Madeleine Burgess say's she spent "the majority of [her] life feeling really unfeminine".
Now 31-years-old, Madeleine, who lives on Gadigal land in Sydney, says she was diagnosed with polycystic ovary syndrome (PCOS) in her early teens and was "put on the [contraceptive] pill pretty early" because of that diagnosis.
Beside struggling with weight, she says a lot of the symptoms seemed minimised until she came off the pill in 2019 — including excess hair growth, or hirsutism.
She thought she'd dodged hirsutism at first, but after six months thicker hair began to grow on her face. Madeleine also experiences hair loss on top of her head.
It's "a blessing" that unwanted hair doesn't grow anywhere else, she says, but your face is also the "most public".
What is excess hair growth and why does it happen?
PCOS is a common hormonal condition, associated with increased levels of insulin and male-type hormones (androgens).
Endocrinologist with Monash Health, Jillian Tay, says that recent studies show that roughly one in eight women have PCOS.
"In women with PCOS, 70 to 80 per cent will talk about hirsutism," she says.
Excess hair growth is usually a response to higher levels of the androgen hormone in women with PCOS, Dr Tay says.
The hair often follows a male hair growth pattern.
"They can get thicker, coarse hair around the face, around the moustache, the upper lips, chin, on their chest, on their arms, abdomen, even buttocks and thighs."
Dr Tay stresses that the degree of hair growth doesn't determine the impact, as even less noticeable growth can have a big impact on wellbeing.
"What women feel is important," she says.
Meanjin/Brisbane consultant dermatologist Leona Yip specialises in scalp and hair loss disorders, and says she sees a lot of women who have PCOS presenting with acne, hair loss or thinning (another symptom), and hirsutism.
She says it can range from "peach fuzz" on parts of the face to "thick terminal hairs" (like the hair on our scalp, eyebrows or under arms).
How to manage unwanted hair
Dr Tay says "PCOS itself cannot be cured, and we have to manage the various symptoms, and hirsutism is one of them".
Before most women "come to see a doctor, they've already self-managed". As a result, Dr Tay says hair growth concerns are sometimes dismissed by doctors because they "haven't seen how much effort women put in" — for example, by plucking, threading and shaving it.
She says "oral medical therapies" can be option. The combined oral contraceptive pill is commonly used to help treat hirsutism as "it regulates the hormones" and "suppresses the women's body's production of androgens". Anti-androgen medication is the "second oral therapy" that can be used to manage excess hair growth, Dr Tay says.
Dr Yip agrees that anti-androgen medication can help reduce hair growth and can be appropriate in some cases.
She says the thickness and colour of the hair has an impact on what methods will work best.
Shaving, waxing and laser hair removal are all common options — however, Dr Yip caveats "the more accurate term for [the latter] is laser hair reduction" as hair can return.
Dr Tay describes laser treatment as "very effective" as a method of "permanent hair reduction". But she says it does require sessions about every four to six weeks, at least initially.
"As time goes on, people can stretch it out every three months [or], every six months for a treatment, and it suppresses the hair growth."
Waxing and shaving
Despite consulting with a few laser clinics, Madeleine says the fair hair on her face doesn't make her a good candidate for laser.
Dr Yip says laser treatment is most suitable for dark hair. But it can be less suitable for people with darker skin pigments as the "hair follicle pigment competes with the skin pigment for the laser".
So instead, Madeline waxes her face and upper lip every few months.
She says it's expensive and leaves her with an irritated red face.
"I just try and hibernate for a day because I find it embarrassing."
Meaghan Butland lives in Naarm/Melbourne. Hirsutism has had a big and long-running impact on her self-esteem. The 54-year-old says darker, thicker hair began to appear in her mid-20s, a few years before she was diagnosed with PCOS after struggling to conceive.
Meaghan says the hair growth is most prominent on her face and along the backs of her legs, and she shaves her face every morning with an electric razor.
She says she has tried laser treatment, which reduced hair growth, but she didn't continue with it. Meaghan says the more "frequent top-ups" needed would be expensive.
She says with age you learn to "deal with things in a different way … but still there's some days it gets me down and affects me".
During the COVID pandemic, she says she would wax instead of shave because wearing a face mask would cover the regrowth.
When Meaghan was younger, she would often just choose to stay home because the exhaustive amount of "behind-the-scenes work to maintain a hair-free existence" made spontaneity hard.
"You don't feel feminine or sexy," she says, and it can "put you off" intimacy.
