The emergence of unwanted hair during menopause.

Menopause is aphysiological phenomenonthat affects all women between 45 and 55 years old. It corresponds to thecessation of ovarian function and therefore theend of menstruation. Medically, a woman is considered menopausal when she has not had her period for 1 year.

In addition to the cessation of menstruation, menopause is characterised in 80% of women by climacteric symptoms. Climacteric disorders are hot flushes (or vasomotor flushes). These symptoms manifest as intense sensations of heat, palpitations, profuse sweating or even chills. These symptoms are transient and tend to diminish over time. Other symptoms such as vaginal dryness or urinary disorders set in more permanently. Moreover, menopause significantly impacts the quality of the skin.

In the long term, menopause also increases the risk of illness such asosteoporosis or cardiovascular diseases.

With ovarian activity ceasing, menopause is characterised by a deficiency in female sex hormones produced by the ovaries: oestrogen and the progesterone.

In addition to female sex hormones, women also have small amounts of testosterone, which is an androgenic male hormone. At the time of menopause, this testosterone level tends to increase and takes precedence over female hormones.

Note : Progesterone has a known anti-androgenic activity . At the time of menopause, the ovaries no longer synthesise progesterone and therefore the anti-androgenic activity is no longer maintained.

Thus, menopause is characterised by a significant hormonal imbalance. While female hormones plummet, androgens, on the other hand, increase. This rise in male hormones is the cause of certain undesirable effects.

Androgens are hormones that trigger the development of male sexual characteristics. The most well-known androgen is testosterone. The growth of hair is linked to testosterone levels, as the hair follicle is androgen-dependent.

Arriving via the bloodstream, testosterone attaches itself to androgen receptors, which are present in the pilosebaceous follicles. Once bound to its receptor, it transforms under the action of the 5-alpha reductase into dihydrotestosterone (DHT), a new active androgen.

Androgens lead to an increase in hair growth, particularly on the faces of post-menopausal women. They transform the downy hair into coarse and thick hair.

Scientifically speaking, this increase in hair growth in unusual places in women, particularly on the face, is known as hirsutism. Indeed, hirsutism is the appearance of hair in so-called male areas, which are normally hairless (devoid of hair) in women (face, chest, back, buttocks etc). In menopausal women, hirsutism is the consequence of hyperandrogenic state related to the changes in the androgen/oestrogenbalance.

A study conducted on post-menopausal women aged 45 revealed that 49% of them noticed the emergence of new facial hair. Of these women, 39% observed unwanted hair on their chin, 22% on their upper lips, and 39% in both areas.

Note : In menopausal women, there is an occurrence of unwanted hair, especially on the face. This can be explained by the high sensitivity of the pilosebaceous follicles to androgens in this area.

The emergence of unwanted hair, particularly on the face, is very common during menopause. This is due to the hyperactivity of 5-alpha-reductase and the disappearance of the anti-androgenic activity of progesterone. Generally, this impacts the quality of life of women and leads to a decrease in their self-esteem.

There are solutions available to combat hirsutism and regain self-confidence:

• Medicinal treatments:

  The molecule that acts against hirsutism is the cyproterone acetate. This medication contains a derivative of progesterone which counteracts androgens due to its anti-androgenic activity. Therefore, this treatment is prescribed when excessive hair growth severely impacts emotional and social life;

• Cosmetic treatments:

  Cosmetic treatments are based onhair removal. In the case of hirsutism, the most effective techniques are electrical hair removal (electrolysis) for the face and laser for larger areas. These techniques are only performed by medical professionals (dermatologists, aesthetic doctors).

• Approach to Hirsutism: Bulletin of Dermatological Aesthetics and Cosmetology (1995).

• WOJNAROWSKA F. & al. Physiological alterations in scalp, facial and body hair following menopause: a cross-sectional population-based study on subjective changes. British Journal of Dermatology (2011).

• GOSSELIN J. Hirsutism in women and its management (2016).