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HAIR LOSS IN WOMEN


Did you know over 22% of women suffer morbidity thoughts (suicidal thoughts) relating to their hair loss?

Hair loss in women could be temporary or long lasting. Temporary hair loss can be easily treated when its cause is identified and dealt with, or difficult when it is not immediately clear what the cause is. Hair loss that could possibly have been temporary, may become long lasting as a result of an erroneous diagnosis. The potential for such misdiagnoses is perhaps the most exasperating aspect of hair loss for women.

The information in this section will help you identify the cause of your hair loss and ideally lead you to the right treatments for your specific kind of hair loss, sooner, rather than later.

  • Female Pattern Hair Loss
  • Telogen Effluvium
  • Anagen Effluvium
  • Other Causes
  • Diffuse Shedding

Alopecia is the medical term for excessive or abnormal hair loss. There are different kinds of alopecia. What all hair loss has in common, whether it’s in men or women, is that it is always a symptom of something else that’s gone wrong in your body. Your hair will remain on your head where it belongs if hormonal imbalance, disease, or some other condition is not occurring. That condition may be as simple as having a gene that makes you susceptible to male or female pattern baldness or one of the forms of alopecia areata, or it may be as complex as a whole host of diseases.

Fortunately, hair loss may also be a symptom of a short-term event such as stress, pregnancy, diet and the taking of certain medications. In these situations, hair will often (though not always) grow back when the event has passed. Substances, including hormones, medications, and diseases can cause a change in hair growth, shedding phases and in their durations. When this happens, synchronous growth and shedding occur. Once the cause is dealt with, many times the hair will go back to their random pattern of growth and shedding, and the hair loss problem stops. Unfortunately, for some women, hair loss becomes a life long struggle.

FEMALE PATTERN HAIR LOSS (ANDROGENETIC ALOPECIA)

The most common type of hair loss seen in women is androgenetic alopecia, also known as female pattern alopecia or baldness. This is distinguished as hair thinning primarily over the top and sides of the head. It affects approximately one-third of all susceptible women, but is most generally seen after menopause, although it may begin as early as puberty.

Average hair fall is approximately 100-125 strands of hair per day. Fortunately, these hair are replaced. Real hair loss occurs when lost hairs are not regrown or when the daily hair shed exceeds 125 hair. Genetically, hair loss can come from either parent’s side of the family.

Just like in men the hormone DHT appears to be at least partially to blame for the miniaturization of hair follicles in women suffering with female pattern baldness. Heredity plays a major factor in the disease.

TELOGEN EFFLUVIUM

When your body goes through something traumatic like child birth, malnutrition, a severe infection, major surgery, or extreme stress, many of the 90 percent or so of the hair in the anagen (growing) phase or catagen (resting) phase can shift all at once into the shedding (telogen) phase. About 6 weeks to three month after the stressful event is usually when the phenomenon called telogen effluvium can begin. It is possible to lose handful of hair at time when in full-blown telogen effluvium. For most who suffer with TE complete remission is probable as long as severely stressful events can be avoided. For some women however, telogen effluvium is a mysterious chronic disorder and can persist for months or even years without any true understanding of any triggering factors or stressors.

  • Physical stress: surgery, illness, anemia, rapid weight change.
  • Emotional stress: mental illness, death of a family member.
  • Thyroid abnormalities.
  • Medications: High doses of Vitamin A, Blood pressure and Gout medications.
  • Hormonal causes: pregnancy, birth control pills, menopause.
  • When the above causes of telogen effluvium are reversed or altered you should see the return of normal hair growth

ANAGEN EFFLUVIUM

Anagen effluvium occurs after any insult to the hair follicle that impairs its mitotic or metabolic activity. This hair loss is commonly associated with chemotherapy. Since chemotherapy targets your body’s rapidly dividing cancer cells, your body’s other rapidly dividing cells such as hair follicles in the growing (anagen) phase, are also greatly affected. Soon after chemotherapy begins approximately 90 percent or more of the hairs can fall out while still in the anagen phase.

