Abnormal hair growth in women -Causes and management

 

1)            What is hypertrichosis?  Increased hair growth at in the androgen-independent areas of body. This is seen in some systemic diseases like hypothyroid states, Anorexia Nervosa, severe malnutrition.

2)              How severe is hirsutism? Is there any evidence of Virilization?

3)              Biochemical evaluation is better prognostically as modified F-G Scare may be false because women often turn to OPD after hair removal.

4)            Treatment of Hirsutism: - Both pharmacotherapy and Cosmetic therapy should be commenced once the etiological diagnosis is arrived. Pharmaco therapy alone will not assure herewith passage of time as drugs usually OCP or Antiandroegns start working the new hairs will be less coarse, grow more slowly. Then, less depilatory methods will be required. Therefore cosmetic methods once thought complimentary methods now are more recognized and more investigations are focused on such topical methods to reassure the woman. Drugs fall under following categories A) OCP B) CPA C) Anti-androgens like Spironolactone, Flutamide and Finasteride. Rarely Gn RH agonist, Metformin has been used.

5)           What are the Lab tests?

TSH, Prolactin, Androgens (Total and if possible free Testosterone, DHEASO4, 17-OH Progesterone) , 24 Hrs. UFC (urinary Free Cortisol), and Pelvic ultrasound. OGTT, Lipid Profile as necessary

Total Testerone: - Most PCOS women will have total T about 150 ng/dL or less than that.   I.e. near normal range of female population. If above 150 ng/dL then tests to exclude ovarian or adrenal androgen secreting tumours by USG/CT/MRI of ovaries.

 

 

 

If there is DHEASO4 is> 700 mcg /Dl then think of adrenal tumour. . Then CT adrenal to be done. 17-OH –P = greater than 200 ng/dLà suggestive of CAHà ACTH stimulation test. If after stimulation the serum level is > 1500 ng/dL then CAH established.

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7)            How effective is COC in reduction of androgens?

8)            COC (combination of EE & Nor-ethindrone) - decreases at least 50% of total Testosterone. . Somehow or other it also reduces adrenal androgen.  It is also suggested that COC has some effect on hair follicles directly (presumptive evidence) Mechanism as yet not known. Subjective improving as rated by women is 60-100%.

9)            Which OCP to choose?

Low androgenic potency progesterones are desirable as desogestrel & norgestimate. Or Classical anti-androgens like CPA or Desogestrel. DSP may increase the incidence of arterial or venous thrombosis therefore may not be used in obese women.

10)  How does CPA acts>

11)  ? It acts as competitively inhibits the action of DHT at receptor level. CPA significantly increases SHBGà Free Tà May be used as COC or monotherapy.