Woman's Hair Loss

Patterns of hair loss

One of the commonest forms of hair loss in women (and men) is a condition called telogen effluvium, in which there is a diffuse (or widely spread out) shedding of hairs around the scalp and elsewhere on the body.

This is usually a reaction to intense stress on the body's physical or hormonal systems, or as a reaction to medication.

The condition, which can occur at any age, generally begins fairly suddenly and gets better on its own within about six months, although for a few people it can become a chronic problem.

Because telogen effluvium develops a while after its trigger, and causes generalised thinning of hair density rather than a bald patch, women with the condition can easily be diagnosed as overanxious or neurotic.

Fortunately, it often gets better with time. Telogen effluvium is a phenomenon related to the growth cycles of hair.

Hair growth cycles alternate between a growth phase (called anagen, it lasts about three years) and a resting phase (telogen, which lasts about three months). During telogen, the hair remains in the follicle until it is pushed out by the growth of a new hair in the anagen phase.

At any one time, up to about 15 per cent of hairs are in telogen. But a sudden stress on the body can trigger large numbers of hairs to enter the telogen phase at the same time. Then, about three months later, this large number of hairs will be shed. As the new hairs start to grow out, so the density of hair may thicken again.

Many adults have had an episode of telogen effluvium at some point in their lives, reflecting episodes of illness or stress.

Another common type of hair loss in women is androgenetic alopecia, which is related to hormone levels in the body. There's a large genetic predisposition, which may be inherited from the father or mother.

Androgenetic alopecia affects roughly 50 per cent of men (this is the main cause of the usual pattern of balding seen as men age) and perhaps as many women over the age of 40.

Research shows that up to 13 per cent of women have some degree of this sort of hair loss before the menopause, and afterwards it becomes far more common - one piece of research suggests that over the age of 65 as many as 75 per cent of women are affected.

The cause of hair loss in this condition is a chemical called dihydrotestosterone, or DHT, which is made from androgens (male hormones that all men and women produce) by the action of an enzyme called 5-alpha reductase.

People with a lot of this enzyme make more DHT, which in excess can cause the hair follicles to make thinner and thinner hair, until eventually they pack up completely.

 

Women's pattern of hair loss is different to the typical receding hairline and crown loss in men. Instead, androgenetic alopecia causes a general thinning of women's hair, with loss predominantly over the top and sides of the head.

Another important cause of hair loss in women is a condition called alopecia areata, an autoimmune disease that affects more than two per cent of the population. In this, the hair follicles are attacked by white blood cells. The follicles then become very small and hair production slows down dramatically, so there may be no visible hair growth for months and years.

After some time, hair may regrow as before, come back in patchy areas, or not regrow at all. The good news is that in every case the hair follicles remain alive and can be switched on again; the bad news is that we don't yet know how to do this.

Myths about hair loss in women

 

It means you're not a proper women with two X chromosomes

It's caused by washing your hair too often

It's caused by too much brushing or combing

Hair dyes and perms can cause permanent loss

It may result from wearing hats and wigs

Shaving your hair will make it regrow thicker

Standing on your head will help it grow back

It's a sign of an overactive brain

There's a miracle cure out there waiting for you

Beware miracle cures

Scan the internet and you'll see all sorts of miracle cures for baldness on offer, from strange herbal lotions to mechanical devices. Perhaps the most useful first step you can take is to avoid the myths.

After this there are several options. You can find some way to accept the change and live with it (let's face it, this is a tall order - most men struggle to come to terms with their baldness and for them at least society equates it with maturity and power).

You can try cosmetic treatments such as wigs or hair thickeners, or you can try medical therapies. The last option is hair-replacement surgery.

Medical treatments

The drug minoxidil was first developed for treating high blood pressure, which was found to have the side effect of thickening hair growth in some people. It's now available as a lotion to apply directly to the scalp.

No one really knows how it works, however, and it's not effective for everyone. Studies show that only about 20 per cent of women between 18 and 45 have moderate regrowth using the drug, while another 40 per cent experience minimal regrowth.

It works best on younger people with early hair loss. A big disadvantage is that you have to carry on using minoxidil indefinitely or the new hair will fall out.

Another drug, finasteride, which was developed for treating prostate cancer, has also been found to be effective but is only available for men.

Surgery

Surgical techniques for restoring hair have improved greatly in the past couple of decades, but this is still an option that requires careful consideration.

There are two main options:

Hair transplantation - tiny punch-holes of skin containing a few follicles of hair are taken from elsewhere in the body (such as the back of the head, if this is still well covered) and implanted into the thinning areas. Some surgeons use a needle to sew in just one or two hairs. However, as women are more likely to have diffuse loss of hair all over the scalp, this technique may not be possible. There has been little success with implanting artificial fibres.

Scalp reduction - devices are inserted under the skin to stretch areas of scalp that still have hair, then the redundant bald areas are removed. Alternatively, flaps of hairy scalp can be moved around the head.

For more on what works and what doesn't see www.fda.gov.

Main points

Many causes of female hair loss are temporary - check your general health and be patient

Take a look at your family for an idea of your risk of female pattern baldness

Don't be taken in by claims for wonder products - there's no cure for female pattern hair loss

Many women cope well by using cosmetic products, hats and wigs, so persevere until you find your own style

For some useful articles on hair loss try the links at the European Hair Research Society www.ehrs.org.

This article was last medically reviewed by Dr Trisha Macnair in August 2005.
First published in November 1997.