The characteristic finding in anagen effluvium is the tapered fracture of the hair shafts. The hair shaft narrows as a result of damage to the matrix. Eventually, the shaft fractures at the site of narrowing and causes the loss of hair.

Diet Considerations

Hair loss may also occur due to dieting. Franchised diet programs which are designed or administered under the direction of a physician with prescribed meals, dietary supplements and vitamin ingestion have become popular. Sometimes the client is told that vitamins are a necessary part of the program to prevent hair loss associated with dieting. From a dermatologists’ standpoint, however, the vitamins cannot prevent hair loss associated with rapid, significant weight loss. Furthermore, many of these supplements are high in vitamin A which can magnify the hair loss.

Physical and Emotional Stress

Surgeries, severe illnesses and emotional stress can cause hair loss. The body simply shuts down production of hair during periods of stress since it is not necessary for survival and instead devotes its energies toward repairing vital body structures. In many cases there is a three month delay between the actual event and the onset of hair loss. Furthermore, there may be another three month delay prior to the return of noticeable hair regrowth. This then means that the total hair loss and regrowth cycle can last 6 months or possibly longer when induced by physical or emotional stress. There are some health conditions which may go undetected that can contribute to hair loss. These include anemia or low blood count and thyroid abnormalities. Both of these conditions can be detected by a simple, inexpensive blood test.

Hormonal Considerations

Hormonal changes are a common cause of female hair loss. Many women do not realize that hair loss can occur after pregnancy or following discontinuation of birth control pills. It is important to remember that the hair loss may be delayed by three months following the hormonal change and another three months will be required for new growth to be fully achieved.

 

Myths Related to Hair Loss

  • Frequent shampooing contributes to hair loss.
  • Hats and wigs cause hair loss.
  • 100 strokes of the hair brush daily will create healthier hair.
  • Permanent hair loss is caused by perms, colors and other cosmetic treatments. Women are expected to develop significant hair loss if they are healthy.
  • Shaving one’s head will cause the hair to grow back thicker.
  • Standing on one’s head will cause increased circulation and thereby stimulate hair growth!
  • Dandruff causes permanent hair loss.
  • There are cosmetic products that will cause the hair to grow thicker and faster.
  • Stress causes permanent hair loss.
  • Hair loss does not occur in the late teens or early twenties.
  • Hair loss affects only intellectuals.
  • There is a cure for Androgenetic Alopecia.

ALOPECIA AREATA

Alopecia areata is a prevalent autoimmune disorder causing the loss of hair on the scalp and elsewhere on the body. It generally starts with one or more small, round, smooth patches on the scalp and can progress to total scalp hair loss (alopecia totalis) or complete body hair loss (alopecia universalis). The scalp is the most commonly affected area, but the beard or any hair-bearing site can be affected alone or together with the scalp. Alopecia areata occurs in males and females of all ages, but onset often occurs in childhood.

Alopecia areata is a highly erratic and recurring condition. The affected hair follicles become very minute and produce no visible hair above the skin’s surface. Hair can grow back in or fall out again at any time, and the disease course is different for each individual. No matter how extensive the hair loss, most hair follicles remain alive and are ready to resume normal hair production whenever they receive the appropriate signal. In all cases, hair regrowth may occur even without treatment and even after many years.

Alopecia Areata can be considered have an autoimmune mechanism but there may be an external trigger such as a sudden shock or extreme stress.

TRACTION ALOPECIA

This condition is caused by localized trauma to the hair follicles from tight hairstyles that pull at hair over time. This causes the hair to be pulled and can damage the follicle if the condition is detected and addressed early enough, the hair will regrow. Over a period of time under these circumstances, Traction Alopecia will result in slowing down the production of hair until it eventually cease.

 

What causes Traction Alopecia?

Traction alopecia normally begins on the scalp where hair is pulled the tightest. Damaged follicles do not regenerate. Accumulation of damaged follicles leads to noticeable hair loss.

