Causes of Female Hair Loss
The phenomenon of hair loss is widespread and affects people across the globe. Though it is usually more common in men, countless women are affected each year—most often following menopause or during other hormonally chaotic periods in their lives. This knowledge does little to ease the stress of an experience that is often tied closely to one’s sense of identity, social standing, and overall emotional well-being. As women are generally seen as the ‘fairer sex’ that is more often equated with good looks than men, the effects of female hair loss are often seen as more traumatic than those that affect male populations. Often seen as a normal loss of youth, this paper will examine the factors that contribute to hair loss and aging in women, and will also explore the emotional and social effects of this hormone. Finally, a discussion will be made of possible treatments or preventions for the most common factors of hair loss. In this paper, the topics of hair loss due to aging, and that generally hormone-related, approached primarily via female disorders and hair loss due to bad health and nutrition are discussed in detail.
Hormones affecting hair loss are many. Both human growth hormone and prolactin, produced by the pituitary gland, as well as sex hormones such as estrogen or androgens, which are made in the ovaries, have effects on the hair follicles. Most common is androgenic alopecia, which affects women through a number of genetic conditions. However, hair loss in many cases is not genetic, but more directly caused by several factors and diseases. Symptoms indicating hormonal problems are irregular menses, pelvic pain, male-pattern growth of hair (or the opposite); hormone imbalances; and an abnormal serum hormone level.
Table of Contents
ToggleWhat is Hair Loss in Women?
Also known as androgenic alopecia, female hereditary hair loss presents as less hair and/or thinner hair, but usually retains a visible feminizing frontal hairline. Because a woman’s hair loss is simply less socially acceptable and not commonly portrayed as in men, many women feel more self-conscious about hair loss. Women, when they see they’re rapidly shedding hair every day, tend to be more emotional and concerned than men.
Hair loss in women can look very different from hair loss in men. In women, androgenetic alopecia generally presents as diffuse thinning rather than a bald patch. Patchy loss can occur but often isn’t of the same distribution as a man’s. An investigation should be carried out in women who are not displaying the classic patterns of androgenetic alopecia; they may have an unsuspected cause of hair loss. Patchy hair loss generally mandates a search for a separate illness. Additionally, alopecia areata (universalis and totalis), secondary syphilis, secondary lupus, and traction alopecia, which are the outcomes of hairstyles pulling on hair roots, in women show up as patchy loss. Postmenopausal frontal fibrosing alopecia shows up as progressive front-temporal recession and flaking of the eyebrows without other evidence of infection.
The Cycles of Hair Growth
To understand the causes of hair loss, first, it is necessary to understand the process of hair growth. The human scalp has about 100,000 hair follicles, give or take a few hundred. Each follicle arises to a hair shaft at a slight angle, which helps to create the subtly crisscrossed pattern of hair growing from the scalp. The shaft consists of three layers. The outermost layer, the cuticle, is durable and provides strength. The middle layer, the cortex, provides hair with its strength. The heart of the hair is the medulla. Light bounces off the scalp, which is the same color as the bottom of the follicle – the sudden transition between dark hair and light scalp can create an artificial shadow. Each follicle of human hair goes repeatedly through three stages: the growth period, the rest period, and the shedding period.
The first stage of the process, the anagen phase, is where a follicle actively develops hair cells. The cell division within the follicle allows hair to grow between 1 and 1.5 cm a month. In the second transitional katagen phase, the hair follicle briefly slumbers. This period, which lasts for only two or three weeks, is when the hair follicle atrophies and the lower portion of the hair shaft becomes a club shaft. The third, the telogen phase, is where the old hair that has stopped expanding remains in the scalp. While this phase normally lasts three to five months, sometimes two to three percent of all human hair enters the resting stage prematurely. At the end of the telogen phase, new hair starts to develop. The old hair that is about to be dumped then falls out, becoming the ordinary 50 to 100 hairs a woman loses each day.
