Our expert says:
Hi Tracy, thank you for the question.
Considering the fact that you have had all the hormonal tests and I presume abdominal ultra sound investigations performed then there may not be much one can do in investigating further. I am also a little surprised that the laser hair reduction has not been successful after nine sessions as we tend to see a noticeable improvement in body hair with the PCOS patients we have treated even after 5 sessions.
I have listed the tests that should have been done performed for a full investigation:
Total and free testosterone
Sex hormone binding globulin
Free androgen index
Androstenedione (drawn after 10 a.m.)
If there is also menstrual disorder, additional tests may be requested:
Luteinizing hormone (LH) and follicle stimulating hormone (FSH)
Oestradiol, 17-hydroxy progesterone
Tests may be requested to evaluate other related aspects of health, for example:
Cortisol or overnight dexamethasone test
Lipids (cholesterol and triglyceride)
Following from your description of the hair growth it sounds that you are suffering from hirsutism. Women who have hirsutism can have dark, thick hair on their face, chest, abdomen and back. This thick, dark hair is different from the hair that some women have on their upper lip, chin, breasts or stomach, or the fine "baby" hair all over their body.
Other symptoms of hirsutism may include:
Acne, Irregular menstrual periods, deepening of the voice, increased muscle mass, decreased breast size
Hirsutism can be caused by abnormally high levels of male hormones (called androgens). The following are some of the conditions that may increase a woman's normally low levels of male hormones:
Polycystic Ovary Syndrome, which is a condition that occurs when an imbalance of hormone levels in a woman's body causes cysts to form in the ovaries
Cushing's Syndrome, which occurs when your body is exposed to high levels of the hormone cortisol for a long period of time
Tumors in the ovaries or adrenal gland, formed when abnormal cells grow out of control and clump together
Hirsutism can also be caused by hair follicles that are overly sensitive to male hormones and no specific cause has been found.
Some medicines can cause hirsutism. These medicines include hormones, anabolic steroids and a medicine used to treat women who have endometriosis (called danazol).
Hirsutism also seems to be hereditary (which means it runs in families).
There are several medicines available to treat hirsutism. Your doctor may prescribe a medicine called an anti-androgen to help block the male hormones associated with hirsutism from being produced in your body. Common anti-androgen medicines include spironolactone and finasteride. Anti-androgens usually take at least 3 to 6 months to work. They can decrease the amount of new hair growth, but they are less likely to change the amount of hair you already have. Anti-androgens can cause birth defects, so you should use a form of birth control while taking these medicines.
Your doctor may also prescribe birth control pills, which can help decrease androgens in the body. This treatment option is especially helpful for women who do not wish to become pregnant in the near future. Birth control can be prescribed in combination with anti-androgen medicines.
There is also a medicine made specifically to slow down the growth of facial hair. It is called eflornithine (brand name: Vaniqa) and is a prescription cream that you apply to the affected skin on your face and chin. This medicine may start to work as soon as 4 to 8 weeks after you begin treatment. Side effects include skin irritation, rash and a stinging sensation. I believe that we cannot get this medication in South Africa but that alternatives do exist.
I really hope the above has helped
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