Hair Loss in Women
Types of hair loss in women
When you think about hair loss, does the image of a balding middle-aged man spring to mind? It’s a common stereotype, after all. But the truth is there are many different hair loss disorders – and women are affected too. The medical term for hair loss is alopecia, and some types of alopecia are more common than others. Alopecia areata, for example, is thought to affect about 15 in every 10,000 people in this country (i).
Here’s what you should know about the main types of alopecia that affect women:
Unlike the types of hair loss that cause bald patches, telogen effluvium is characterised by general shedding from all over the head. It’s normal to lose up to 100 or so hairs a day (ii) (and even more when you wash your hair), but this shedding can increase when your body reacts to things like physical and emotional stress, illness, hormone changes, dietary changes or certain medicines. Telogen effluvium is thought to be the second most common form of hair loss seen by dermatologists (iii). It is usually a temporary problem, with hair often starting to grow back after three to six months (iv).
However, when telogen effluvium lasts longer than nine months, it’s classed as chronic. Chronic telogen effluvium (CTE) can start suddenly or gradually, and often has no obvious cause.
If you’re affected by CTE you may notice your hair becoming thinner or your parting becoming wider, or your hair may not be as long as it used to be (or it may seem as if it has stopped growing, as longer hairs tend to be more affected than shorter ones).
This may be the most common type of progressive hair loss in men (half of all men are thought to be affected by male-pattern baldness by the time they reach their 50th birthday (v) ), but it affects women too. Indeed, according to the National Institute of Health and Care Excellence (NICE), around 10 percent of premenopausal women are affected by what’s commonly known as female-pattern baldness. However it becomes more prevalent in women as they get older, with a third of Caucasian women aged 70 and older affected (vi). While the condition is known to run in families in men, it’s not clear whether or not there’s a genetic link in women with female-pattern baldness. Many experts believe that in androgenetic alopecia, the male sex hormone testosterone converts to another hormone called dihydrotestosterone (DHT). This affects the hair follicles on the scalp, making them produce thinner hairs and eventually stopping hair production altogether (testosterone may be commonly associated with men, but women also produce small amounts of it in their ovaries and adrenal glands).
The pattern of hair loss is different in men than women, with women usually experiencing thinning around the crown area. Women may also be more affected by androgenetic alopecia as they get older because of the hormonal changes that take place after the menopause.
Alopecia areata can affect anyone of any age, though half of cases start during childhood and 80 per cent of cases develop before the age of 40 (vii). Many cases of alopecia areata are caused by problems with the immune system, such as diabetes, overactive thyroid and lupus, and experts believe some people may be genetically predisposed to developing it if they have family members who are affected (one in five people with alopecia areata have a family history of the condition (viii) ). It has also been linked with stress.
Alopecia areata causes round patches of hair loss, though sometimes the hair loss can be diffused rather than in definite patches. The good news is in many cases, the hair grows back without any treatment.
This is the type of hair loss mainly seen in people having chemotherapy treatment. As well as affecting the scalp, it may cause loss of hair from other parts of the body and face. Thankfully it’s usually temporary, and hair tends to grow back within a few months of finishing treatment.
How hair grows
The average hair grows by 0.3-0.4mm each day, which works out to around six inches a year (ix). If you don’t have a hair loss problem, you should have between 90,000 and 150,000 hairs on your head, depending on your hair colour (redheads, for instance, have an average of 90,000 hairs on their head, while blondes have 150,000) (x).
The hair growth cycle is in three stages: anagen, catagen and telogen.
Around 90 percent of the hair on your head is normally in this stage – the growth or active stage. This is when the cells in the roots of your hair are dividing and new hairs are formed. These new hairs push those in the non-active stages up the follicle, where they eventually fall out. The anagen phase lasts between two and six years.
If your hair doesn’t grow to a very long length, it’s probably because it has a relatively short anagen phase. The hair on the rest of your body has an anagen phase of between 30 and 45 days, which explains why it only grows to a relatively short length.
This transitional stage affects around three percent of all the hairs on your head at any one time. This is when growth stops and the hair follicle shrinks. It lasts for anything from two to three weeks.
This stage – where the hair follicle is completely at rest – affects between six and eight percent of hairs. The hair on your scalp remains in this phase for about 100 days, but other hairs (such as eyebrow, eyelash and body hairs) stay in the telogen stage for longer. Hairs in this stage are normally shed at a rate of about 100 a day. When large numbers of hairs switch from the anagen to the telogen phase, the result is the condition telogen effluvium.
Causes of hair loss in women
Hair loss may be less common in women than it is in men, but you may be surprised at how many women are affected. Indeed according some researchers, fewer than 45 per cent of women go through life with a full head of hair (xi).
Hormones are thought to play a major part in female hair loss, but they aren’t always the cause. Taking certain medicines can cause hair loss, including anticoagulants (medicines that thin your blood), some antidepressants and some heart and blood pressure medicines. If you suspect you have a problem with hair loss that’s linked to a medicine you’re taking, speak to your GP, as an alternative may be available.
Here are some of the things that may be causing your hair loss:
In women of child-bearing age, iron-deficiency anaemia can be caused by heavy periods and pregnancy. Anaemia is a condition caused by a reduced number of red blood cells – or haemoglobin – in your bloodstream, which means your body’s cells and organs don’t receive the amount of oxygen they need (as red blood cells carry oxygen in the blood).
