Female Hair Loss

A woman who loses more than 150 hairs a day does suffer from female hair loss and should seek treatment.

Female hair loss is a major problem for women, regardless of age.

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. It is estimated that all women will experience some degree of hair loss at some stage of their lives.

The life cycle of hair

hair life cycle phase 1 - anagen
Anagen phase
hair life cycle phase 2 - catagen
Catagen phase
female hair loss
Telogen phase

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, whereas the catagen and telogen phase last only for a few months. In some types of female hair loss, the anagen phase lasts only a few months. A loss of 100-150 hairs per day is normal, and does not constitute a sign of female 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 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, whereas the catagen and telogen phase last only for a few months. In some types of female hair loss, the anagen phase lasts only a few months. A loss of 100-150 hairs per day is normal, and does not constitute a sign of female 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.

Normal state of hair

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Percentage of hair in the anagen phase
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Percentage of hair in the telogen phase
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Normal daily hair loss

Types of Alopecia

Androgenetic alopecia

One important class of female hair loss, is the male pattern hair loss 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 occurrence requires the existence in both parents. The clinical picture of this form of female hair loss is different than in men, as it is 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.

Alopecia areata

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.

Cicatricial alopecia

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.

Of fungal aetiology

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.

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The progression of female pattern baldness is classified on the Ludwig scale.

Find out the stage you belong to.

Female Hair Loss – Diagnosis & Treatment

female hair loss

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. In case that female hair loss is due to underlying causes, the latter’s elimination leads to treatment e.g. with increased iron intake, improved diet, and avoidance of stress.

At Advanced Hair Clinics, each case of female hair loss is treated individually, starting with the correct diagnosis and resulting in the appropriate treatment that is different for everyone. Our clinic is one of the most specialised clinics in the treatment of female hair loss having extensive experience that counts thousands of cases in Greece and abroad, from Europe to the Middle East.

Female Hair Loss - Treatment options

Medication

Minoxodil (2%), an FDA approved medication for hair loss, rejuvenates and enhances blood flow around shrunken hair follicles, leading to their increase in size, and causing their thickening. Furthermore, it extends the growth phase of hair follicles and encourages hair regrowth. Minoxidil lotion is applied once or twice per day. It stimulates the local blood flow in the region that exhibits alopecia, resulting in the growth of hair. The main side effects are the irritation, erythema, oily hair and skin peeling, but they can be resolved once the dose is appropriately adjusted. Finasteride must be given only during menopause. It is an anti-androgen and it can be taken as follows: 1mg/day.

Hair Transplantation

Hair transplantation offers an optimum solution to 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. The medical team of Advanced Hair Clinics applies FUE hair transplant method which leaves no scars, causes no pain, does not require stitches and gives a perfectly natural result. In the majority of female hair loss restoration cases, Unshaven FUE method is applied. As the scalp is not shaved, there is no indication that the patient has undergone hair transplantation. The patient can return to her normal activities with no delay.

Female Hair Loss - FAQs

What are the causes of female hair loss?

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 that coexist with acne, overweight and menstrual disturbances
  • Thyroid and parathyroid diseases
  • Cushing’s syndrome
  • Hypercortisolism
  • Chronic medication with systemic corticosteroids
  • Pituitary adenomas such as prolactinoma
  • Hyperandrogenism, which may occur in the case of adrenal or ovarian neoplasms,
  • Use of oral contraceptives
What are the causes that lead to diffuse hair loss?

Causes that lead to diffuse, i.e. the shedding and thinning of the hairs that is evenly distributed over the entire scalp, are:

  • Poor diet, thus diet low in iron, proteins, minerals, vitamins and trace elements
  • Iron deficiency anaemia (a very common cause of female hair loss that occurs during the reproductive age of women, usually with menometrorrhagia or during pregnancy)
  • Stress (one of the most common causes of female hair loss)
  • Excessive use of chemicals and hair styling products
  • String pulling and rearward combing (e.g. ponytail) undoubtedly lead to female hair loss.
  • 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.
What are the causes of telogen 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
  • harmful environmental factors
What are the causes that lead to patchy hair loss in women?

The most common causes of patchy female hair loss, i.e. localised and not diffused, are:

  • alopecia areata
  • fungal infections
  • injuries
  • skin carcinomas
  • folliculitis
  • skin infections
  • lichen planus
  • cutaneous lupus erythematosus
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