Unwanted facial hair growth is a common experience during the transition to and through menopause. Menopause is defined as the point when a woman has gone 12 consecutive months without a menstrual period, marking the end of reproductive years. This natural biological change involves significant hormonal shifts that lead to various physical changes, including changes in hair texture and distribution. For many women, this includes the appearance of thicker, darker hairs in areas of the face where only fine, nearly invisible hair existed before.
The Hormonal Shift Driving Hair Changes
The primary reason for increased facial hair is a change in the balance of sex hormones within the body. While both estrogen and androgens decline during menopause, they do so at different rates. Estrogen levels drop rapidly as the ovaries cease function. Androgen levels, produced by the ovaries and adrenal glands, decrease much more gradually. This differential decline creates a state of relative androgen dominance, where the ratio of androgens to estrogens increases. The increase in the free androgen index is also a contributing factor. This increased influence of androgens stimulates hair follicles on the face to change their growth pattern, transforming soft, fine vellus hairs into thick, coarse, pigmented terminal hairs.
Identifying Excess Facial Hair
The technical term for the growth of terminal hair in areas typically associated with a male pattern, such as the face, chest, and back, is hirsutism. Hirsutism specifically involves the development of dark, coarse strands on the chin, upper lip, and jawline. This must be distinguished from the growth of fine, light “peach fuzz” that can sometimes be more noticeable with age.
To clinically assess the degree of excess hair growth, healthcare providers may use the Modified Ferriman-Gallwey score. This standardized tool evaluates hair growth in nine androgen-sensitive body areas, assigning a score from zero to four for each site. A total score of eight or higher in Caucasian women is considered indicative of hirsutism, though the subjective distress caused by unwanted hair is also a primary factor in seeking management.
Methods for Managing Unwanted Hair
There are numerous practical options for managing unwanted facial hair, ranging from temporary at-home methods to longer-lasting professional treatments.
Temporary Methods
Cosmetic approaches include tweezing for stray hairs or threading, which removes hair from the root in larger areas like the upper lip. Shaving is an accessible option that quickly removes hair at the skin’s surface, despite the common misconception that it causes hair to grow back thicker. Depilatory creams use chemicals to dissolve the hair structure just above the skin, but they require careful application to avoid irritation, especially on sensitive facial skin.
Long-Term Solutions
For longer-term solutions, laser hair removal targets the pigment in the hair follicle with light energy. This works best on dark hair but is ineffective on white or gray hair. Electrolysis is considered a permanent hair removal method because it destroys the hair follicle’s growth center using a fine probe and electrical current.
Medical Management
Medical management options are often prescribed by a dermatologist or endocrinologist. A topical prescription cream called eflornithine can be applied to the face to slow down the rate of hair growth. Oral medications like spironolactone, which blocks the effects of androgens, may be prescribed to address the underlying hormonal stimulation.
When to Consult a Healthcare Provider
While a mild increase in facial hair is a common and expected change during menopause, certain signs should prompt a medical evaluation. Rapid onset or severe, excessive hair growth that progresses quickly suggests a need for further investigation. This is particularly important if the hair growth is accompanied by other symptoms of high androgen levels, a condition known as virilization.
These accompanying symptoms can include a noticeable deepening of the voice, significant acne, or an increase in muscle mass. A healthcare provider will want to rule out conditions beyond typical menopausal changes, such as Polycystic Ovary Syndrome (PCOS), which is a common cause of hyperandrogenism. They will also check for rare but serious issues like Cushing’s syndrome or an androgen-producing tumor on the ovaries or adrenal glands.