Hair Loss in Women Articles

In the words of Elizabeth Steel, hair loss is miserable enough for a man: a downright catastrophe for a woman. A survey by Hairline International, the baldness support group, found that 78% of its female members no longer felt like women, 40% said their marriage had suffered and 63% had considered suicide.

Women who lose their hair often worry that they are going bald like a man, and that their hormones are becoming masculinized. In fact, patchy baldness (alopecia areata) and total baldness (alopecia totalis and alopecia universalis) are unrelated to hormones and occur equally commonly in men and women.

Thinning hair after the menopause

Like men, most women develop widening partings and thinning of the hair all over the scalp with age; this is normal. It actually starts in the teens or early 20s, and by the age of 50 over half of all women have thinning hair. After the menopause, thinning of the hair is more pronounced. Hair can also become thin at the front, similar to the male pattern. This is because the hair follicles are responding in exactly the same way as in balding men to the testosterone in the blood. All women have testosterone; this is perfectly normal. The balding does not mean that the woman has more testosterone; it simply means that the hair follicles on her scalp are oversensitive, which is probably inherited. The hair will eventually not become any worse. There is no need to worry that you will become completely bald.

Hair loss and other symptoms

A few women develop male pattern baldness with other problems such as growth of hair on the face, lumpy acne, deepening of the voice and irregular periods. In rare cases, this can mean that too much testosterone is being produced by a tumour, so it is important to see your family doctor so that appropriate tests can be done.

Causes of thinning hair in women

Thinning hair may be caused by:

• age (most old people have thinner hair than when they were young)
• heredity (some people are programmed to have thin hair, particularly as they get older)
• a hormone disorder (particularly an underactive thyroid gland)
• drugs
• iron deficiency (most likely in women who are vegetarians)
• severe mental stress (such as bereavement), 2–3 months previously
• severe physical illness of any sort, 2–3 months previously (particularly a high fever or severe infection – the hair grows again when the body has fully recovered)
• childbirth (it is common to shed a lot of hair for 1–6 months after childbirth, but it usually grows again afterwards)
• systemic lupus erythematosus (SLE, a disease affecting the connective tissue)
• damage from bleaches and relaxers, which can make the hair become ‘soapy’ in texture and break off (Afro-Caribbean hair is especially vulnerable).

Treatments for thinning hair in women

Looking after your hair. Just because your hair is thinning there is no need to avoid hairsprays, careful perming or hair dyes. These will not worsen the problem. In fact, perms and hairsprays lift the hair and disguise thinning. However, you should avoid bleaches and hair relaxers. Short, bouncy hairstyles give lift and body. It is also all right to use hair colorants on thinning hair, but darker shades may make thinning more obvious.

Diet. Low stores of iron in the body can sometimes cause hair loss so, particularly if you are vegetarian, ask your doctor for a blood test. Iron-rich foods include lean red meat, game, offal, egg yolks, dark green leafy vegetables and pulses. Vitamin C helps your body to absorb iron. Although hair follicles need plenty of the essential amino acids – the building blocks of proteins – it is doubtful whether increasing your intake of protein or taking amino acid supplements will really help.

HRT, depending on the type, can affect the hair. If you are taking HRT containing progestogen, ask your doctor for a third-generation type of progestogen HRT, which is less similar to male hormones and may be better for women with hair loss.

Hair transplantation. If you are very distressed by thinning hair, and Regaine has not helped, you might consider hair transplantation, which can be done for women as well as men.

About Hair Loss in Women

Hair loss is relatively common in women with about 30% experiencing at least some degree of thinning in their lifetime. However, because female hair loss tends to be diffuse (less hair all over) and because women often maintain their frontal hairline their hair loss may not be noticeable, particularly in its early stages.

The psychological effects of hair loss can be significant for women and many are emotionally affected, even with modest amounts of thinning. This is, in part, due to the false assumption that it is uncommon for women to lose their hair and that hair loss in women is perceived to be socially unacceptable. Both of these erroneous perceptions make dealing with hair loss particularly difficult for women.

