carried out by a trained and registered professional.
Facial Hair FAQs
Unwanted facial hair is also called hirsutism. It occurs when women have an excess amount of male sex hormones. Collectively, these are called androgens – the most commonly-known is testosterone. Although it is a male sex hormone, smaller levels of testosterone are also found in women. In women, it increases libido, and also affects fertility and the menstrual cycle.
In around 72% of premenopausal women with hirsutism, the primary cause is polycystic ovary syndrome (PCOS). Other possible causes of excess androgen activity include:
- Cushing’s syndrome – an uncommon hormonal disorder, which leads to sudden weight gain and bloating of the torso
- Congenital adrenal hyperplasia – a hereditary condition affecting the production of sex hormones
- Acromegaly – a disorder leading to an excess of growth hormone
- An androgen-producing tumour
- Medicines e.g. anabolic steroids
For about 23% of cases, there is no single identifiable cause.
PCOS is a medical condition whereby tiny sacs of fluid (cysts) form on the outside of a woman’s ovaries. Because the ovaries produce sex hormones, PCOS can lead to an imbalance of androgens, leading to unwanted hair growth. On top of this, PCOS can cause acne and weight gain, and affect the regularity of the menstrual cycle.
A woman has reached menopause once she has stopped ovulating and has not done so for at least one year. Many hormonal changes are associated with menopause. In some cases, this will lead to an excess of androgens in the body, causing an excess of body and facial hair.
If you have unwanted facial hair, you may want to see a GP. This is because excess hair may contribute to problems with self-confidence and depression.
Before recommending treatment, your GP will determine the severity of the hirsutism and of any other symptoms. This procedure involves looking at the hair growth on nine different parts of the body, and then grading this growth on a scale from zero to four. This will produce a total ‘score’ between zero and 36. On this scale, a total above 15 corresponds to at least moderate hirsutism.
On top of this diagnosis, the doctor will try to identify the cause of the hair growth. They will try to see whether the hair growth might be connected to medication or to a tumour, or whether you exhibit symptoms of PCOS.
If the GP determines that the hair growth might be due to another condition, one or more further tests might be required. This might include a blood test to determine testosterone levels, an ultrasound scan for cysts near the ovaries, or a urine test for cortisol in the case of Cushing’s syndrome.
There is no permanent cure for hirsutism, but many treatments exist to manage the appearance of unwanted hair.
It affects up to 15% of premenopausal women.
Due to the hormonal changes associated with menopause, excess facial hair is much more common in older women. Three in every four women might experience the condition.
There is a myth that shaving causes increased hair growth, but this untrue. Some women, however, may dislike the stubble that grows back, and regular shaving can cause skin irritation. Waxing, while effective for many women, has the risk of irritating and even scarring the skin. Both shaving and waxing can also inflame hair follicles. Use caution if waxing facial hair.
Hair removal creams are called depilatories. They leave no stubble, because they chemically dissolve each shaft of hair. These also have the risk of irritation, especially for women with sensitive skin. Ensure that you follow the appropriate instructions before testing and using any of these creams.
Bleaching creams lighten dark hairs, making them less visible. These are often unsuitable for women with darker skin tones, and can also irritate the skin.
In electrolysis, a hair follicle receives a small electric current, in an attempt to permanently destroy the hair root. Before an electrolysis treatment, ensure that the operator is recognised as qualified by the Institute of Electrolysis. The practitioner must use new disposable needles. Electrolysis can cause scarring, and can be very dangerous if the equipment is not used properly and by trained professionals.
Electrolysis may not be available on the NHS, as it is expensive and time-consuming.
Other methods that involve permanently destroying the hair root are intense pulsed light (IPL) and laser treatments. These must be performed at specialty clinics by fully qualified operators – members of the British Medical Laser Association or Healthcare Commission. Laser and IPL treatments can cause scarring, as well as a slight change in the colouration of the skin. During these treatments, patients must stop all other hair removal procedures and avoid exposure to ultraviolet radiation, such as from tanning beds.
Again, these treatments may not be available on the NHS due to their cost and duration.
Eflornithine cream, unlike depilatory creams, only slows down hair growth. It is a recently-developed treatment which is most often recommended for women who cannot use other treatments, or for whom other treatments have been unsuccessful. The cream is left on the skin, and so it can be used in conjunction with any other method of hair removal. Eflornithines take at least two months of consistent use before having a visible effect. Acne and burning can occur as side effects, but these are most often mild.
Anti-androgens can be prescribed to inhibit the hormonal activity that sometimes causes unwanted hair. This medication often takes from four to six months to take effect. After this time, hair growth will slow down and the hair itself will be noticeably thinner. There are several anti-androgens, including:
- Low-dose combined oral contraceptive pills. One such pill is specifically designed to impede the activity of androgens.
- Side effects: nausea, headaches, menstrual irregularities. Some women are more susceptible to these problems, and so are advised against taking oral contraceptives.
- Cyproterone tablets, when combined with an oral contraceptive pill.
- Side effects: blood clots in the legs, depression, loss of libido.
- Spironolactone, more commonly prescribed in the US than in the UK. When taken daily, can reduce androgen activity and hence slowly reduce unwanted hair growth.
- Side effects: liver damage, irregular menstruation
- Finasteride is as effective as spironolactone, but is not approved for treating hirsutism in women in the UK. It blocks the enzyme that converts testosterone into dihydrotestosterone, an active androgen, and so has anti-androgen effects at higher doses.
For each of these anti-androgens, hair will return once you stop regularly taking the medication. Furthermore, they have been shown to harm unborn male babies. As such, they must only be taken while using effective contraception.
Excess hair itself is not hereditary, though some of the underlying causes may be.