Menopause, a natural biological process marking the end of a woman's reproductive years, brings about various hormonal changes that can impact different aspects of health, including hair growth patterns. While some women may experience hair thinning or loss on the scalp, others might notice increased hair growth in unexpected areas, such as the face. This condition, known as hirsutism, can be a source of concern and self-consciousness for many women undergoing menopause. Understanding the causes, symptoms, and available treatment options can help women navigate this transition with confidence and peace of mind.
What is Menopausal Facial Hair?
Menopausal facial hair refers to the growth of coarse, dark hairs on the face during menopause. It’s normal to have had peach fuzz or vellus hairs throughout adulthood, but terminal hairs-coarse, dark, and beard-like-tend to pop up or intensify with age, particularly on the chin, upper lip, and sides of the face.
The Hormonal Shift: Why Increased Hair Growth Occurs
Hair grows in four stages: anagen (growth), catagen (transition), telogen (resting), and exogen (shedding). Hormonal changes during menopause may disrupt this cycle and cause increased hair growth.
The primary culprit behind increased facial hair growth during menopause is the shift in hormone levels, specifically the decline in estrogen and the relative increase in androgens. Androgens like testosterone play an important role in increasing hair fiber diameter, hair follicle size, and the duration of the anagen phase - factors that contribute to hirsutism. Estrogen and progesterone are essential for keeping androgen levels in check. Estrogen helps convert excess androgens into estrogen, while progesterone prevents the conversion of dihydrotestosterone (DHT) into testosterone. As estrogen and progesterone levels decline during menopause, androgens can go unchecked, leading to increased hair growth. Relatively high androgen levels can also affect hair quality by shrinking hair follicles and turning soft, fine hair (vellus hair) into thicker, coarser hair (terminal hair).
During menopause, a woman’s body stops circulating estrogen but continues to circulate the same amounts of testosterone. The imbalance of hormones causes the appearance of some male secondary sex characteristics, like coarse facial hair.
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Prevalence of Hirsutism During Menopause
Studies suggest that about 5% to 10% of women may experience hirsutism. The prevalence of hirsutism increases during menopause, with 50% of women over 50 experiencing excessive hair growth after menopause.
Recognizing the Symptoms of Increased Hair Growth
Hirsutism involves excessive coarse hair growth, or “peach fuzz,” on various body parts like the chest, face, and back. Hirsutism typically causes an increase in coarse hair on the following body parts:
- The sides of the face
- Upper lip
- Chin
- Upper back
- Shoulders
- Sternum
- Upper abdomen
The type of hair may also change from fine, light-colored strands to darker, thicker ones. When high androgen levels cause hirsutism, other signs might develop over time, a process called virilization.
Treatment Options for Increased Hair Growth During Menopause
Fortunately, various treatment options are available to manage increased hair growth during menopause, ranging from temporary solutions to more permanent removal methods. The most suitable treatment depends on individual preferences, the extent of hair growth, and any underlying medical conditions.
Epilation Techniques
Epilation techniques involve removing hair from the root, providing longer-lasting results compared to shaving. Common epilation methods include:
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- Shaving: You may balk a little at the idea of shaving your face, but it’s a cheap, effective remedy. Plan on shaving in or just after a shower when hair is softer and use a sharp razor to prevent rashes or ingrown hairs.
- Waxing: Waxing involves applying hot or cold wax to the skin and then quickly removing it, pulling out the hair from the follicle.
- Plucking: Pull “em out. If you only have a few, grab a tweezer and pull them out. For more hair, waxing or threading may be more practical solutions.
- Threading: Threading uses thin, doubled thread pulled tight and rolled over the face to remove hairs. Both options should be done by an expert to prevent ingrown hairs.
- Dermaplaning: Also, specifically for the face, there is a technique called dermaplaning, which shaves hairs using a medical grade scalpel. “This can be done with a medical professional or at home,” Dr. Javaid adds. If you decide to try it at home, there are special dermaplaning tools you can get that are made with safety in mind. “Make sure to keep the skin taut, use short strokes, and keep it at a 45-degree angle in the direction of the hair growth,” Marisa Garshick, M.D., F.A.A.D., a board-certified dermatologist based in New York previously told Prevention.
However, these epilation methods may have some side effects, including inflammation, irritation, and discoloration of the skin.
Depilatory Creams
Try creams. Depilatory creams have come a long way from the “Who wears short, short?” days. While they are gentler and smell better, some women are sensitive to the chemicals that break down the hair. Always do a small patch test somewhere else on your body to check for any reaction.
The ingredients in these creams can dissolve hair, offering temporary results. Depilatory creams may also cause irritation to the skin, so patch testing is recommended to avoid such complications.
