What is hair loss in women?
Hair loss in women is just that—when a woman experiences unexpected heavy loss of hair. Generally, people shed from 50 to 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 name for hair loss is alopecia.
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.
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 some 30 million women in the United States.
Who is affected by hair loss in women?
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.
What causes hair loss in women?
- Family history (heredity): Causes thinning of hair along the top of the head. This type of hair loss is female-pattern hair loss. (FPHL is also called androgenetic alopecia or androgenic alopecia.) This type of hair often gets worse when estrogen is lost during menopause.
- Hair style: Causes hair loss when hair is styled in ways that pull on 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.
- Extreme stress or shock to the body: Causes temporary hair loss. This category includes events like losing a lot of weight, surgeries, illness, and having a baby. This type of hair loss is called telogen effluvium. It happens to hair in the resting stage.
- Toxic substances, including chemotherapy, radiation therapy, and some medications: Cause sudden hair loss that can occur anywhere on the body. This type of hair loss is called anagen effluvium. It happens to hair in the growth stage. Sometimes, this type of hair loss can be permanent if the hair follicles are damaged.
- Other medical conditions:
- Alopecia areata is an autoimmune skin disease that causes patchy hair loss on the head and possibly other places on the body. It is 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 did not have it 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. Other factors, such as stress, your diet, and heredity, may contribute to hair loss.
The aging process may mean that some women experience female-pattern hair loss (FPHL). This is also called androgenetic alopecia or androgenic alopecia. This type of hair loss may get worse due to hormone changes.
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. FPHL often means that thinning hair is centered at the crown and top of the head.
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.
Antiandrogens might be prescribed for either excess hair (hirsutism) or for hair loss, but the studies on usage are not clear. For hair loss, minoxidil lotion or shampoo combined with antiandrogen drugs like spironolactone is one approach. Another is to use antidandruff shampoos with ingredients like ketoconazole and zinc pyrithione. You might also be told to try things that do not actually repair hair loss but do allow you to hide it.
If you are already taking hormone therapy (HT) for menopausal symptoms, you might see an improvement in the condition of your hair. However, HT is not recommended solely to treat hair loss.
What are the symptoms or 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 on the sink
- Seeing noticeable patches of thinner or missing hair, including a part on the top of your head that gets wider
- Having smaller ponytails
- Seeing hair break off
How will a doctor diagnose hair loss in women?
Contact a doctor if you are concerned about hair loss. A dermatologist can help you diagnose or treat hair loss. The doctor will take a medical history, which will include asking about things like:
- What medications and/or supplements you take
- What type of food you eat (protein is important for hair growth)
- What might be going on in your life in terms of stressful situations
- Which family members might have had hair loss
- What kind of hair styles you tend to have and what hair care products and processes you have used
- Whether or not you have a habit of pulling your hair out (trichotillomania)
After reviewing this information, the doctor might do or order certain tests, including:
- Gentle hair pulling to determine how many hairs come out
- Blood tests to test 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
- Scalp biopsy to remove and examine a very small piece of tissue
How is hair loss in women treated?
Treatment depends on the cause of the 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 depends on 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 3-5 mg 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.
- 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.
- 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
- Prostaglandin analogs
- 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, such as 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 something called 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.
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 these. You might be able to prevent some hair loss by eating a healthy diet that provides necessary nutrients in terms of vitamins and minerals. You can stop smoking if you smoke.
What is the prognosis/outlook for women with hair loss?
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 and diabetes.
What tips are there 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 things:
- 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.
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