In addition, the widely used medication Propecia is not indicated for women, so there is a misconception that medical progress in treating female hair loss is not as advanced, or that the medical community does not take the treatment of female hair loss as seriously. Lastly, because hair loss in women can so often be disguised with existing hair, many women choose to hide their hair loss from others. Not sharing their problem tends to isolate them and makes the ability to deal with their hair loss all the more difficult.

Hair loss in women is generally very gradual, with the rate accelerating during pregnancy and at menopause. It can also show seasonal variations and it is more easily affected by hormonal changes, medical conditions and external factors.

Causes of Hair Loss in Women

Common or “hereditary” baldness in women, also called female pattern alopecia, is genetic and can come from either the mother’s or father’s side of the family. It is affected by the actions of two enzymes; aromatase (which is found predominantly in women) and 5-alpha reductase (which is found in both women and men). However, since the diffuse pattern of hair loss typically seen in women can be caused by a number of medical conditions other than common genetic hair loss, a thorough evaluation is particularly important for female patients. If an underlying medical cause can be found and treated, the hair loss can often be reversed.

Classification of Female Hair Loss

The common diffuse pattern of female hair loss caused by heredity is organized by the degree of thinning. This system of classification for hair loss in women is called the Ludwig Classification. Hair loss in the Ludwig system is labeled as being mild, moderate and extensive.

Diagnosis of Hair Loss in Women

The diagnosis of “female pattern” hair loss is relatively straightforward when there is a history of gradual thinning in the front and/or top of the scalp, a relative preservation of the frontal hairline, a positive family history of hair loss and the presence of miniaturization in the thinning areas. Miniaturization, the progressive decrease of the hair shaft’s diameter and length in response to hormones, can be identified using a hand-held device called a densitometer.

Besides densitometry, two other common diagnostic tests that can be performed in the physician’s office are the hair-pull (a test for shedding) and the hair pluck (a test for hair damage). If common causes are ruled out, a more thorough diagnosis is called for, which may include blood work, a biopsy, or other laboratory testing.

Treatment of Hair Loss in Women

Hair Loss Medication

Rogaine (minoxidil), a topical hair loss medication, has a 2% solution that is approved for women. Although Propecia (finasteride), is not indicated for women, some female patients with hair loss may benefit from using the oral medication spironolactone (used mainly to control blood pressure).

Laser Therapy

Low-Level Laser Therapy (LLLT) is a treatment for hair loss based on the principle of photo-biotherapy where a laser stimulates hair follicles on the scalp producing thicker hair shafts and a fuller appearance. LLLT is most useful in patients with diffuse hair loss (the most common pattern seen in women) although the benefits are generally modest. Two commonly use forms of laser treatment for hair loss are the Laser Comb and the Laser Cap. Both products can be used at home.

Camouflage

Since women’s hair loss is typically diffuse with a persistent frontal hairline, it is generally possible for women to be able to hide their thinning with creative styling and other camouflage techniques. Using cosmetic camouflage products may also help. A number of over the counter products are now available that can make the hair look thicker. They come in a variety of forms; powders, sprays and creams. The main limitation of these products is that one must have enough hair to hold the cosmetics in place and, unless it is applied properly, it may not look natural.

Surgical Hair Restoration

The development of surgical hair transplant techniques, particularly Follicular Unit Transplantation (FUT), allows many women to have a completely natural hair restoration. When performed on a good candidate, hair transplantation can produce a dramatic change in a woman’s appearance.

Women Thinning Hair

As part of the natural growth cycle females lose on average 50 to 100 hair strands each day, but what happens when they stop regrowing back?

While it is generally accepted that men lose their hair as they age, it is not often recognised that female hair loss is almost as common with an estimated 40% of women making up thinning hair sufferers, many suffering their hair loss in silence.

How Does Hair Grow?

To best understand why females suffer hair loss it is important to understand how it grows.

The Anagen phase is the growth period for a hair follicle and can last anywhere from 2-5 years. This is followed shortly afterwards by the Catagen phase, a short 1-2 week transitional stage which signals the end of the active growth of the hair follicle. The final stage is known as the Telogen phase, a period where the hair follicle ‘rests’ for 3-6 weeks until a new hair shaft grows and pushes out the old hair, signalling a return to the Anagen phase to repeat the process again.

