A survey of British women found that they spend an average of £8,000 on hair removal during their lives. The women also revealed they'd be willing to spend hundreds of pounds to remove unwanted hair permanently (1). It seems that being hairless is important to lots of women, with or without PCOS, and getting rid of those seemingly ever-growing hairs can help us feel more confident. When women with PCOS experience excessive bodily and/or facial hair growth as part of the condition, it can be understandably distressing. A study in 2002 found that some women with PCOS were embarrassed about their excessive hair growth, describing it as "freakish" and feeling it was socially unacceptable (2).
What causes skin and hair issues in women with PCOS?
It's all down to a group of hormones called androgens which originate from the ovaries and adrenal glands in women. Despite often being considered as male hormones, all women make androgens including testosterone. Men produce more androgens than women and they are responsible for male characteristics such as facial and bodily hair growth and muscle development. However, women with PCOS produce higher levels of androgens than normal which can lead to skin problems and the development of some male characteristics.
Androgens travel through the bloodstream to different parts of our body. A very potent androgen produced in our body is dihydrotestosterone (shortened to DHT). DHT is formed when testosterone interacts with an enzyme called 5-alpha-reductase. Both DHT and testosterone bind to hair follicles. There are two types of hair follicles: vellus hairs are fine, soft, short and not that noticeable; terminal hairs are the thick, dark, long hairs that a lot of women try to get rid of in unwanted areas.
A study found that some women with PCOS were embarrassed about their excessive hair growth, describing it as "freakish"
Androgens have different effects on hair follicles depending on their location in the body. For example, when higher amounts of androgens target areas such as the upper lip, jaw line, abdomen, chest and back, they turn fine vellus hairs into thick terminal ones. However, excess androgens at the scalp or crown of the head have the opposite effect and terminal hairs turn to the vellus type which leads to hair thinning.
What skin and hair issues can women with PCOS experience?
Excessive hair growth (the medical term for this is 'hirsutism'): Women with PCOS can have excessive growth of terminal hairs in a male distribution pattern i.e. of the jaw line, chin, upper limb, chest, lower abdomen and back.
Hair loss and thinning (the medical term for this is 'androgenetic alopecia'): Here's a paradox of PCOS - whilst it can cause excessive hair growth in certain areas, it can lead to hair loss in others. Androgenetic alopecia is typically characterised in women by: 1) hairs on the scalp turning to vellus hairs 2) a shortened growth phase which means the hair in the area does not grow beyond a certain point. Women can also experience hair loss in varying patterns, such as at the front hairline.
The mechanisms of androgenetic alopecia are not fully understood. Studies have found that increased androgen levels appear to be linked to hair loss in women (3). There is also a genetic pre-disposition to androgenetic alopecia and it runs in families.
Acne (the medical term for this is 'acne vulgaris'): Increased androgen production is thought to cause acne in women with PCOS (4). We all have sebaceous glands that exist on most of our skin with the highest amounts on the back, forehead and chin. These glands produce an oily substance called sebum which protects and lubricates our skin and hair. High androgen levels are thought to cause acne as they enlarge these sebaceous glands, producing more sebum. Too much sebum can lead to clogged pores and trapped bacteria underneath the skin creating red, sore inflammations. If not managed properly, acne lesions can cause scarring.
Acanthosis nigricans: This is a term for brown, thickened, velvety patches of skin most commonly seen on the neck, armpits and groin. These patches are linked to insulin resistance and often seen in people who are overweight. Acanthosis nigricans is a symptom of an underlying condition such as PCOS. It can also be an indicator of early diabetes or, in very rare cases, cancer and should be discussed with a medical practitioner (4).
What treatment is available to manage hair and skin issues due to PCOS?
Diet and exercise are the first things to address when trying to manage PCOS symptoms (5). For women who are overweight, losing some weight can help balance hormone levels. Try limiting your intake of processed and refined foods and eat a healthy, varied, low GI diet combined with exercise. High GI foods raise insulin levels which, in turn, could increase the amount of sebum produced in the skin and lead to acne (6). You can read more about low GI diets, PCOS & Nutrition and PCOS & Exercise here.
Drinking plenty of water is essential to hydrate the skin and keep it healthy. Eating anti-inflammatory foods rich in antioxidants and omega-3 fatty acids, such as plenty of fruit and vegetables, salmon, walnuts and chia seeds, can also help.
Vitamins: Certain nutrients promote skin health. Our bodies convert beta-carotene into Vitamin A, which is an anti-oxidant essential for skin health (6) and helps ward off bacteria. Vitamin A deficiencies can lead to dry skin and hair, and brittle nails. Beta-carotene gives fruit and vegetables their yellow/orange pigment and sources include carrots, sweet potatoes, tomatoes, yellow and red peppers. Vitamin E is another anti-oxidant important for skin health and food sources include olive oil, apples, carrots, healthy nuts and seeds, and wholegrains.
Dairy & Acne: Some research has found that milk impacts insulin levels and is linked to acne (6). It is important to consider the impact of foods which contain chemicals known to harm our health and increase hormonal levels in women with PCOS. For example, milk, fish, eggs and butter are likely to be contaminated with a chemical called dioxin. Read more about endocrine-disrupting chemicals, the role they play in PCOS and how to reduce your exposure to them here.
