Hair is one of the first things people notice about us when we meet them. Hair conveys aspects about your style and personality. Throughout their lives, particularly as they age, hair care may become even more important for women. Some researchers found that beginning in the late 20th century, perceptions about old age began to shift. It became increasingly important for older women to have groomed, managed hair to avoid negative perceptions related to aging. Some women begin to experience hair loss as they age, particularly during menopause. It can be distressing and negatively affect self-esteem, but there are many strategies and treatments to manage hair loss in women. The medical term for baldness is alopecia. Complete baldness of the scalp is alopecia totalis. Continue reading to learn more about hair loss causes and treatment strategies in women.
Hair Loss in Women
We think of hair loss as a common problem in men, but women experience it, too. Fewer than 45% of women go through their whole lives with a full head of hair. Female pattern hair loss (FPHL) increases with advancing age. Women who experience hair loss often experience psychological distress and impaired social functioning as a result of it. As female pattern hair loss tends to be a chronic, progressive condition, early diagnosis and treatment are critical. This may help arrest subsequent hair loss. Some treatments may even help stimulate the growth of new hair. See your dermatologist if you are experiencing hair loss. A trichologist is a dermatologist who specializes in the health of the scalp and hair.
How Hair Grows
The human scalp contains about 100,000 hair follicles. Hair grows from the bottom of the follicle from an area called the root. Blood vessels nourish the root, allowing hair to grow. Hair grows up and toward the skin, passing an oil gland. Oil glands keep hair shiny and soft. Too much oil may make hair greasy. Hair is dead by the time it pokes out through the skin. Hair on the head grows at a rate of about half an inch per month. Hair on your head remains there for between 2 to 6 years. That is about the length of time for the growth phase. Then the hair stops growing for a period before it falls out. The resting phase of the hair follicle is called the telogen phase. Then the cycle begins anew.
Is Hair Loss Normal?
We all lose hair. Some hair loss is perfectly normal, as hair falls out after it completes the 2 to 6 year growth phase. You may notice loose hairs that have fallen out on your clothes or in your comb or hairbrush. The average person loses about 50 to 100 hairs per day. This is normal. What is not normal? If your hair starts to fall out in clumps, especially when you brush or comb it or are in the shower, you should see your doctor. If you notice that you can see larger areas of your scalp or that your hair is thinning, see your dermatologist for diagnosis and treatment of your hair loss condition.
What Causes Hair Loss?
There are many different types of hair loss with a variety of potential underlying causes. Several medical conditions are associated with hair loss. Common causes include thyroid problems and hormone imbalances. When these are adequately diagnosed and treated, hair loss may stop, and hair may grow back. Stress, nutritional factors, and genetics may may also play a role in hair loss. Severe physical stress such as going through childbirth, surgery, or suffering a serious illness may precipitate a type of hair loss called telogen effluvium. This is a condition in which stress forces large numbers of follicles to enter the resting phase, and after a few months, hair will fall out. Sometimes doctors are not able to determine what is causing hair loss. Other potential causes of hair loss include radiation therapy, cancer, kidney failure, liver failure, medication side effects, and autoimmune disease. If you are experiencing new or increasing hair loss, see your doctor for a diagnosis and treatment.
How Do You Measure Hair Loss?
Doctors characterize the severity of hair loss using something called the Savin density scale. This scale has 8 stages and describes hair loss around the midline part as well recession in the front of the hairline. Some women lose hair to various degrees around the midline and/or in the front of the hairline. Some women experience hair thinning all over the scalp. Hair loss may occur in episodes or continuously. The doctor parts the hair down the middle of the head and then determines the severity of hair loss. The most common pattern for female pattern baldness is thinning around the midline that occurs in the shape of a Christmas tree. The pattern and severity of female hair loss helps determine the appropriate course of treatment.
The Thyroid Disease Connection
The thyroid is a butterfly-shaped gland that rests in the front base of the neck. It secretes thyroid hormones that are used by every cell in the body. Imbalances in thyroid hormone levels are a common reason for hair loss in women. Too much thyroid hormone (hyperthyroidism) and too little thyroid hormone (hypothyroidism) may both trigger hair loss. Other symptoms of hyperthyroidism include weight loss, rapid heart rate, inability to fall asleep or stay asleep, and anxiety. In addition to hair loss, hypothyroidism may be associated with weight gain, fatigue, feeling cold, slow heart rate, and constipation. Luckily, thyroid hormone imbalances are easily detectable with blood tests. Treatment helps alleviate symptoms, including hair loss.