Why do Females Lose their Hair?

Female hair loss is caused when the balance between shedding of the hair follicle and regrowth is disturbed, this is created through either a shorter Anagen phase or an increase in the number of hair follicles in the Telogen Phase. There are many factors that can contribute to hair loss in women including genetics, stress and medical conditions.

Common Reasons Why Women Lose Hair

Androgenic Alopecia

Androgenic alopecia is the most common form of hair loss for women and affects about 50% of women over the age of 40 and up to 75% of women over the age of 65. For women Androgenic Alopecia is due to the action of Androgens, male hormones that are typically present in only small quantities in women. Their increased presence in women can be heredity or be created by numerous other factors including the onset of menopause, the taking of high androgen index birth control pills and pregnancy.

Androgenic Alopecia in women can be best characterised by the minaturisation of the hair follicle and a general thinning on all areas of the scalp.

Telogen Effluvium

Telogen Effluvium is characterised by the thinning of hair resulting from the early entry of the hair follicle from the Anagen phase (growth stage) into the Telogen phase (resting phase). For women it Is a common form of hair lose and is usually a reaction to stress on the body’s physical or hormonal systems, or as a reaction to medication.

For women Telogen Effluvium can occur at any age and the onset can happen quickly, however under normal circumstances it will get better on its own within about six months, although for a few people it can become a chronic problem.

Traction Alopecia

Traction Alopecia is a form of alopecia, or gradual hair loss that is caused by localised trauma to the hair follicles. This trauma is often associated with women who frequently wear their hair in a particularly tight style like ponytails, pigtails or braids. It can also be caused through hairstyles like dreadlocks and extensions which can create the same effect. Typically for women affected by Traction Alopecia the hair loss occurs around the hair line, primarily the temples and the sides of the head, and if detected early enough the hair will regrow.

Alopecia Areata

Alopecia Areata is one of the main causes of female hair-loss and is due to an autoimmune disease which effects more than 2 percent of the population. Alopecia Areata is caused when white blood cells attach and attack the hair follicles, with the result being the suppression or even stopping of hair growth.

Thinning Tresses? Hair Loss Treatments Increasingly Marketed to Women

When surgeon Alan Bauman started his hair restoration practice in Boca Raton, Fla., in the late 1990s, about 10% of his patients were women. Now, he says, half are. Joseph Greco, a hair loss specialist in Sarasota, Fla., says his share of female patients has gone from 25% to 60% in the last decade alone.

There's no reason to think more women these days are losing hair. Almost all women lose some hair as they age and some women – just like some men – are genetically predisposed to lose a lot. Women rarely go bald, but what starts with a widening part, noticeable shedding or a shrinking pony tail can become significant, scalp-exposing hair thinning for about one third of women, studies show.

How women feel about that may be changing, says Melissa Piliang, a dermatologist specializing in hair loss at the Cleveland Clinic.

"I think there is an increased awareness and an increased interest in treatment," Piliang says. "For our grandmothers' generation, women over 50 were considered old. Now women that age are considered pretty young. Many also have jobs in which appearance is important."

And, it's fair to say, many also are seeing marketing for an increasing array of hair restoration products and procedures aimed at women – including a pricey but unproven treatment that both Bauman and Greco specialize in. It involves scalp injections with something called platelet-rich plasma (PRP).

Bauman, Greco and other practitioners – some of whom market PRP as a "vampire hair treatment," akin to the bloody "vampire facials" made famous by Kim Kardashian – say that substances in concentrated plasma, taken from a patient's own blood, can stimulate hair regrowth. They say the procedure is safe and produces noticeable results in most, but not all, male and female patients. A 20% to 25% increase in hair mass is typical, Bauman says.

But studies so far have been small and most have lacked the comparison groups that would show how PRP stacks up against other treatments or no treatment at all. "The early findings show promise, but more studies are needed to know whether this is a safe and effective treatment," the American Academy of Dermatology says.

Also, a lack of standardization – with each clinic using its own methods – "means it's buyer beware out there," Bauman says.

