Female hair loss is a major problem for women, regardless of age. It is estimated that all women will experience some degree of hair loss at some stage of their lives.
The life cycle of hair consists of the anagen, the catagen and the telogen phase. Female hair loss occurs when there is a fast transition from the anagen to catagen and telogen phase. Normally, around 95% of the scalp hair is in the anagen phase, which lasts several years, while the catagen and telogen phase only last a few months. In some types of female hair loss, the anagen phase lasts only a few months.
Hair loss in the range of 100-150 hairs per day is normal, and does not constitute hair loss. The shedding of these catagen hairs occurs mainly during shampooing and combing and doesn’t necessarily indicate female hair loss. However, a woman who loses more than 150 hairs a day does suffer from female hair loss and should seek treatment.
The most common ages for the onset of female hair loss are puberty, the postpartum period, and menopause. In all three cases, the psychological stress caused by female hair loss is intense, as hair has always been a crucial element of femininity and beauty.
The causes of female hair loss vary and may be either normal or pathological. Normal hair loss is a seasonal phenomenon that occurs mainly during autumn.
Hair loss may also be due to hormonal reasons, such as polycystic ovary syndrome. This type of hair loss usually coexist with acne, obesity, and menstrual disorders. Thyroid and parathyroid diseases are also common causes. Cushing’s syndrome or hypercortisolism and chronic medication with systemic corticosteroids are also significant hormonal causes of female hair loss. Pituitary adenomas such as prolactinoma lead to female hair loss. Hyperandrogenism, which may occur in the case of adrenal or ovarian neoplasms, and the use of oral contraceptives can also lead to hair loss in women. In all the above cases, female hair loss is usually diffuse, i.e. the shedding and thinning of the hairs is evenly distributed over the entire scalp.
One important class of female hair loss, is male pattern or androgenetic alopecia. This type is inherited and the causes are polygenic. Unlike with men, the genes that are responsible for this type of female hair loss are inherited as an autosomal or X-linked recessive trait. For this reason, female hair loss of this type is less frequent, as its occurence requires the existence in both parents. The clinical picture of this form of female hair loss is different than in men, as is it diffuse and rarely leads to baldness. Usually there is a predisposition, but it manifests itself only during menopause. The Ludwig scale ranks male pattern hair loss in women in stages, depending on its severity. One discerning feature is that in female hair loss, the frontal hairline is maintained and thinning occurs mainly at the crown of the head.
One other cause of diffuse hair loss may be poor diet, thus diet low in iron, proteins, minerals, vitamins and trace elements. Iron deficiency anaemia is a very common cause of female hair loss and occurs during the reproductive age of women, usually with menometrorrhagia or during pregnancy.
Stress is nowadays one of the most common causes of female hair loss. This diagnosis is set after all other causes of hair loss are excluded.
Excessive use of chemicals and hair styling products, and string pulling and rearward combing (e.g. ponytail) undoubtedly lead to female hair loss. Also, frequent hair straightening and salon styling lead to hair loss from traction.
Exposure to the sun without hat or suitable protection damages the scalp; the skin becomes thinner and the resulting immunosuppression causes the hair follicles to degenerate, intensifying all forms of female hair loss.
Telogen hair loss in women is due to factors that cause the hairs to pass quickly into the telogen phase. Such factors may be endocrine or metabolic diseases, malnutrition, childbirth, heavy surgery, chronic disease, cancer, certain drugs, heavy metals, and harmful environmental factors.
The most common causes of patchy hair loss in women are alopecia areata, fungal infections, injuries, skin carcinomas, folliculitis and skin infections, lichen planus and cutaneous lupus erythematosus. In these cases, the female hair loss is not diffuse but localised.
Alopecia areata is a common autoimmune cause for both male and female hair loss. It can be distinguished into monolocalularis (in one spot), multilocularis (in more spots), circumscribed, diffuse, ophiasis, total and universal. Often other autoimmune diseases coexist, such as thyroiditis. The diagnosis of this form is performed clinically or through biopsy. Female hair loss has significant psychological effects, which in turn aggravate the problem. Treatment consists of topical application of corticosteroids, steroid infiltrations, minoxidil, calcineurin inhibitors, local sensitizing substances, and PUVA.
Female hair loss of fungal aetiology is due to dermatophytes and various types of trichophyton. It is diagnosed by cultivation and treated with antifungals. Female hair loss due to microbial infections occurs in the form of folliculitis in the scalp. The little pustules may discharge pus and the region is led to scarring and hair loss. This does not occur only in women, but also in men and children, and is treated with antibiotics.
Lichen planus is the most common form of cicatricial hair loss in women. It is an autoimmune disease that affects the skin, the hair and the mucous membranes. It causes cicatricial alopecia which appears as smooth shiny patches, with hyperkeratosis around the opening of the follicle. Female hair loss of this type has a very poor aesthetic clinical picture, as there are scars, the hair is doll-like, and it is irreversible. It is treated with hydroxychloroquine, minoxidil and corticosteroids.
Hair loss in women due to discoid lupus is the second most common autoimmune form of cicatricial alopecia. It is caused by a disease called lupus erythematosus, which among others affects the skin and the scalp. Erythematous inflammatory patches, leaving atrophic scars with hair loss, are the main feature of this type of female hair loss. The diagnosis is made by biopsy and immunofluorescence, and the treatment of lupus that induced hair loss in women is done with steroids and immunosuppressants.
Diagnosis starts by taking the patient’s history, performing blood and hormonal tests, phototrichogram, or even with skin biopsy, depending on the type of hair loss.
The prognosis depends on the type. Generally, the prognosis for diffuse hair loss in women of childbearing age is better than for men, as the female hormones act protectively.
The treatment, due to underlying causes, requires their elimination e.g. with increased iron intake, improved diet, and avoidance of stress.
The main drugs that fight hair loss are minoxidil (usually 2%) and finasteride. The former is administered as a lotion that is applied 1 to 2 times a day. It increases the blood flow to the scalp and stimulates the regrowth of the hair. The main side effects of female hair loss are irritation of the scalp, erythema, oiliness and peeling, which are resolved after dose adjustment.
Finasteride should be administered only for female hair loss during menopause. It is an antiandrogen and is administered at a dose of 1mg per day for female hair loss.
Nowadays, hair transplantation offers a solution for many cases of female hair loss. It is applied for androgenetic alopecia and other types of diffuse or cicatricial hair loss. Advanced Hair Clinics is specialised in clinical treatment of both male and female hair loss. We apply the FUE hair transplant method which leaves no scars, causes no pain, does not require stitches and gives a perfectly natural effect. In many cases of hair loss in women, Unshaven FUE method is often applied. As the scalp is not shaved, there is no indication that the patient has undergone hair transplantation and the patient can return directly to her normal activities.
At Advanced Hair Clinics, each case of female hair loss is treated individually, starting with the correct diagnosis and resulting in appropriate treatment that is different for everyone. Our clinic is one of the most specialised clinics in female hair loss treatment with experience of thousands of cases in Greece and abroad, from Europe to the Middle East.