Wondering what your options are for hair removal when you have PCOS?
Caci and the team at Ovie have teamed up to create awareness and education of PCOS and Laser Hair Removal. Read on to hear from Clare Goodwin, Registered Nutritionist, Exercise Scientist and trained teacher in Natural Fertility at Ovie, and how she understands the impact PCOS and hair growth have on women and how laser hair removal can help those who want it.
In my decade of working with patients with Polycystic Ovarian Syndrome, I've seen that facial and body hair growth (hirsutism) is the symptom that has the biggest toll on a woman's mental health and quality of life over her lifetime. In a world obsessed with ensuring that female bodies conform to specific ideals, this is not surprising.
In the biggest analysis of all the research on PCOS (the international evidence based guidelines), they also found this to be true. The prevalence of depression and anxiety in women with PCOS is staggering, up to 80% and 76% respectively. That’s 2.5-3 times higher than in women without PCOS, and hirsutism is one of the factors that contributes to that. While mental health is complex, one treatment that has been found to improve quality of life and depression and anxiety scores was laser hair removal.
What is hirsutism?
Hirsutism is a term used to describe excessive and unwanted hair growth in areas of the body where hair is typically associated with a male pattern. The specific areas commonly categorized as hirsutism include:
Face: This often includes the upper lip, chin, cheeks, and sideburn areas.
Chest: Hair growth on the chest, particularly along the sternum or between the breasts, can be characteristic of hirsutism.
Back: Excessive hair on the back, especially in the upper back region, is another common area for hirsutism, as are the buttocks.
Abdomen: Some women with hirsutism may experience hair growth on the lower abdomen.
A couple of hairs on your chin, upper lip, nipples, or lower belly are completely normal, as are darker hairs on your legs and arms. This isn't to say you can't remove them if you don't want to, but they wouldn't be classified as hirsutism.
What causes us to sprout these hairs?
We actually have hair all over our face, but generally it is so fine and short you don’t notice it. In fact, the only places we don’t have hair is on the soles of our feet, palms of our hands, and lips. However, not all of these hairs are the same. There are actually 2 types of hair.
Villus hairs are those soft short (less than 2m length) hairs that cover our body where we would otherwise think of as hairless i.e. our faces, chests, and backs.
Terminal hairs are the coarse, pigmented hairs that make up our scalp hair, eyelashes, brows, pubic hair, etc.
In hirsutism, these soft hairs are converted into coarse hairs, primarily by the ‘androgen’ or male hormones, but also by our blood sugar hormones insulin too.
What are the hormones involved in Hirsutism?
High Androgens (Testosterone)
Androgens are a group of hormones that are thought of as more ‘male’ hormones. The main one that you’ll be familiar with is Testosterone, but it also includes DHEA-S, which is produced from your adrenal glands when you are stressed.
These are a completely normal part of the female body, but when they get too high they cause absolute havoc. They get into the hair follicles on our face and chest, turning the very fine hair that normally grows there into thick, dark hair.
They also get into the hair follicles on our head and can cause that hair to fall out (androgenic alopecia) and also seep into the glands under our skin and cause acne.
The main cause of high androgens and hirsutism is PCOS and 95% of women with hirsutism have PCOS, so if you do have abnormal hair growth, it’s highly likely that you have PCOS.
While it’s true that there is a genetic component to PCOS, we know that the right environment must be present for these genes to exhibit. These environmental factors include inflammation, stress, hypothyroidism, and the birth control pill, but the most common one is insulin resistance.
Insulin is our storage hormone. When we eat, our body detects a rise in blood sugar. Our body doesn’t like blood sugar to be high, as over the long term this damages the cells in the brain, liver, pancreas, heart, and eyes—so it stores it away in the cells in our muscles and liver for later use.
Insulin is the hormone that tells the cells to open up and let glucose in. It’s excreted by the pancreas and binds to a receptor on the cell to open it up, similar to the way a key opens a door. When the key has been used too much, or there is chronic low grade inflammation, the lock starts to get a bit worn and clogged up; the key no longer fits. This is insulin resistance.
I’ve written a comprehensive guide to insulin resistance and the tests you should get to diagnose this here.
High insulin levels stimulate the ovaries to produce more androgens and also reduces the amount of Sex Hormone Binding Globulin (SHBG). SHBG is like a sponge for excess hormones. If it is low then the amount of hormones running free will be much higher.
Studies have shown that high insulin has a twofold impact on hirsutism: It not only increases these androgens (and decreases SHBG), but it also independently causes hirsutism.
One study of 749 women with PCOS, showed that high insulin was actually more important in causing unwanted hair growth than high androgen levels.
What treatments are effective for hirsutism?
While you absolutely do not have to remove this for society's sake (the ancient egyptians didn’t, women of high social status actually wore wigs adorned with false beards and facial hair), if you want to here is what the research says about the most effective treatments:
Waxing, plucking and threading
These are all just variations of the same thing: mechanically removing the hair. While popular, these methods are not good options for unwanted facial hair treatment for two reasons:
- These methods are not really a treatment. Mechanically removing the hair doesn’t kill the hair over the long term, so it’s really just like shaving but takes longer to grow back. You might have been told that if you pluck or wax enough that the hair eventually stops growing back, however there is no evidence to support this.
- It actually damages the hair shaft, so you are more likely to get ingrown hairs. For those that have had bikini waxes over a number of years will be all too familiar with ingrown hairs.
IPL vs Laser
IPL and laser are more permanent hair removal processes. They both operate by the same principle, which is to kill the hair at the root so stop it growing again.
IPL, uses pulsed light to do this, while laser uses a concentrated beam of light
Studies show that laser is the most effective treatment.
The international evidence based guidelines for PCOS state that laser hair removal is the most effective based on the current evidence, and that there is very low risk of adverse reactions if this is done by a qualified professional.
Laser hair removal works by using light to selectively kill the hair follicle, without damaging the tissue around it. This is why it works best if you have some contrast between your skin colour and hair colour as it needs the difference in light wavelength to select what to kill.
Additionally the guidelines state that a greater number of laser treatment sessions may be required in women with PCOS, compared to other women, to achieve hair reduction.
Laser PLUS reducing androgens and insulin
The international guidelines also found that the most effective treatment of all is treating the hormones as well as laser hair removal. That’s why Ovie has teamed up with Caci. Caci are the experts in laser hair removal, and Ovie are the experts in helping you regulate your hormones, and we can do this in many ways. Tweaking what you eat, how you move, your sleep, stress management and your vitamin and mineral intake are all incredibly effective in helping to regulate your hormones. But equally, medications can also be very helpful for some people. We give you all the details for both so that you can make an informed decision on the way you want to treat your PCOS.
Let’s get started in helping you feel your best! Start you journey by booking a free consultation with your local Caci