Types of Hair Loss in Women
Women experience hair loss for a variety of reasons. An accurate diagnosis by a healthcare provider is the first step in creating the best treatment plan. There are several different forms of female hair loss. The most common type is called androgenetic alopecia (AGA) or female pattern hair loss. In certain cases, a scalp biopsy may help to confirm an appropriate diagnosis for women with a non-classic presentation of female hair loss. Below are descriptions of the various forms of female hair loss.
The primary symptom of alopecia areata is sudden hair loss. Hair loss can occur all over the body but may be most noticeable on the scalp. The hair loss can be sudden and rapidly progressive, or slow. The diagnosis of alopecia areata is usually clinical. If necessary, a physician may advise additional testing, possibly including bloodwork, a scalp biopsy, or even other specialty testing depending on the individual.
Trichotillomania is hair loss from the repeated urge to pull or twist the hair until it breaks off. This can be a type of impulse-control disorder. Treatment is by a psychologist who understands this diagnosis.
Androgenetic Alopecia is hair thinning that can begin as early as the teen years. It’s due to the effects of a hormone called dihydrotestosterone, or DHT, which blocks the hair follicles from producing vital hair building proteins. Hair-flick styles are the most prone. Overall thinning and a widening part are the initial signs of female pattern hair loss.
Prevalence of Hair Loss in Women
An estimated 30 million women in the United States have some degree of hair loss, and of the women who seek treatment for hair loss, only 10% have had a surgical hair restoration. The prevalence of hair loss increases with age. In one study, hair loss began in 57 percent of women aged 70-79 years. In another study, thinning hair was more common than hairless in all age groups from 16-21 to 41-50. Most women suffering from hair loss exhibit “normal” levels of circulating androgens, with the cause of hair loss often difficult to diagnose.
One study of 373 women seen in specialty clinics found that 92 percent of these women had hair loss which was not underlying medical conditions, such as lupus, diabetes, or anemia. Genetic hair loss (mother’s or father’s side of the family), infection, childbirth, use of oral contraceptives, and use of hormones for menopause, patchy hair loss, other diseases, medications or treatments, poor diet and nutrition are top causes of hair loss as characterized by this study. Another study of 214 women solely with decreased hair density displayed similar causes, with disease as the biggest factor (48%). An investigation of 82 women clinically diagnosed with female pattern hair loss carved out a more complete list of underlying diagnoses. Fifty-four percent of these women had the category of disease alone, with hormonal disorder (18%) and hypothyroidism (15%) being the individual most common diagnoses. Host factors, a category ranging from genetic or spontaneous hair loss to stress, generally accounted for less than 20% of diagnoses.
Risk Factors for Hair Loss in Women
The body of research done on the topic has produced names for the genetic traits that might predispose you to hair loss, such as the androgen receptor gene (AR). Extensive studies also name a few lifestyle choices and medical conditions as potential triggers for hair loss in people who have a genetic predisposition. These studies include real patients and were consistently repeated across geographical locations.
Information on lifestyle triggers indicates that irregular or insufficient hormonal production is a starting point for hair loss. Possible hormonal triggers include hypothyroidism and unspecified malformations. Other research also shows that environmental factors, specifically high-energy visible light therapy (HEVLT) used in some dermatology treatments, might be a trigger for hair loss in some genetically predisposed individuals. Additionally, some reports indicate possible damage to hair follicles due to UV light exposure and smoking, but the evidence is limited. Publication bias affects the smoking research in particular, as current estimates are likely influenced by papers reporting larger associations more frequently. Pregnancy is responsible for hormonal irregularities, but hair loss after pregnancy rarely occurs for unknown reasons, since abnormal or suboptimal hormone exposure is a trigger for hair loss in other situations. Because of this, childbearing as such is not a hair loss risk factor.
Common Myths About Female Hair Loss
- Pregnancy and breastfeeding can cause hair loss. The truth is actually that these conditions can make hair look great. The fact is that having increased hormones makes the hair grow faster and look prettier. When you lose extra hair after your pregnancy ends, it just means that your body is no longer making extra hair. Once your hair growth returns to normal, you will stop losing the extra hair that you gained earlier.
