Understanding Hair Loss In Women

Women are accustomed to having “good hair” days and “bad hair” days, but when those bad days threaten to become permanent because of hair loss, it may be time to take a closer look.

Female hair loss is more prevalent than you may think. Fewer than 45% of women go through life with a full head of hair. Female pattern hair loss (FPHL) is the most common cause of hair loss in women, and the chances of experiencing this increase with age.

The average person loses 50 to 100 hairs daily. Though the number can seem high, it typically isn’t noticeable because new hair grows simultaneously. The problem begins when hair is not replaced at the same rate at which it is lost.

The generic term for hair loss is alopecia, but there are many kinds.

Types of Hair Loss

• Gradual thinning. Female pattern hair loss is the most common type. FPHL usually appears as a progressive widening at the part of the hair and the gradual exposure of the scalp all over the head. Increasingly, women may also notice a receding hairline, which can be from a condition known as frontal fibrosing alopecia.
• Patchy bald spots. Patchy bald spots on the scalp, beard, or eyebrows, called alopecia areata, are usually caused by an autoimmune disease. Skin can become itchy or painful before the hair falls out.
• Loosening. Physical or emotional shock or stress can cause hair to loosen and fall out in handfuls when combing or washing. Loosening usually takes place over the entire scalp but is temporary.
• Full-body hair loss. Chemotherapy and other medical treatments or conditions may cause hair all over the body to fall out — usually temporarily.

Causes of Hair Loss

The reasons and types of hair loss are many, though hereditary reasons due to aging is the most common cause. Other triggers include:

• Hormonal changes that come with age
• Chemotherapies and other drugs
• Any hairstyle that repeatedly pulls the hair (like tight ponytails and braids)
• Repeated use of harsh chemicals can cause hair to break or fall out
• Low levels of vitamin D and iron deficiencies
• Restrictive diets and rapid weight loss
• Physical stress or shock
• An abnormal thyroid
• Medications and supplements: blood pressure medicines, gout medicines, high doses of Vitamin A
• Autoimmunity against the hair follicles

Treatment

Sometimes simply addressing a medical condition or practice that causes hair loss is enough to encourage hair growth. In other instances, additional help may be necessary.

• Medication: Minoxidil (Rogaine) is a topical medicine that is known to encourage growth, strengthen strands, and stimulate hair follicles, but care must be taken when combining the treatment with over-the-counter hair dye and other irritants.
• Oral medicines: These may be used for autoimmune forms of alopecia like alopecia areata, lichen planopilaris or frontal fibrosing alopecia. These include anti-malarial medicines like plaquenil, steroids like prednisone, or other immunosuppressants like mycophenylate mofetil. Newer medicines are being tested to treat autoimmune forms of alopecia like alopecia areata with exciting results, including oral inhibitors of Janus kinase (JAK) proteins.
• Platelet-rich plasma: A newer option in hair loss treatment, a physician isolates the plasma and platelet proteins in a patient’s blood and injects them both into the scalp where hair is thinning.
• Low-level LED laser light: Also known as red-light therapy and cold laser therapy, the treatment works on some types of hair loss by promoting circulation and encouraging the follicles to grow hair.
• Wigs: Wigs are a popular choice for many women, especially those experiencing hair loss due to chemotherapy or a medical condition.
• Hair transplantation: Those looking for a more permanent solution may investigate hair transplants. This surgical procedure relocates active follicles from the back of the scalp to areas where the hair is thinning. Once transplanted, the hair grows normally. While the procedure can be successful for many patients, the technique is most effective in treating smaller, defined areas of balding and will not work for diffuse thinning across the scalp. Other considerations include the expense – hair transplants can cost thousands of dollars and aren’t covered by insurance – and recovery time.

While the reasons for hair loss are many, so are potential treatments. The first step is figuring out why those locks are falling out. Consult your physician for help in untangling the mystery and determining the best solutions for you.

Guest Blogger: John Harris, MD, Chair, Department of Dermatology