Hair Loss in Women

By Dr Emma Rees

Alopecia (hair loss) in women is often thought to be relatively uncommon, but did you know 49% of women suffer with hair loss throughout their life? That’s almost half of us! It is a staggering figure when you consider how little female hair loss is talked about. There are a number of different factors that can lead to increased hair loss which can happen at different times, including not only your own life cycle, but also a hair’s life cycle.

An important place to start is understanding the life cycle of hair. Hair has three life phases, the growing phase (the anagen phase), the transition phase the catagen phase) and the resting phase (the telogen phase).

When the hair on your head is growing it takes 2-8 years.  At any one point about 90% of your hair is in this phase.  It then moves into a shorter transition phase when the actual follicles shrink in size before entering the final resting phase which lasts between 2 and 4 months.  Hair will fall out after this phase.

There are 3 main types of hairloss, including;

  • Reduced hair growth – anagen effluvium.
  • Increased hair loss – telogen effluvium.
  • Female pattern hair loss – this is thinning on the top of your head and at the sides.

Reduced hair growth (anagen effluviam)

  • This is usually sudden onset.
  • You may be able to see empty hair follicles when you look closely at the scalp.
  • Medications including chemotherapy and autoimmune conditions can be the cause

Increased hair loss (telogen effluviam)

  • There may have been a significant event affecting hair growth in the preceding 6 months
  • You will see a complete hair with a little bulbous shape on the end.
  • Medications including contraception, hormonal changes such as childbirth, rapid weight loss and nutritional deficiencies.

Female pattern hair loss

  • Usually causes general hair thinning over the front and sides of your head.
  • Hair usually grows in little tufts of multiple hairs on the head.  The number of hairs in each tuft reduces with female pattern hair loss causing a thinned appearance.
  • Genetic.

Other factors including particular hair styles or colourants can also impact upon hair loss.

Some broad factors can also impact upon hair growth:

  • Infections-including localised scalp infections such as tinea, generalised infections such as sepsis.
  • Skin problems such as psoriasis.
  • General conditions such as thyroid disease or anaemia.
  • Nutritional deficiencies.

What happens next?

If you experience changes to your hair that concern you, it is worth discussing it with your health professional. The first step will be exploring what is happening and trying to identify an underlying cause. You may be asked a variety of questions including, but not exclusively:

  • The time frame of your concerns
  • Any recent life events
  • Any changes to diet or weight loss
  • Any changes to styling
  • Any skin conditions
  • Any new medical conditions or medications in the last 6 months
  • Family history of hair loss

Some examinations may contrast images of your hair now compared to what it looked like previously previously. Examining the lost hair helps to determine if they predominantly have bulbous ends or not. Your examiner may also magnify the hair and skin to understand if an infection is causing the loss, or in some cases, use blood tests to rule out other causes.

If it is hard to identify a cause for your hair loss or it continues and is distressing, you may be referred to a dermatologist to perform microscopic examinations and scalp biopsies if needed.

What can I do to prevent further hair loss?

If your hair loss is due to a major event or hormonal change, it is worth giving it time as your excess hair loss will usually stop after a period of time. Alternatively, you may find that if you change your hair styling or colouring practice your hair loss will reverse without further treatment.

If you have a nutritional deficiency, taking supplements may help.

If you have a medical condition such as anaemia or thyroid problems, treating the condition can prevent excess hair loss, and sometimes, it will even remind you to have your levels checked if your hair starts to fall out again.

If you have female pattern hair loss some treatments have been shown to help (1)

  • A topical solution called minoxidil has been shown to be helpful and can be purchased over the counter.  It comes in a variety of strengths, higher strength options are more likely to irritate the scalp.
  • Medications that block androgen receptors (male hormone receptors) are also often prescribed such as spironolactone.
  • Finasteride has been shown to work in men and has been studied in women.  It is important to ensure you do not use this if you are pregnant and are using adequate birth control if you do decide to try this medication, even in a topical form.

Cosmetic treatments including wigs are also possible solutions and it is worth considering these options if you do experience distressing female pattern hair loss.

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