Hair Loss in Women

OVERVIEW

What’s hair loss in women?

Hair loss in women is just that — when a woman experiences unexpected, heavy loss of hair. Generally, humans shed between 50 and 100 single hairs per day. Hair shedding is part of a natural balance — some hairs fall out while others grow in. When the balance is interrupted — when hair falls out and less hair grows in — hair loss happens. Hair loss is different than hair shedding. The medical term for hair loss is “alopecia.”

Hair grows on almost all of your skin surfaces — not the palms of your hands, soles of your feet, lips or eyelids. Light, fine, short hair is called vellus hair. Terminal/androgenic hair is thicker, darker and longer.

What are the cycles of hair growth?

Hair goes through three cycles:

• The anagen phase (growing phase) can last from two years to eight years. This phase generally refers to about 85% to 90% of the hair on your head.
• The catagen phase (transition phase) is the time that hair follicles shrink and takes about two to three weeks.
• The telogen phase (resting phase) takes about two to four months. At the end of this phase, the hair falls out.

Your shorter hairs like eyelashes, arm and leg hair and eyebrows have a short anagen phase — about one month. Your scalp hair can last up to six years or even longer.

What are the types of hair loss?

There are three: anagen effluvium, telogen effluvium and FPHL.

• Anagen effluvium: This is caused by medications that poison a growing hair follicle (like chemotherapy).
• Telogen effluvium: This is caused by an increased number of hair follicles reaching the telogen phase, which is the stage where hair falls out.
• Androgenetic alopecia/female pattern alopecia/female pattern hair loss (FPHL)/baldness: This type is the most common. Hair thins over the top of the head and on the sides.

How common is hair loss in women?

Many people think that hair loss only affects men. However, it is estimated that more than 50% of women will experience noticeable hair loss. The most significant cause of hair loss in women is female-pattern hair loss (FPHL), which affects about one-third of susceptible women, which equals out to some 30 million women in the United States.

Which women are likely to experience hair loss?

Any girl or woman can be affected by hair loss. However, it is usually more common in:

• Women older than 40.
• Women who have just had babies.
• Women who have had chemotherapy and those who have been affected by other medications.
• Women who often have hairstyles that pull on the hair (like tight ponytails or tight braids) or use harsh chemicals on their hair.
• Menopausal women.

What are the myths about hair loss?

Myths about hair loss are widespread. Nothing in the following list is true:

• You’re losing hair because you shampoo it too much, or because you’ve colored it or gotten a perm.
• Dandruff causes permanent hair loss in women.
• Stress causes permanent hair loss in women.
• If you shave your head, your hair will grow back twice as thick.
• If you stand on your head you’ll increase circulation, stimulating hair growth.
• If you brush your hair 100 strokes a day that will make your hair healthier.
• Hats and wigs cause hair loss in women.
• Hair loss only affects intellectual women.

SYMPTOMS AND CAUSES

What are the common causes of hair loss in women?

What causes hair loss?

• Hair style: Your style of hair can cause hair loss when your hair is arranged in ways that pull on your roots, like tight ponytails, braids, or corn rows. This type of hair loss is called traction alopecia. If hair follicles are damaged, the loss can be permanent.
• Vitamin deficiency.
• Dieting (rapid weight loss).
• Restrictive diets.
• Over processed scalp hair (breakage).

What causes anagen effluvium hair loss?

• Toxic substances, including chemotherapy, radiation therapy and some medications. These cause sudden hair loss that can occur anywhere on your body. It happens to hair in the growth stage. Sometimes, this type of hair loss can be permanent if your hair follicles are damaged.

What causes telogen effluvium hair loss?

• Extreme physical stress or shock to your body: This causes temporary hair loss. This category includes events like losing a lot of weight, surgery, anemia, illness and having a baby.
• Extreme emotional stress: mental illness, the death of a loved one, etc.
• An abnormal thyroid.
• Medications and supplements: blood pressure medicines, gout medicines and high doses of Vitamin A.
• Hormone changes caused by pregnancy, menopause or birth control pills.

What causes FPHL (Female Pattern Hair Loss)?

• Genes: Your family’s genes can cause thinning of hair along the top of your head.
• Aging: Hormone changes as you age can cause balding.
• Menopause: This type of hair loss often gets worse when estrogen is lost during menopause.

There are also some conditions that affect hair loss:

• Alopecia areata is an autoimmune skin disease that causes patchy hair loss on your head and possibly other places on your body. It’s usually not permanent.

What is the relationship between hair loss in women and menopause?

During menopause, you might see one of two things happen with your hair. You might start growing hair where you didn’t before. Or, you might see the hair you have start to thin. One cause may be changing levels of hormones during menopause. Estrogen and progesterone levels fall, meaning that the effects of the androgens, male hormones, are increased.

During and after menopause, hair might become finer (thinner) because hair follicles shrink. Hair grows more slowly and falls out more easily in these cases.

Your healthcare provider will do a thorough examination and take a detailed history to help you deal with changes in hair growth. You may be directed to have your iron levels or thyroid hormone levels tested. Your medications might be changed if what you take is found to affect hair loss or growth.

What are the signs of hair loss in women?

• Seeing more hair fall out daily either on your brush, on the floor, in showers, on your pillows, or in the sink.
• Seeing noticeable patches of thinner or missing hair, including a part on the top of your head that gets wider.
• Seeing scalp skin through hair
• Having smaller ponytails.
• Seeing hair break off.

DIAGNOSIS AND TESTS

How will a healthcare provider diagnose hair loss in women? What tests are done?