Those buyers are spending big bucks: Bauman charges $2,500 for a PRP treatment that he says needs to be repeated once a year on average. Greco says he repeats his version three times over the first 18 months for typical "female pattern hair loss" patients, charging $1,600 for the first treatment, $1,400 for the second and $1,000 for the third. Patients have an incentive to return because any new hair will fall out when treatment stops – just as it does with any treatment except for hair transplants.

But no one considers PRP the first-line treatment for women with hair loss.

That distinction goes to minoxidil, a liquid or foam applied to the scalp, available over the counter for years. The Food and Drug Administration approved a full-strength foam (a 5% solution) for women in 2014 and it is now sold as Women's Rogaine. The big advantage over older 2% versions is that it can be used once a day, instead of twice. It costs about $35 for a four-month supply.

Pililang says about 80% of women using minoxidil will stop losing hair and about half will regrow some. "It's not going to take someone who's 50 or 60 back to the hair they had at 20," she says.

"It doesn't work for everybody, but I tell my patients to use it diligently for six months and then look in the mirror and see how they feel," says Paradi Mirmirani, a dermatologist specializing in hair loss at Kaiser Permanente in Vallejo, Calif. Because hair loss caused by aging and genes gets worse over time, even maintaining hair "is a win," she says. "But patients have to decide whether it's worth the time and money."

The main side effects associated with minoxidil are scalp irritation and itching. And some women report unwanted facial hair growth – something that package instructions say might be prevented with careful application.

Another treatment that might work for some women: laser therapy with comb devices that sell for about $200 to $500 or caps that cost even more. These are FDA-approved for safety and recent studies suggest "a modest benefit," Mirmirani says.

Some women are candidates for hair transplant. But because women tend to lose hair all over their heads, not in the distinct bald spots common in men, finding lusher sections that can be moved to cover sparser areas is "more challenging," Piliang says.

Supplements such as biotin, marketed for hair health, are unproven, Piliang and Mirmirani say. But eating a healthy diet, protecting hair from the sun and not smoking can help, they say.

Also important to know: not all women's hair loss is the result of aging and genes. And some causes are treatable or temporary. Among them:

• Pregnancy. Many women see temporary hair loss after pregnancy.

• Stress. Hair also can shed after stressful or traumatic events.

• Iron deficiency, thyroid, hormone and immune disorders. Treating them can often stop any associated hair loss.

• Medications. Cancer drugs but also drugs used to treat acne, depression, blood clotting and other conditions can cause hair loss.

Hair Restoration For Her

At the Irvine Institute of Medicine and Cosmetic Surgery-Orange County Hair Restoration, we recognize women suffering with hair loss require a different approach than men when considering hair and eyebrow restoration. Compared to men, hair loss in women manifests in different patterns, generally is more diffuse, and can occur at any age. In men, there is a strong genetic pattern,  whereas in women other underlying conditions play major role in thinning of the hair.

Hair loss in women is a devastating disorder that can be treated medically or surgically. For women, a thorough disease specific medical evaluation is necessary in treating hair disorders with a trained medical hair specialist. Women typically notice hair loss during the menopausal period with reduced hair density usually in the middle of the scalp that thins laterally. The hair is often miniaturized because of a longer resting telogen phase. Rarely hair loss occurs in the frontal hairline.

The great news for women is female patterned hair loss can be treated successfully medically or surgically. This fact is confirmed by recent research conducted by the International Society of Hair Restoration Surgery. In their recent studies they estimate more women are being treated for hair loss than in the past decade. In 2008, 15% of hair surgery patients were women up from 11% in 2004.

Establishing the Correct Diagnosis

Every patient evaluated in our office undergoes a routine hormonal and medical evaluation for hair loss. The work up and evaluation of female hair loss is quite different than men. We take your hair loss seriously by performing a disease specific medical evaluation. A compete history and physical is the first step in evaluating women with hair loss and this is done at your initial consultation with Dr. Williams.

Diffuse hair loss is caused by a variety of conditions other than "hereditary balding." A disease specific work up is important because it establishes whether hair loss treatment is managed by medical, surgical, or a combination of both treatment options. The final decision to have surgery is generally dependent upon whether your hair loss appears to have stopped, your loss is mainly at the hairline, and balding is concentrated in one or two areas.