PCOS Can Be a Trigger
Polycystic ovary syndrome (PCOS) is a condition in women in which the body manufactures more androgens, or male hormones, than it normally should. Women who suffer from this condition may grow facial hair and extra body hair. One of the other symptoms of this condition is thinning of hair on the head. Women affected with PCOS may also experience weight gain, acne, menstrual irregularities, ovulation problems, depression, and infertility. Hair thinning may be the only outward sign that a woman is suffering from this condition.
Alopecia Areata
Alopecia areata is a condition that causes hair loss in round patches on the scalp and body. Alopecia is the medical term for baldness. With alopecia areata, missing hair often grows back approximately 6 months to 1 year later. Less than 5% of people lose all the hair on their head and body. Complete baldness of the scalp is called alopecia totalis. This type of hair loss is not contagious.. What causes alopecia areata? It is an autoimmune condition in which the immune system attacks and destroys hair follicles. Hair loss due to alopecia areata tends to come on suddenly. The condition may be treated with steroids, anti-inflammatory drugs, or immunosuppressive medications. People with alopecia areata suffer from more allergies, asthma, and autoimmune conditions compared to those who do not have the condition.
Ringworm and Hair Loss
Ringworm is a fungal skin infection that causes patches of hair loss*. The official medical name for ringworm on the scalp is tinea capitis. The infection starts out as a small pimple that grows larger. Affected areas are itchy, red, inflamed, scaly patches with temporary baldness. The skin may ooze. The fungus triggers hair loss* by causing hair to become brittle and to break off. The skin often appears most red around the edge of the lesion, with a more normal appearing skin tone in the center. That is one of the reasons the condition is called ringworm. The condition is contagious with skin-to-skin contact. It is also transmissible by infected combs, hairbrushes, unwashed clothing, and surfaces in gyms, showers, and pool areas. Your doctor can treat ringworm with antifungal medication.
Childbirth May Be a Trigger
Moms-to-be are often very happy that their hair seems much fuller during pregnancy, but they are then disappointed when they experience hair loss* after giving birth. Losing hair after pregnancy is not true hair loss* and is normal. Hair falls out after women give birth due to decreasing estrogen levels. Some women notice that they lose a lot of hair in a short period of time after giving birth. The good news is that after this shedding period, hair fullness often returns to normal within 1 to 2 years. While you are waiting for your full head of hair to return, use over-the-counter volumizing shampoo and conditioner formulated for fine hair to make your hair appear fuller.
Be Mindful of Birth Control Pills
Birth control pills are a form of contraception that works by suppressing ovulation and/or making it more difficult for a fertilized egg to implant into the lining of the uterus. The hormones that make birth control pills effective may also cause hair thinning in women who use them. You are more likely to experience this side effect from birth control pills if you have a family history of hair loss. Women may also lose hair when they stop taking the pill. Hormones are not the only medication that may be associated with hair loss*. Blood thinners and blood pressure medications may do it, too. So can drugs used to treat depression, heart disease, and arthritis.
Crash Diets Are Dangerous
Crash diets and fad diets promise quick weight loss, but most do not work and can be dangerous. If you lose 15 pounds or more very quickly, you may lose a significant amount of hair within a matter of months. Stick to a healthy, balanced eating plan. Fresh fruit, vegetables, lean meats, and complex carbs give your body the fats, proteins, carbohydrates, vitamins, and minerals you need to maintain a healthy body, including a full head of hair. Other dietary risk factors for hair loss? Excess vitamin A and protein deficiency may both set the stage for your luscious locks to fall out.
Style Hair Carefully
Tight ponytails, hats, scarves, cornrows, and bandanas can all pull on hair and lead to hair loss by a process called traction alopecia. The gradual, constant tension irritates the scalp and may cause hair to fall out. Ditto for tight rollers. Wear your hair down to eliminate tension, and your hair should grow back if traction alopecia was to blame for losing your locks. Beware especially of long-term use of tight hairstyles. These may scar your scalp and lead to hair loss that is permanent.
Cancer Treatment Is a Trigger
Radiation and chemotherapy used to treat cancer are common causes of hair loss. Both therapies harm hair follicles in addition to killing cancer cells. People undergoing cancer treatment often experience dramatic hair loss* as a result of these therapies. They may wake up with clumps of hair on their pillow or they may lose large amounts of hair in the shower. Hair loss often starts within 2 weeks of beginning treatment. It may be worst between 1 to 2 months into therapy. The scalp may be extra sensitive during this time. It may be irritating to wash, brush, and comb hair. The good news is that once cancer treatment is over, hair tends to grow back.
