Female hair loss

Many women are affected by hair loss.  In fact, around 40% of women by age 50 show signs of hair loss and less than 45% of women actually reach the age of 80 with a full head of hair. Women typically experience diffuse thinning of hair on the scalp due to increased hair shedding or a reduction in hair volume, or both.

What causes female pattern hair loss?

There are a wide range of hormonal conditions that can bring on hair loss, with some of the most common being pregnancy, thyroid disorders, PCOS, and menopause. In fact, hair loss is more common after menopause, suggesting estrogens may be stimulatory for hair growth.

Stress can also be another common trigger of a persistent type of hair loss condition. When reacting to stressors, the body releases hormones such as cortisol, which is known to impact the immune system, digestive system, skin, and even hair. Research shows that stress boosts levels of stress hormones such as cortisol, which inhibits the body’s main sex hormones GnRH (gonadotropin releasing hormone). GnRH is responsible for the release of follicle-stimulating hormone (FSH) by the pituitary gland which in turn stimulates estrogen release from the ovaries. With stress comes a drop in GnRH and FSH which leads to the suppression of estrogens – which may be needed for hair growth.

The stress can be in many forms including of a sudden shock or trauma or emotional stressors such as divorce or a bereavement. It can also be due to prolonged stresses like the pressure of work or family life. This can lead to thinning hair all over the scalp and may last for six months or more – in some cases this can appear gradually over a number of years.

The host of conditions that may cause hair loss is long, and may also be due to one or a combination of the following as well:

  • Autoimmune Diseases
  • Psoriasis
  • Seborrheic Dermatitis
  • Genetics
  • Lack of Nutrients
  • Anemia

How does Hair Grow?

Hair grows in three different cycles: anagen, catagen, and telogen. About 90% of the hair on the head is in the anagen, or growth phase, which lasts anywhere from two to eight years. The catagen, or transition phase, typically lasts 2-3 weeks, during which the hair follicle shrinks. During the telogen cycle, which lasts around two to four months, the hair rests.

An overwhelming majority of the time the hair is on the scalp, it is growing. Only about 10% of the strands are in transition or resting at any one time. Hair grows about 6 inches a year for most people. 

Hair shedding

Most people lose anywhere from 50 to 100 strands of hair each day, according to the American Academy of Dermatology. On the days when hair is washed, people can lose up to 250 strands. But don’t avoid washing in an attempt to keep the hair, as it will fall out eventually, anyway.

For those who don’t plan on counting their hair every day, there are ways to know when hair is thinning or being lost at a higher rate. When waking up in the morning, there may be an unusually large amount of hair on your pillow. When you comb your hair (especially without tugging, which can pull the hair out), more than normal will be left in the comb.

There are also other visual cues that women can look for over time. Although men’s hair tends to recede from the forehead or the crown of the head, women tend to notice thinning on the top third to one half of the scalp. Sometimes their frontal line stays intact. Women may see a part that is gradually becoming wider or see more of their scalp than normal when their hair is pulled back.

Genetics & Hair Miniaturization

This is a hereditary condition and is one of the most common type of hair loss doctor’s see in their practice, and may occur in about 50% of women. Although it mostly occurs in the late 50s or 60s, it can happen at any time, even during teenage years.

Typically, each time a normal hair follicle is shed, it is replaced by hair that is equal in size. However, with miniaturization, the new hair is finer and thinner - a more miniaturized version of itself. The hair follicles are shrinking and eventually they quit growing altogether.

What are the effects of female pattern hair loss?

Many studies have shown that hair loss is not merely a cosmetic issue, but it also causes significant psychological distress. Compared to unaffected women, those affected have a more negative body image and are less able to cope with daily functioning. Hair loss can be associated with low self-esteem, depression, introversion, and feelings of unattractiveness. It is especially hard to live in a society that places great value on youthful appearance and attractiveness.

Should I have any hormone tests done?

When a patient comes in with concerns about hair loss, there is a combination of ways to make a diagnosis. Preliminary blood work is usually taken to make sure the thyroid gland or an autoimmune disease isn’t the culprit.

Blood should include female and male sex hormone levels as well as thyroid function, as part of the diagnostic workup.

Other than lab tests, a complete medical history including an assessment of stress levels should be taken.

What treatments are available?

Treatments are available for hair loss. It is important to manage expectations when seeking treatment, as the aim is to slow or stop the progression of hair loss rather than to promote hair regrowth. However, some women do experience hair regrowth with treatment. Results are variable and it is not possible to predict who may or may not benefit from treatment.

  • Minoxidil. A Cochrane systematic review published in 2012 concluded that Minoxidil solution is effective for hair loss. It can also increase the diameter of individual hair shafts by 30% when used at higher strengths.
  • Androgen Blockers. Hormonal treatment, i.e. oral medications that block the effects of androgens (e.g. spironolactone, finasteride) is also often tried.
  • Tretinoin. Topical application of tretinoin (usually used for acne) alone or in combination with minoxidil has been shown to significantly improve hair growth, reduce shedding and improve hair density. Interestingly, Minoxidil alone may have its best hair growing results only at the vertex of the scalp, while the combination seems to work all over the scalp. Tretinoin should NOT be used during pregnancy or in women expecting to become pregnant.
  • Melatonin. Melatonin has long been recognized as a hormone produced in the brain and for its antioxidant benefits in aging. Its use topically has been proven to act on the skin and in hair follicles by inducing hair growth by keeping hair follicles in the anagen phase (the growth phase).

Once started, treatment with these types of solutions need to continue for at least six months before the benefits can be assessed, and it is important not to stop treatment without discussing it with your doctor first. Long term treatment is usually necessary to sustain the benefits.

Where do I go to seek help?

Your first stop would be to see your general practitioner (GP) who can perform a medical workup to exclude other reasons for hair loss. Sometimes, it may be necessary for your doctor to perform a scalp biopsy to confirm this diagnosis.

It is important to seek reliable information and advice from authoritative sources as there are many bogus treatments that are expensive and do not work.