- There is no cure for female hair loss. In fact, there are many treatment options that are effective at stimulating new hair growth if used correctly. Many of the new hair loss treatments are much less messy and have fewer side effects than the old hair loss products that have high amounts of minoxidil.
- Sunblock can cause hair loss. The truth is, if you use sunblock on your face, neck, or the area where your head has lost hair because of hair loss, you could be protecting yourself from getting a sunburn or even skin cancer. If you are pregnant or breastfeeding and are using a hair loss treatment for women that contains minoxidil, then it is strongly recommended that you don’t allow the other untested hair loss treatments available to touch your face or skin when you apply them. Then you could consider using sunblock as a safety step to protect your skin from exposure to these types of experimental hair loss treatments.
Causes of Hair Loss in Women
Most often, the cause of hair loss in women arises from some type of ovarian hormone imbalance or deficiency. For example, a decreased estrogen level has been found in women suffering from hair thinning, although some menopausal women have. There is a great overlap in diagnostic symptoms between androgens (such as testosterone) and androgen hormone imbalances. When androgens are variably present in the follicles, the resulting events cause hair thinning (like in men). The influx of testosterone into the hair root impairs the normal hair pattern, resulting in a decreased hair shaft, and the decreased hair shaft results in a hair follicle which lacks follicle.
Nutritional deficiencies like malabsorption and anemia (iron or vitamin B12 deficiency) can cause diffuse hair loss in women. Other underlying medical causes of hair loss can be associated with weight loss or loss of appetite. Physical stress (e.g. surgery and “chronic” systemic diseases) can cause diffuse hair loss. Systemic diseases like infections may cause sudden hair loss. Other types of alopecia (loss of eyebrow, etc.) have associated gastrointestinal disturbances and are generally an autoimmune disease. Medications can cause hair loss, such drugs include blood thinners, chemotherapy, or oral agents for diabetes. The most frequent general cause of hair thinning results from a binge cycle (telogen effluvium). The injured hair often has increased shedding.
The Role of Menopause in Female Hair Loss
Many women may experience thinning hair or hair loss later in life, around the onset or after menopause. Graham et al. showed a 42% incidence when behaving and counseling aging menopausal women. It is unlikely that few doctors’ offices are visited by unaffected women. If the frequency is accurate, then 18 million women in the United States suffer similar pain to their estrogen-deprived postmenopausal close neighbors, who lose their scalp hair as a direct result of low hormonal levels.
Reports of hair changes during perimenopause and menopause are complementary. Some report increased hair shedding in perimenopause, while others argue that increased hair shedding is more likely to occur after menopause and peak at 3 years. However, a more recent consensus is most commonly agreed upon that perimenopausal peak hair shedding and thinning occurs up to 5 years postmenopause. Unfortunately, attempts at accurately quantifying hair loss after this point have not met with a great deal of success.
Diagnosis of Hair Loss in Women
In order to confirm the cause of female hair loss, the healthcare professional will use different strategies, including the patient’s clinical history, a clinical examination, and laboratory tests when necessary. It is crucial to discover the underlying cause of hair loss in women in order to begin treatment. Blood count, hormonal profile, searching for certain antibodies, ferrum, zinc, metabolites, and thyroid hormones are among the recommended laboratory tests. A scalp biopsy may be necessary in certain instances in which the diagnosis remains in doubt.
An assessment of signs, indications, and personal history is an important initial step throughout the examination as well as treatment of hair loss in women. Visual diagnosis is frequently sufficient, but additional examination towards confirmation of the medical disorder is essential when the diagnosis isn’t clear or when more than one reason for female hair loss must be considered. Excessive hair loss may occur at times; it is very frequently irregular and might have numerous causal components within a single individual. Folliculitis, discoid eczema, and other conditions lead to permanent scarring alopecia. It constitutes androgenetic hair loss (AGA) – that progresses in a patterned way – the second-most prevalent reason for more, impacting 21 million American ladies. The rest is due to a variety of sources, including medical disorders, fever, chronic wasting. When hair shedding isn’t noticeable, it is described as chronic telogen effluvium (TE). This is particularly common in ladies who have only modest hair loss and are frequently frustrated by the reality that their friends and family think that they are imagining things. Varying tinctures, style colors, in addition to more can provide clues that might assist in the diagnosis and are necessary.