Physical and Emotional Stress
Extreme physical or emotional stress may trigger female pattern hair loss. Hair loss due to physical or emotional stress is called telogen effluvium. Things that may precipitate this pattern of hair loss include serious illness or injury, surgery, severe emotional upset, blood loss, and weight loss. Sometimes a reaction to medication may trigger this kind of hair loss. Telogen effluvium may last for 6 to 8 months before resolving.
Medication for Hair Loss
Minoxidil, or Rogaine, is a topical medication that is used to treat female pattern hair loss and male-pattern baldness. It was initially developed as a blood pressure medication and was used off-label to treat hair loss*until it became FDA-approved for that purpose. Minoxidil can slow the progression of hair loss. Most women who use the medication experience regrowth of hair. The medication needs to be used continuously to maintain results. Other types of treatment work for different kinds of hair loss*. Corticosteroids help suppress the immune response that damages hair follicles in people who have alopecia areata. Once the follicles recover, hair can grow back. If nutritional deficiencies underlie hair loss, eating a healthy diet with adequate and protein and nutrients can help you regrow hair. Certain medical problems may trigger hair loss. Adequately treating these conditions may help restore hair growth.
Do Lasers Work?
Low-level laser therapy (LLLT) is a treatment that may help regrow hair. The lasers are available for home use and in doctor’s offices. Laser therapy must be used for between 2 to 4 months before results are visible. Laser therapy is an alternative to medication and hair transplant surgery. The devices are approved by the FDA, but the approval process for devices is not as stringent as it is for medications that undergo a rigorous clinical trial process. Long-term safety and efficacy data for low-level laser therapy is not available. Laser therapy may be effective for 50% of men over the age of 40 and 75% of women over the age of 65 who suffer from certain kinds of hair loss*.
Hair Transplant Surgery
Hair transplantation is a surgical procedure in which a doctor removes hair from part of the scalp and transfers it to areas of the scalp where it is thinning. In cases of female pattern hair loss, hair may be thin all over, so it may be difficult to find adequate donor sites for harvesting hair. Hair transplantation is more effective for those who suffer from male pattern baldness or those who suffer from thinning of the frontal scalp. Patients may need multiple sessions to achieve desired results.
Beware of Big Promises
There are numerous devices and products that are marketed as effective hair loss* treatments, but many of them do not work. Beware of all of the false advertising associated with these products. Before-and-after pictures may have been doctored to be misleading. How do you know if a hair loss treatment really works? Ask your dermatologist about any treatment you are considering. Look on the FDA and Federal Trade Commission (FTC) websites to search for approved medical devices and drugs.
Style Your Hair Right
A new haircut or hairstyle may be just what you need to make your hair appear fuller. Ask your stylist for advice about getting a shorter cut, parting your hair in a different location, or adding curls or waves to add volume to your hair. Use styling products designed for thin hair. Some products are added to the roots while hair is damp before blowing dry. Some cosmetic products can help disguise the appearance of bald spots. Keratin fiber hair cosmetics have a static charge that makes hair appear fuller than it is. Ask your stylist or dermatologist for recommendations about the products and strategies that will work best for you.
Managing Major Hair Loss
There are many things you can do to disguise hair loss that is abrupt or severe. You can use a hat, scarf, or bandana to cover your head. If you have bald areas, consider getting a weave or concealing the bald area with a hairpiece. Wigs can be very natural looking. They fit so well you can even wear them while you are working out at the gym or swimming. If hair loss* causes severe distress and it is affecting your self-esteem or ability to carry out daily activities, seek the help of a therapist.
What Are the Roots of Hair Loss?
There’s no single cause. Triggers range from medical conditions — as many as 30 — to stress and lifestyle factors, like what you eat. Your genes play a role, too. Sometimes doctors can’t find a specific reason. As a starting point, hair loss experts suggest you get tested for thyroid problems and hormone imbalances. Hair often grows back once the cause is addressed.
Can You Measure Hair Loss?
Yes. Doctors use the Savin scale. It ranges from normal hair density to a bald crown, which is rare. The scale helps document female pattern baldness, a condition your doctor might call androgenic alopecia. You probably know it as male pattern baldness, but it affects about 30 million American women. Experts think genes and aging play a role, along with the hormonal changes of menopause. Your hair could thin all over, with the greatest loss along the center of the scalp.