Laser Hair Removal
Lasers have become a popular method for long-term hair reduction, though they do not offer complete hair removal. The beams of light overheat the follicle, damaging it so hair can no longer grow. The results are permanent, but it is expensive (several hundred dollars per session depending on where you live and the amount you want done), and it may require multiple sessions. They work by using selective photothermolysis, where laser energy specifically targets and destroys melanin in the hair. Since lasers only affect hair follicles in the growth phase (anagen), multiple treatments are required to achieve a significant reduction, typically around 80%.
“The laser targets melanin, which gives hair and skin its color,” says Dr. Williams. “Laser treatment only works on dark hair. If your unwanted hair is light, the laser won’t work.” If the hair has not turned white, which then won’t respond to lasers, Dr. Javaid says this is an option.
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Electrolysis
Like using tweezers, electrolysis targets hairs one at a time. A thin probe goes directly into the hair follicle, and a low-level electrical current heats the follicle to the point of destruction. The zap can hurt or even scar a little. Because it’s a one-at-a-time deal, it can take up to 18 months of treatments to get the results you want.
This method involves applying electric energy through a fine needle inserted into each hair follicle, targeting the follicle's ability to produce hair. Over multiple treatments, electrolysis can achieve 15% to 50% permanent hair loss. However, it can be slow and less practical for large areas of the body.
Medications
Certain medications, such as androgen receptor blockers and 5-alpha reductase inhibitors, can help manage androgen levels and reduce related symptoms. Dr. Hart says there are topical and oral prescription medications that can slow down facial hair growth, including spironolactone, a medication typically prescribed to treat acne, and eflornithine cream, which slows hair growth using a topical enzyme.
Hormone Replacement Therapy (HRT)
Some studies suggest that HRT may help manage increased hair growth, especially on the face.
Prevention Strategies for Unwanted Hair Growth
One of the best ways to prevent androgen excess is by eating a balanced diet rich in quality proteins, complex carbohydrates, and colorful fruits and vegetables. When the body is getting too many refined carbohydrates, such as simple sugars, white bread or pasta, it produces more insulin. Other ways to prevent unwanted facial hair growth during menopause include balancing your hormones, taking a high-quality multivitamin to fill in any nutritional gaps, reducing stress, and keeping your body fat under 30%.
When to Seek Medical Advice
Facial hair growth by itself isn’t a danger, however in some cases, it can signal a more serious problem like polycystic ovary syndrome or adrenal gland issues. If hair is growing on other areas of the body where it normally only grows on men, or it is excessive, you should check with your doctor.
Menopausal changes-including facial hair-are totally normal, and thankfully, straggling strands are harmless and easy to remove, if they bother you. With that being said, if you feel like your whiskers ever multiply to an extent that feels concerning, it’s worth letting your doctor know, because excess facial hair can be linked to adrenal disease, polycystic ovarian syndrome, and hormonal fluctuations linked to a tumor, Dr. Javaid says. “Please see a medical provider to obtain the correct diagnosis before making a health care plan,” she stresses.
Conditions Associated with Hirsutism
See your doctor for assessment if over a few months you experience severe or rapid hair growth on your face or body or signs of virilization.
- Polycystic ovary syndrome (PCOS). This condition, which often begins with puberty, causes an imbalance of sex hormones. Over years, PCOS may slowly result in excess hair growth, irregular periods, obesity, infertility and sometimes multiple cysts on the ovaries.
- Cushing syndrome. This occurs when your body is exposed to high levels of the hormone cortisol. It can develop from your adrenal glands making too much cortisol or from taking medications such as prednisone over a long period.
- Congenital adrenal hyperplasia. This inherited condition is characterized by abnormal production of steroid hormones, including cortisol and androgen, by your adrenal glands.
- Tumors. Rarely, an androgen-secreting tumor in the ovaries or adrenal glands can cause hirsutism.
- Medications. Some medications can cause hirsutism. These include minoxidil (Minoxidil, Rogaine); danazol, which is used to treat women with endometriosis; testosterone (Androgel, Testim); and dehydroepiandrosterone (DHEA). If your partner uses topical products containing androgens, you can be affected as well, through skin-to-skin contact.
- Family history. Several conditions that cause hirsutism, including congenital adrenal hyperplasia and polycystic ovary syndrome, run in families.
- Ancestry. Women of Mediterranean, Middle Eastern and South Asian ancestry are more likely to have more body hair with no identifiable cause than are other women.
- Obesity. Being obese causes increased androgen production, which can worsen hirsutism.
Acknowledge Your Feelings
Hirsutism can be emotionally distressing. Some women feel self-conscious about having unwanted hair. Some develop depression. Also, although hirsutism doesn't cause physical complications, the underlying cause of a hormonal imbalance can.