Management Strategies for Female Hair Loss
There are a variety of management strategies that can be considered when treating the female client with hair loss. These may encompass a variety of tactics and interventions. Each conference speaker or author will provide an insight into how they approach their management of female hair loss and the outcomes they achieve. Lifestyle modification, treatment with antiandrogens (oral combined contraceptive pill, spironolactone, flutamide, cyproterone acetate, droperidol, finasteride), medical treatments (steroid injections, ketoconazole, zinc, biotin), alternative therapies, and surgery are all treatment options that have, on occasion, been attempted. Successful management of female hair loss usually incorporates a combination of one or more of these options, and it must be made explicit that all of these treatment combinations are likely to be most effective when used in conjunction with a complete trichologic assessment and patient education.
Although there are no specific treatments for AGA in women, some treatment strategies are effective for a very specific subset of women suffering from androgenetic alopecia, e.g. minoxidil and hormonal treatments such as the oral contraceptive pill. For the large majority of women with AGA, treatment success is only moderate, and the benefit of this treatment is greater in those who seek early intervention. Hormone suppression therapy can be used as an effective treatment for hirsutism, and in patients with hair loss derived from an androgenic source, we can also use them to treat hair loss. The commonly used oral antiandrogens are OCP and spironolactone; however, medium to long-term studies show concerns over the use of these medications because of potential side effects that can affect cosmetic appearance, such as affecting weight gain.
FAQs About Female Hair Loss
Why is my hair falling out? There are many different types of hair loss, each of which has a different cause. Female androgenetic alopecia, or thinning hair, is the most common cause of hair loss in women. Other causes of hair loss in women may include hormonal imbalances, anemia, stress, depression, thyroid issues, autoimmune diseases, and genetic disorders. A DIET analysis by a hair loss expert will help determine the cause and best course of action for you.
Is balding a hereditary disease from the mother or father’s side of the family? There are some recessive and dominant genetic traits for hair loss. Hair loss can come from either or both sides of the family. Your hair loss specialist will determine which genetic traits are causing YOUR hair loss during your hair loss consultation at Hermest Clinic – your hair loss experts.
If I undergo permanent laser hair removal, will any hairs around the treated area grow back? Almost all patients that undergo laser hair removal have a reduction in hair. Some patients have a near permanent reduction in hair, while others see a temporary reduction in the hair. There are many factors in hair growth and genetics that will determine the results of your laser hair removal treatments.
Conclusion
In summary, the evidence shows that female hair loss is complex and many factors must be evaluated and sometimes addressed to prevent any further hair loss or to help hair regrow. Female hair care and hair styling practices can be the initiators of certain conditions such as traction alopecia, but other hair conditions or hair loss disorders have a complex and multifactorial background and must be identified and treated in the specific manner as discussed. Tests to identify the potential causes of the hair loss after further questioning and examination include blood tests, microscopic hair analysis, biopsies, or growing hair in specific media. Specific treatments for female hair loss are tailored after a full consultation and explanation of the options and management plan for each individual case.
Management of female hair loss can be complicated, especially in chronic cases, but the physician who listens and understands what her hair signifies to the female patient will find a ready listener and, with patience and persistence, the physician will have the satisfaction of helping for the most part restore both to the female patient. General hair care and grooming have long been concerns of most women (and recently of more men) of all ages. Hair and hair styles even in the 20th century have been linked with the status of the individual. Women and hair have long been associated and now men are identifying more and more with hair being an essential aspect of the individual to be cared for and polished.