When should I consider hair transplantation?

In male pattern baldness the sides and back are still covered with hair. Men who have this balding pattern usually have successful hair transplant surgery. The donor hair from the back of the scalp survives the procedure and continues to grow on the area it is transplanted on the scalp.

DHT is what's responsible for the balding pattern on the top of men's heads. DHT, however, does not have any adverse effect on the hair follicle on the sides and back of the head. Typically, these areas of the head have healthy hair follicles, and the hair in these areas is excellent for use in hair transplant surgery. Referred to as stable sites, the hair follicles in these areas don't shrink or affected by DHT.

Women, on the other hand, typically don't have these stable sites wherein balding-resistant hair follicles can be found. Unlike men, women are likely to go bald not just on the top of their head but also on the sides, back and front. All areas of a woman's head are affected by DHT.

This makes women not good candidates for hair transplant surgery. Since the hair follicles in basically all areas of a woman's head are affected by DHT, any attempt to move them to the balding areas of the head is futile; the transplanted hair is simply going to fall out. Since the hair follicle is already damaged by the DHT in the first place, transplanting them to the balding area on the head is not going to solve the problem of baldness.

Note also that unlike men, women typically don't have to deal with receding hairlines. Instead, baldness in women occurs in a more diffuse manner, with uniformly thinning all over the head. In the case of female pattern baldness, the problem is more of how much hair is left on the head than where the baldness is occurring.

That said, a small percentage of women (approximately 5%) with baldness problems that can benefit from hair transplant surgery. These women tend to have areas (donor sites) in their head that have healthy hair follicles.

Who Is a Candidate For Hair or Eye Brow Restoration?

Some women with thinning scalp hair and virtually all women with thinning eyebrows

A person who has lost some but not all hair as a result of burns or other scalp injuries.

Women who want to restructure their hairline.

Women who have suffered hair loss due to mechanical or traction alopecia (non-hormonal).

Women who have a distinct pattern of baldness, similar to that of male pattern baldness-hairline recession, vertex thinning (on the crown or top of the scalp), and a donor area that is not affected by Androgenetic Alopecia.

Women who suffer hair loss due to trauma, including burn victims, scarring from accidents, and chemical burns.

Women who have had previous cosmetic or plastic surgery and are concerned about hair loss around the incision sites.

Women diagnosed with traction alopecia or alopecia marginalis.

Women who want to thicken or restore eyebrows.

Women who experienced hair loss after face lifts or other cosmetic procedures.

Who Is Not a Candidate for Hair Replacement?

Women with a diffuse, or wide-spread, pattern of hair loss.

Those who do not have sufficient "donor" sites (hair-bearing portions of the head from which hair-bearing skin is taken)

Women who form keloid scars or thick fibrous skin tissue that can result from trauma, burns, or radiation injury

Hair Replacement Procedures

Hair grafting, also called hair transplant surgery, is an outpatient surgical procedure performed in a hair surgeon's office. Gone are the days when a hair transplant made a scalp look like a field of newly planted corn. New technology and improved surgical techniques are transforming the hair transplant industry.

Dr. Ken Williams is one of a few board certified hair surgeons that is deeply involved in hair loss evaluations for women. For our patients who suffer from hair loss, the most important decision for you is to have a proper diagnosis and appraisal from a specialist of hair disorders. After the correct diagnosis is made, about 10% of patients elect to go on for surgical hair transplantation.

There are basically two types of surgical procedures available for women who want desire thicker hair or fuller eyebrows. For those women who are eligible to have surgery, the harvesting procedures available are the Strip method and Follicular Unit Extraction (FUE).

There are strengths and weaknesses for both procedures. No one procedure for female hair transplantation is best. Ideally, a surgical consultation is completed and a full examination of the hair and scalp is made before making the decision for hair surgery. FUE is a desirable cosmetic procedure because it does not leave a large linear scar at the back of your scalp for men with short hair styles. For women who have naturally longer hair, strip donor harvesting might be more ideal.