Try to include fewer animal products in your diet and go organic. The American Academy of Dermatology (AAD) suggest that women speak with their medical practitioner if they feel dairy products negatively affect their acne. The AAD also advises that adequate levels of calcium and vitamin D are consumed from other sources if dairy is eliminated from the diet (7).
Spearmint tea: A study in Turkey found that drinking spearmint tea decreased androgen levels and recommended it as a treatment for mild hirsutism (8). Further research is needed but you could always give spearmint tea a try as it's also full of antioxidants. (8)
Hair removal: We all know the list - shaving, waxing, threading, plucking are some ways of removing unwanted hair. Keeping on top of hair removal can seem never-ending and frustrating but some of the methods mentioned can be less expensive than other options and don't need to introduce chemicals into your body. Some women choose laser therapy where unwanted hair is 'zapped' and falls out but be aware of potential side effects, such as scarring and redness.
Skin Care: Proper skin care is essential. Skin is the largest organ in our bodies. Everything we put on our skin is absorbed into our body - ingredients can penetrate into our blood vessels and move around our body. It's therefore important to consider what you are putting on your skin and it makes sense to use organic products without added chemicals that will impact already imbalanced PCOS hormonal levels. That's everything from body lotions and moisturisers to sunscreen, make-up (especially foundation which can be a staple if you have skin issues), deodorant, shower gels/soaps and bath products.
The AAD advocates the use of tea tree oil to treat acne and advise that you consult your dermatologist if you have any queries regarding the suitability of ingredients in skin care products (7). You have most likely heard this advice before but try not to pick your spots, however tempting! With acne, there can already be issues with bacteria without introducing more with your fingers or forcing it deeper under the skin.
Liaise with your medical practitioner: Creams and oral medications are available. For example, oral contraceptives, the 'pill', with combined estrogen and progestin to decrease the amount of androgens produced in the body and improve hirsutism. There are concerns over the pill's potentially negative effects on insulin resistance, blood clots and heart health (4). Having access to safe and effective contraception is important and you should liaise with your medical practitioner to discuss options that meet your needs.
Metformin is a drug used mainly to increase insulin sensitivity. Studies looking at the benefits of Metformin for treating hirsutism are limited (4). A Cochrane Review (9), which is a highly regarded review of evidence based health care, looked at the benefits of the pill compared to Metformin and concluded that 1) there isn't sufficient evidence to say whether the pill or Metformin is more effective in treating excessive hair growth or acne and 2) the long term effects of both the pill and Metformin on PCOS symptoms are unknown. If you wish to consider prescription medications it is advisable to seek professional medical advice.
Everything we put on our skin is absorbed into our body - ingredients can penetrate into our blood vessels and move around our body
Looking after your emotional health: Having hirsutism or acne can be understandably upsetting and distressing. It can negatively impact your confidence, make you worry about your appearance and be frustrating having to constantly keep on top of managing your symptoms.
Be kind to yourself and remember to remind yourself of how great you truly are regardless of your hair or skin. Let's not be afraid to create our own ideas of beauty and put less pressure on ourselves to try conform to other people's views.
It's important to recognise if you're feeling low in mood and need some support. Speaking to women with PCOS or reading that others are going through something similar can help. Verity, a UK charity for women with PCOS, has a discussion forum and information on local groups who meet to provide peer support. You may find it useful to talk with someone, like trusted friends or family, or a professional counsellor.
With all the potential stresses that invariably come with PCOS, try to take some time out for yourself to relax, do things that make you feel good about yourself and treat your emotional health as a priority.
Note that referenced or mentioned authors, websites and organisations are not affiliated with, nor endorsing, the content published on Positive PCOS.
1: Professional Beauty Magazine. Accessed on 05/01/15. No longer live
2: Kitzinger, C & J. Willmott. 2002. The thief of womanhood: women's experiences of polycystic ovary syndrome. Social Science & Medicine. 54 (3): 349-361
3: Kaufman, K. 2002. Androgens and alopecia. Molecular and Cellular Endocrinology. 198 (1-2): 89-95
4: Lee, A.T. & L.T. Zane. 2007. Dermatologic manifestations of polycystic ovary syndrome. American Journal of Clinical Dermatology. 8 (4): 201-19
5: The Jean Hailes Foundation for Women’s Health on behalf of the PCOS Australian Alliance. 2011. Evidence-based guideline for the assessment and management of polycystic ovary syndrome. Copies available to download at www.jeanhailes.org.uk. Accessed on 12/01/15
6: Apostolos, P. 2009. The relationship of diet and acne: a review. Dermatoendocrinology. 1 (5): 262–267
7: American Academy of Dermatology: www.aad.org/stories-and-news/news-releases/growing-evidence-suggests-possible-link-between-diet-and-acne
8: Akdogen, M. et al. 2007. Effect of apearmint teas on androgen levels in women with hirsutism. Phytotherapy Research. 21 (5): 444-447
9: Costello, M.F. 2007. Metformin versus oral contraceptive pill in polycystic ovary syndrome: a Cochrane review. Human Reproduction. 22 (5): 1200-1209