Does menopause cause an increase in facial hair?

Menopause and Facial Hair Growth

Yes, menopause does cause an increase in facial hair growth in many women due to hormonal changes that result in relative androgen predominance.

Hormonal Changes During Menopause

Menopause brings significant hormonal shifts that affect hair growth patterns:

• During perimenopause and menopause, estrogen levels decline significantly while testosterone levels remain relatively stable or decrease less dramatically 1, 2
• This creates a relative increase in the androgen-to-estrogen ratio, leading to androgenic effects on hair follicles 3
• Endocrine therapies may cause excessive hair growth in androgen-dependent areas of the body in women (hirsutism) 4

Mechanism of Increased Facial Hair

The physiological basis for increased facial hair during menopause includes:

• The ovaries remain important sites of testosterone production in peri- and postmenopausal women 5
• While adrenal production of testosterone pro-hormones decreases, the relative androgen predominance persists 5
• This hormonal imbalance affects hair follicles in androgen-sensitive areas, particularly the face 6
• Hair follicles in facial areas become more responsive to even normal levels of circulating androgens 3, 6

Clinical Presentation

Menopausal hirsutism typically presents as:

• Increased unwanted hair growth specifically on facial areas 3
• Most commonly affects the upper lip, chin, and jawline
• May be accompanied by other androgenic symptoms like scalp hair thinning 6
• Usually develops gradually over months to years after menopause onset

Management Options

For women troubled by increased facial hair:

1. Mechanical hair removal methods:

   • Shaving, waxing, plucking, threading
   • Electrolysis for permanent hair removal
   • Laser hair removal (particularly effective for dark hair)

2. Topical treatments:

   • Eflornithine cream (slows facial hair growth)
   • Prescription-strength retinoids may help with associated skin changes

3. Hormonal approaches (when appropriate and after careful consideration of risks):

   • Hormone replacement therapy may help balance hormones but is not indicated solely for hirsutism 3
   • Anti-androgen medications in selected cases

Important Considerations

• Sudden or severe hirsutism warrants further investigation to rule out androgen-secreting tumors or other pathologies
• Laboratory evaluation including testosterone, DHEAS, and prolactin may be indicated in cases of rapid or severe hair growth
• Psychological impact should not be underestimated, as unwanted facial hair can significantly affect quality of life 6

When to Seek Medical Attention

Women should consult healthcare providers if:

• Facial hair growth is sudden, severe, or accompanied by other masculinizing features
• There are associated symptoms like irregular bleeding, significant weight changes, or voice deepening
• Hirsutism causes significant psychological distress

Menopause-related facial hair growth is a common but often overlooked symptom that can significantly impact women's quality of life and self-image. Understanding that this is a normal physiological response to changing hormone levels can help women better manage this aspect of menopause.