Common symptoms include tiredness, shortness of breath and palpitations. Hair loss – or chronic telogen effluvium – is also a symptom. Eating more iron-rich foods may help, including fish, eggs, poultry, red meat, beans, tofu and dark green leafy vegetables.
If your thyroid gland produces too much or too little thyroid hormone – that is, if you have an overactive or underactive thyroid – one of the symptoms could be hair loss. Other symptoms of hyperthyroidism and hypothyroidism include hyperactivity, irritability and insomnia (overactive) and feeling cold and tired all the time (underactive).
Women are 10 times more likely to have an overactive thyroid gland than men (xii) and are more likely to have an underactive thyroid too. So if you suspect you have a problem with your thyroid, ask your GP for a blood test. The good news is both conditions can be easily treated with medicines, which usually help to restore your hair to normal.
After having a baby, it may seem as if you’re losing far more hair than normal. This is because most women lose less hair than normal when they’re pregnant, and when your body’s oestrogen levels decrease after childbirth, all that extra hair starts to fall along with your normal hair shedding.
The good news is this is usually temporary, and your hair should start to settle back to its normal shedding pattern once your hormone levels become more balanced.
Losing a dramatic amount of weight can result in thinning hair, especially if you have been following a strict weight-loss diet and you haven’t been getting the right amount of nutrients, including protein, vitamins and minerals.
If you’re losing weight and your hair is thinning, it could also be a sign that you have an eating disorder such as anorexia. If, on the other hand, you have lost a lot of weight without trying, see your GP as it could be a symptom of a medical condition.
This impulse control disorder causes people to pull out their own hair, and is more common in teenagers and young adults, particularly younger women and girls (xiii). It can leave you with bald patches on your scalp, as well as on other parts of your body such as your eyelashes and eyebrows. If diagnosed with trichotillomania, you may be offered cognitive behavioural therapy or another type of psychotherapy as part of your treatment.
Polycystic ovary syndrome
Millions of women in the UK are affected by PCOS (it’s estimated that five to 15 per cent of women of reproductive age are affected (xiv)). If you have PCOS, you may develop cysts on your ovaries, you may have high levels of androgens (male hormones) or your ovaries may not release an egg on a regular basis. One of the symptoms of PCOS is thinning hair and hair loss. Weight gain, excessive hair growth and acne are among the other symptoms. Treatments include diet, exercise and hormone therapy.
Hair loss myths and facts
The subject of hair loss has more of its fair share of old wives’ tales. Here are some that are true – and some that are just myths:
TRUE: stress causes hair loss
This is probably true, but usually only in major cases of psychological stress, such as after the death of a loved one. Physical trauma – such as a severe illness or an accident – may also cause temporary hair loss.
FALSE: hair styling can make you bald
Using hair products such as gel, mousse and styling cream doesn’t have an effect on how much hair you have. And while too much heat styling can burn or dry your hair and cause some of your hairs to fall out, they grow back normally. However, certain types of extreme styling – such as hair weaves or using chemical relaxers – may harm the roots of your hair, causing it to fall out permanently.
TRUE: colouring your hair can weaken your hair
The chemicals in many hair dyes may harm your hair if you don’t use them properly, and can make your hair break more easily or even cause temporary hair loss. Treating your hair more gently can help reverse the damage.
FALSE: Scalp massage can stop you going bald
It may boost your circulation, but there’s no link between increased blood circulation and hair growth. The same goes for washing your hair in cold water and standing on your head – neither has any effect on thinning hair.
Remedies for hair loss
There are several pharmacy and natural remedies for hair loss available, but choosing the one that will be effective for you will depend on the type of hair loss you’re experiencing:
If your hair loss is caused by iron-deficiency anaemia – as can be the case with chronic telogen effluvium – taking an iron supplement to boost your blood level of haemoglobin may help to reverse the problem with your hair. However, as some people experience constipation when taking iron tablets, it’s advisable to take a form of iron that’s easily absorbed, such a citrate form.
Nutrients that help increase the absorption of iron include vitamin C (xv) and the amino acid l-lysine. Indeed, an analysis of several studies suggests 90 percent of women with hair loss are deficient in both iron and lysine (xvi).
General hair maintenance nutrients
Taking a multivitamin and mineral supplement to support overall health may also be recommended, especially if it contains nutrients approved by the EU’s European Food Safety Authority (EFSA) for the maintenance of normal hair. These include biotin (vitamin B7), selenium, zinc and copper (the EFSA confirms that deficiencies in two of these nutrients – selenium (xvii) and zinc (xviii) – may result in hair problems).
This pharmacy product for hormone-related hair loss is available without prescription. Minoxidil foam or lotion is available in two strengths, with the lower-strength version (two percent) licensed as a treatment for female-pattern hair loss.
Managing hair loss as a woman may be difficult, but this guide should help to make it a little easier. If you’d like more information on a range of other common health conditions, visit our health library for some helpful articles.
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Christine Morgan has been a freelance health and wellbeing journalist for almost 20 years, having written for numerous publications including the Daily Mirror, S Magazine, Top Sante, Healthy, Woman & Home, Zest, Allergy, Healthy Times and Pregnancy & Birth; she has also edited several titles such as Women’ Health, Shine’s Real Health & Beauty and All About Health.