The tests performed to diagnose hair loss in women can be simple or complicated:

• Gently pulling on your hair to see how many hairs come out.
• Blood tests. These check for vitamin and mineral levels (like vitamin D, vitamin B, zinc and iron) and hormone levels (including thyroid and sex hormones).
• Scalp examination under a microscope and trichoscopy.
• Scalp biopsy to remove and examine a very small piece of scalp skin.

What questions might your healthcare provider ask to diagnose and categorize your hair loss?

Your healthcare provider might ask about your habits:

• What kinds of hair products do you use?
• What kinds of hair styles do you wear?
• What types of food do you eat (protein is important for hair growth)?
• Do you have a habit of pulling your hair out (trichotillomania)?

They might ask about your history:

• Has anyone in your immediate family experienced hair loss?
• Is there anything stressful going on in your life?
• What medications and supplements do you take every day?
• Has hair loss ever happened to you before?
• What foods are in your diet?

And, they might ask about your observations:

• How long have you been losing hair?
• Have you been shedding more?
• Have you noticed hair loss in places other than your scalp, like your eyebrows? Leg and arm hair?
• Does anything worsen your hair loss?
• Does anything improve your hair loss?
• Have you noticed hair loss occasionally or has it been going on continuously?
• Have you noticed if your hair growth has changed?
• Has your hair been breaking more often?

MANAGEMENT AND TREATMENT

What kind of healthcare provider treats hair loss?

You may be treated by a dermatologist.

How is hair loss in women treated? What medicines or supplements may help?

Treatment depends on the cause of your hair loss.

• In cases where the loss is due to stress or hormone changes like pregnancy, there might be no treatment needed. The hair loss will stop after a period of time.
• In cases of hair loss being due to hair styling practices, like tight braids or ponytails or certain chemicals, treatment means not doing the things that caused the damage.
• In cases due to nutritional deficiencies, you might be told to take supplements. For instance, you might be told to take a multivitamin and three to five milligrams of biotin daily.
• Minoxidil (Rogaine®) is approved for treating FPHL. The 2% or 5% solution can be purchased in stores. However, you have to follow directions exactly and use the product indefinitely. Don’t use this product if you’re pregnant, if you plan to get pregnant, or if you’re breastfeeding.
• The HairMax Lasercomb® low light laser is approved by the US FDA to treat FPHL. Another FDA-approved laser product is the Theradome LH80 PRO® helmet and low light laser helmets and caps.

Other medications that have been studied, but not approved, for hair loss in women include:

• Spironolactone and other anti-androgens.
• Finasteride and other alpha-reductase enzyme inhibitors.
• Estrogens.
• Prostaglandin analogs.
• Steroids.
• Other light treatments.

It is important to note that premenopausal women should not take medications for hair loss treatment without using contraception. Many drugs, including minoxidil and finasteride, are not safe for pregnant women or women who want to get pregnant.

• Hair transplant surgery is another option. Small pieces of scalp with hair follicles are taken from the back of the head and moved to slits in the areas of baldness. Potential problems with this treatment include the usual risks of surgery like infection, folliculitis and shock loss — where the hair falls out in the transplant area. In cases where the bald areas are large, there might be trouble trying to find enough hair to transplant. In addition, the surgery can be costly and is usually not covered by insurance.
• Injections of protein-rich plasma (PRP) have also been done to encourage hair growth. PRP is generally made from blood drawn from a patient. The platelets are removed and concentrated and then added back to the blood for injection.
• Microneedling of the scalp with and without the application of minoxidil.

Are there complications/side effects of treatment?

Minoxidil may irritate your scalp and cause dryness, scaling, itching and/or redness. See your dermatologist if this happens.

With Minoxidil you might also see hair growing in other places other than your scalp (cheeks and forehead, for example). Wash your face after you apply Minoxidil and make sure you avoid other areas when you apply it.

PREVENTION

How can hair loss in women be prevented?

Preventing hair loss is not possible when it is due to disease, aging, heredity or physical stressors like injuries. You can prevent hair loss caused by caustic chemicals or tight hairstyles by avoiding them. You might be able to prevent some hair loss by eating a healthy diet that provides necessary nutrients in terms of vitamins, minerals and protein. You can stop smoking.

What is the prognosis/outlook for women with hair loss?

Your diagnosis determines the prognosis:

• Anagen and telogen shedding may stop with time.
• Treat any diseases associated with hair loss.
• Disguise or cover your hair loss using a wig or hat.
• Early treatment of alopecia may reduce the speed of thinning and may promote regrowth.

While hair loss is not itself dangerous, women with hair loss tend to be very upset by the changes to their appearance. These negative feelings can affect self-esteem and social lives. Recent studies suggest that FPHL can be associated with conditions that include metabolic syndrome, endocrine disorders and diabetes.

What are some tips for dealing with hair loss in women?

There are some things you can do on your own. You might check with your stylist or try some of these:

• Coloring your hair adds volume to the strands, making your hair seem fuller.
• Massaging your head, like when you are washing your hair, can stimulate blood flow to the scalp and hair follicles.
• Getting your hair cut shorter, and having layers added, can make your hair seem fuller.
• Using the right kind of shampoo can also help. Look for a shampoo that adds volume without using sulfate detergents.
• Using the right kind of product at the right time can also help. There are products that add volume that you add while your hair is still wet. However, using too much product can add weight.

When should I see my healthcare provider?

See a dermatologist as soon as possible when you notice hair loss. The sooner you get treatment, the more effective it will be.