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Hirsutism

Hirsutism is a condition where a woman has male-pattern hair growth. It results in excessive coarse dark hair where women don't generally have hair, such as the face, chest and back. It can happen due to high androgen levels or increased skin sensitivity to androgens caused due to certain medical conditions. Else it could be traced to ethnicity and genes.


Excessively high androgen levels are most often the cause for Hirsutism. Some signs of virilization might be noticed along with Hirsutism such as acne, balding, deepening voice, enlarged clitoris and reduced breast size. Other causes include:


  • PCOS- Polycystic Ovarian Syndrome

  • Cushing's Syndrome H- or Hypercortisolism as it is known owing to the high levels of cortisol in the body.

  • Tumor

  • Acromegaly - A hormonal disorder that results from excessive secretion of growth hormone.

  • Congenital adrenal hyperplasia

Tackling Hirsutism

Anti-androgens are often prescribed to block the androgen effect thereby reducing the excessive hair growth. The effect is slow as the hair takes about 6 months to get thinner and less noticeable. Oral contraceptives, Finasteride, Spironolactone and Cyproterone are commonly prescribed anti-androgens.

Women resort to waxing and shaving to get rid of unwanted hair. Depilatories and eflornithine cream are also self-care options. Laser treatment or IPL (Intense Pulsed Treatment) are undertaken to destroy the hair root permanently. They are done over several sittings and must be done under qualified practitioners.


Diuretics

Also called as Water Pills as this group of drugs lower the blood pressure by excreting excess water and sodium. Originally Diuretics enhance the rate of urine excretion - diuresis. These drugs are prescribed for the treatment of hypertension, (High blood pressure), Congestive Heart Failure (CHF) and Edema, a condition in which excess fluid is accumulated in the body tissues.

Even caffeine, alcohol and some fruit extracts and juices like that of cranberry juice have mild diuretic effect.

Types of Diuretics

Loop type diuretics:

  • Furosemide
    - brand name Lasix
  • Bumetanide
    - brand name Bumex
  • Torsemide
    - brand name Demadex
  • Ethacrynic acid
    - brand name Edecrin

Potassium retaining Diuretics:
  • Spironolactone
    - brand name Aldactone
  • Triamterene
    - brand name Dyrenium
  • Amiloride
    - brand name Midamor

    Thiazide Diuretics:
  • Methyclothiazide
    - brand name Aquatensen
  • hydroflumethiazide
    - brand name Diucardin
  • Chlorothiazide
    - brand name Diuril
  • Hydrochlorothiazide
    - brand name Hydro chlor

Sometimes a combination of the diuretics like hydrochlorothiazide and triamterene is also prescribed.


Polycystic Ovarian Syndrome

In PCOS, under-developed follicles accumulate in the ovaries. Since they fail to mature, they accumulate as cysts in the ovaries. The low levels of follicle stimulating hormone (FSH) and elevated levels of androgens may be the reasons for this condition. When there is no ovulation, the progesterone hormone is not created and the lining of the uterus is not shed in a timely fashion. This increases the chances of endometrial hyperplasia and even cancer.


Another feature associated with PCOS is hyper androgenism or increased responsiveness to testosterone. This usually shows up in oily skin and acne. Excess hair may be noticed on the face and other parts of the body. Women suffering from PCOS have a weight problem, especially around the waist. Insulin resistance is also noticed in some women. This increases the risk of developing diabetes in later years.


Polycystic Ovarian Syndrome Symptom


  • Absence of menses or abnormal or scanty menstrual periods
  • Weight gain
  • Infertility
  • Aggravated acne
  • Increased hair growth in a male pattern

High levels of insulin can result in symptoms such as high androgen levels, infertility and lack of ovulation. These symptoms are usually noticed when women are in their 20s or 30s. Diagnosis of PCOS is after a physical examination and laboratory tests. Thyroid and prolactin levels in the blood are tested. Serum levels of male hormones (DHEA and testosterone) are tested for higher than normal levels. Tumors in the ovary or adrenal glands can be diagnosed with vaginal and abdominal ultrasounds. Insulin resistance is vital in the diagnosis of PCOS. Insulin is instrumental in regulating the ovarian function. An ovarian biopsy may also be done.


Treatment for Polycystic Ovarian Syndrome

Treatment for women with Polycystic Ovarian Syndrome depends on what stage of a woman's life this condition has manifested and her fertility desires. Birth control pills are prescribed to regularize the menstrual cycle and reduce the risk of uterine cancer. Other medications used in the treatment of PCOS are flutamide and spironolactone.

Clomiphene induces the pituitary gland to secrete more FSH and this stimulates release and maturity of ova. Insulin resistance is reduced with drugs such as Metformin (Glucophage) and Troglitazone. 'Ovarian drilling' is a process of using laser to place small holes in the ovaries so as to normalize the hormonal environment and allow normal ovulation.

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Bibliography / Reference

Collection of Pages - Last revised Date: November 22, 2019