| from the book How to Have a Baby: Overcoming
Infertility
by Dr. Aniruddha Malpani, MD and Dr. Anjali Malpani,
MD.
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The Cervical Factor
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-- The Silent Invader
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What
is hirsutism ?
How
is the cause of hirsutism diagnosed ?
How
is hirsutism treated ?
What
is hirsutism ?
Hirsutism is the growth of long, coarse
hair on the face and body of women in a pattern similar
to that found in men. Besides being cosmetically distressing,
hirsutism may also signal the presence of a hormone
imbalance or a hormone-producing tumor.
Each hair grows from a follicle deep in the skin. As
long as these follicles are not completely destroyed,
hair will continue to grow even if the shaft, which
is the part of the hair that appears above the skin,
is plucked or removed.
Adults have two types of hair, vellus
and terminal. Vellus hair is soft, fine, colorless,
and usually short. In most women, vellus hairs grow
on the face, chest, and back and give the impression
of "hairless" skin. Terminal hairs are the longer, coarser,
darker, and sometimes curly hairs that grows on the
scalp, pubic, and armpit areas in both adult men and
women. The facial and body hair in men is mostly of
the terminal type.
Most often, excess facial and body hair is the result
of abnormally high levels of androgens or male hormones
in the blood. Androgens are present in both men and
women, but men have much higher levels. These hormones
cause hairs to change from vellus to terminal. Once
a vellus hair has been transformed to the coarser terminal
hair, it usually does not change back. Androgens also
cause terminal hairs to grow faster and thicker. Both
the ovaries and the adrenals produce androgens. To some
degree, estrogens and progesterone, female hormones,
prevent the effect of androgens.
The circumstances described below can
lead to high androgen levels, which in turn can cause
hirsutism.
Genetics
There are very obvious family and racial differences
in hirsutism patients. In some women, the skin is very
sensitive to even low levels of androgens and their
follicles produce primarily terminal (coarse and dark)
hairs. If your mother , grandmother or sister experienced
the disorder, then you are at a greater risk of developing
it.
Polycystic ovarian
syndrome
This is the commonest reason for hirsutism in infertile
women. Polycystic ovarian syndrome causes the ovaries
to develop many small cysts and to overproduce male
hormones. The disorder is often associated with hirsutism,
irregular ovulation, menstrual disturbances and obesity.
Ovarian tumors
On rare occasions, androgen-producing ovarian tumors
cause hirsutism. When this is the case, hirsutism progresses
rapidly; and may even cause virilisation - in which
the woman starts developing masculine characteristics,
such as a deep voice and an enlarged clitoris. An ovarian
mass may be detected during a pelvic examination. Tests
may also need to be done to make sure that tumors are
not present when male hormone levels are high.
Adrenal disorders
The adrenal glands, which are located just above each
kidney, also produce androgens. The most common disease
of the adrenal gland that can result in hirsutism is
an inherited disorder called late onset adrenal hyperplasia.
Adrenal tumours and other adrenal diseases such as Cushing's
disease can also cause overproduction of androgens.
How is the cause of
hirsutism diagnosed ?
When trying to determine the cause of hirsutism, several
blood tests need to be done to measure androgen levels.
These tests are done by radioimmunoassay in a specialised
laboratory - and include levels of: testosterone; androstendione;
17-hydroxyprogesterone; and DHEA-S ( dehydroepiandrosterone
sulphate). These tongue-twisters are simply the chemical
names of androgens produced in the body. Which particular
hormone is increased will tip off the doctor as to where
the problem lies -whether in the ovaries or in the adrenal
glands. A pelvic ultrasound or special x-ray studies
may also need to be done to detect ovarian or adrenal
tumors. Hormone suppression or stimulation tests which
further evaluate the function of the ovaries and adrenal
glands may also be required. During these tests, blood
is measured for hormone levels both before and after
the administration of a specific hormone medication.
For example, the ACTH (adrenocorticotropic hormone)
stimulation test is conducted in order to check for
the presence of late onset adrenal hyperplasia.
How
is hirsutism treated ?
Of course, the priority will be to correct the problem
of infertility - thus for example, if the problem of
hirsutism is due to anovulation due to polycystic ovarian
syndrome , the primary goal will be to induce ovulation.
Low doses of steroids called dexamethasone
or prednisone may also be prescribed if the adrenal
gland is overactive. This medicine is usually taken
at bedtime and serves to suppress production of the
ACTH hormone which stimulates the adrenal gland.
Hormone treatment may prevent new hairs
from developing. However, it usually takes many years
for the excess hair to develop, and a significant decrease
in the rate of hair growth will not be seen for at least
six months of hormone treatment. Once a hormone treatment
has proven to be effective, it may be continued indefinitely.
However, terminal hairs that are already present will
not fall out or disappear with hormonal therapy and
must be removed by other means.
For temporary hair removal, many women with mild hirsutism
pluck the unwanted hairs. Waxing, another alternative,
is essentially the same as plucking.
Depilating agents are chemicals that
dissolve the hair shafts on both facial and body hair
and may also be used to remove unwanted hair. These
chemicals can cause irritation and facial skin is particularly
sensitive.
Shaving is probably the simplest and
safest temporary hair removal procedure. Although frequently
required, it is virtually painless and seldom has side
effects. Contrary to popular belief, shaving does not
make hair grow faster. An electric razor produces less
skin irritation than a blade.
Electrolysis is the only permanent way
to remove unwanted hair. During this procedure, a very
fine needle is placed next to the hair shaft into the
follicle. A mild electric current is sent through the
needle and permanently kills the hair follicle. It is
not possible to use this technique to remove hairs from
very large areas of the body because each hair must
be treated individually. In addition, the technique,
although quite effective, is expensive, time consuming,
and moderately uncomfortable. If hormonal therapy is
being started, it is best to delay electrolysis for
at least six months so that the growth of new terminal
hairs will be reduced.
The latest cosmetic technique to remove
hair uses a laser to kill the hair follicles very precisely,
and this is now becoming increasingly popular. Laser
depilation is speedy, relatively painless, efficient
and possibly permanent. A Ruby Laser produces red light
which is highly absorbed by the melanin pigment in the
hair and only minimally absorbed in skin. This means
that the hair is selectively targeted by the light and
hence destroyed without any damage to the skin around
the hair follicle.
Next page: Endometriosis
-- The Silent Invader
Previous page:
The Cervical Factor
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