treatment

There are a number of different treatments that can remove the excess hair in women with hirsutism, and help stop it coming back.

The main treatments are:

Hair removal methods

Eflornithine cream

Oral contraceptives

There are also several additional medicines that may be prescribed by a specialist if the above treatments haven't helped.

Hair removal methods

There are a number of ways to removeor disguise excess hair.Some can betried at home, while more specialist treatmentsarecarried out in clinics.

Your GP can advise you about the hair removal options available. You may need to try a number of methods to find one you prefer.

Home hair removal techniques

Home hair removal techniques are relatively inexpensive, although they need to be carried out regularly because the results are only temporary.

The main techniques are:

• shaving quick and easy, and won't make the hair grow back quicker or thicker, but may irritate your skin and there may be unpleasant stubble growth between shaves
• bleaching can make dark hair look better in the short term, but may irritate your skin and isn't effective if you have dark skin
• waxing, plucking or threading can reduce regrowth if done regularly, butcan be painful and may causeinflammation ofthe hair follicles(folliculitis) and, occasionally,scarring
• hair removal (depilatory) creams can remove hair from large areas of skin without leaving stubble behind, but can irritate the skin and should be tested on a small area at first
• epilators (electrical hair removal devices) can remove hair from large areas relatively easily, but can be painful and cause folliculitis

Specialist hair removal techniques

Specialist hair removal techniques may have longer-lasting results than the techniques you can try at home, although they'rerarely available on the NHS and can be expensive.

The main treatments are:

• electrolysis (where electricity is used to destroy hair follicles) can be a permanentsolution, but may require several treatments; can also be painful andmay cause scarring or changes to your skin colour
• laser hair removal (where powerful beams of light are used to destroy hair) can remove hair for longer periods than home removal methods, but the results aren't permanent; side effects can include redness, darkening or lightening of the skin, and scarring

Eflornithine cream

Eflornithine cream is a prescription medicine applied twice daily that can help treat excessive hair growth on the face and under the chin.

Itcan be prescribedforboth premenopausal women and menopausal women, but isn't suitable for women who are pregnant, breastfeeding or under the age of 19.

The cream helps slow down hair growth and can be used alongside the hair removal methods mentioned above.

You should notice an effect within eight weeks. Treatment will be stopped if no benefit is seen after four months.

Ifeflornithine cream does work, you'll usually need to continue using it, as hair growth will returnwithin eight weeks of stopping treatment.

Side effects ofeflornithine cream can include:

• mild Blackheads
• skin redness
• a burning or stinging sensation
• dry, itchy skin

Oral contraceptives

For hirsutism affecting large areas of the body, your GP may prescribe oral contraceptives or co-cyprindiol (Dianette).

Co-cyprindiol is a type of combined contraceptive pill that can treat excess hair growthby blocking the effects of male hormones (androgens) in the body. It's only suitable for premenopausal women with hirsutism.

The pills are taken once a day in cycles lasting 21 days, followed by a seven-day break before you start the next cycle. Itmay take around six months to see an effect.

Once your excess hair growth has improved, you'll be advised to stop taking thepills after a further three or four months because continuous long-term treatment increases your risk of developing a blood clot .

If your hirsutism returns after you stop taking the tablets, your GP may recommend starting treatment again orchanging to a different combined contraceptive pill.

Common side effects ofco-cyprindiol include:

• weightgain
• breast pain or tenderness
• irritability or low mood
• feeling sick
• tummy (abdominal) pain

Additional medicines

Your GP may refer you to a specialist if the treatments above aren't suitable or don't work. There are several additional medicationsa specialist can prescribe if necessary.

These include:

• anti-androgens (medicines that suppress androgens) such ascyproterone acetate and spironolactone
• finasteride a type of medication thatworks by preventing testosterone (an androgen) from turning into a stronger form of testosterone inside your body's cells
• insulin-sensitising medication (medicines thatmake your body more sensitive to insulin) metformin and pioglitazone
• gonadotrophin-releasing hormone (GnRH) analogues (man-made hormones) such asgoserelin and leuprorelin

Many of these medicines are unlicensed for the treatment of hirsutism.

This means they haven't undergone clinical trials for this use, but your doctor believes they're likely to be effective. They will discuss the possible benefits and risks with you.