Due to the nature of the hairstyles that tend to cause Traction Alopecia, this hair loss condition is predominantly seen in women. However, men who wear their hair in tight braids, dreadlocks or sport hair extensions are also susceptible to Traction Alopecia. Many celebrities, dancers and models suffer from this condition due to their over-use of hair extensions and tightly-fixed hair embellishments, such as hairpieces.

If you notice hair loss, stop styling your hair in tight hair styles straightaway. Avoid putting your hair braids and ponytails. Use a bobby pin to secure your hair. Bobby pins exert less tension on the hairline. Employ prevention as your first treatment against traction alopecia.

 

SCARRING ALOPECIA

Also called cicatricial alopecia, the word “scarring” is used in scarring alopecia to mean “permanent”. It also just means permanent hair loss. There is usually no visible scarring. In fact for advances scarring alopecia, what you usually see is a shiny scalp. The scarring has happened underneath the scalp surface, where the hair follicles are replaced with scar tissues.

All scarring alopecias show the body’s immune cells attacking the skin and hair follicles. It occurs when the hair follicles are destroyed. The skin and hair follicles undergo certain changes and can look quite similar to non-scarring alopecia.

These changing conditions can be based on the following:

  • Changing skin characteristics: The attack of the immune cells causes the skin to lose its shine and becomes dull and hard to touch, but susceptible to erupt.
  • Particular areas of the scalp may be affected in similar ways. Meanwhile the surrounding skin can be perfectly normal.
  • The skin may develop blister type changes with redness that may appear to be infectious.
  • Different alopecias have their own evolutionary changes in the skin over time. Different parts of the body may be affected differently.
  • The skin may appear to weep, producing wetness. Some of these diseases can also cause the skin to be dry and crusty, some stay normal, while others develop fine thin skin.
  • While the skin changes, hair follicles are destroyed below the surface.

TRICHOTILLOMANIA

Trichotillomania is a disorder that involves recurrent, irresistible urges to pull out hair from your scalp resulting in noticeable hair loss. Hair pulling can occur in any area of the body where hair grows. The scalp is the most common area, followed by the eyelashes and eyebrow. The alopecia that results from hair pulling can range from small undetectable areas of hair loss to total baldness.

Hair pulling from the scalp often leaves patchy bald spots, which causes significant distress and can interfere with social or work functioning. People with trichotillomania may go to great lengths to disguise the loss of hair.

For some people, trichotillomania may be mild and usually manageable. For others, the compulsive urge to pull hair is overwhelming. Some people who suffer from this are unable to stop this behavior even as their hair becomes thinner.

Signs and symptoms of trichotillomania often include:

  • Repeatedly pulling your hair out, usually from your scalp, eyebrows or eyelashes, but can be from other body areas, and sites may vary over time.
  • An increasing sense of tension before pulling, or when you try to resist pulling
  • A sense of pleasure or relief after the hair is pulled
  • Shortened hair or thinned or bald areas on the scalp or other areas of your body, including sparse or missing eyelashes or eyebrows
  • Preference for specific types of hair, rituals that accompany hair pulling or patterns of hair pulling
  • Biting, chewing or eating pulled-out hair
  • Playing with pulled-out hair or rubbing it across your lips or face
  • Polycystic Ovarian Syndrome (PCOS) And Hair Loss

Polycystic Ovarian Syndrome (PCOS) is an endocrine disorder that affects how a woman’s ovaries work. It commonly produces symptoms such as weight gain, fatigue and increased facial hair. But it can also cause excessive hair shedding and hair thinning in those with a genetic predisposition and follicle sensitivity.

POLYCYSTIC OVARIAN SYNDROME (PCOS) AND HAIR LOSS

PCOS can cause hyperandrogenism – where your body produces too many androgens (male hormones). Androgens are naturally found in all women. They affect the degree and frequency of bleeding during your menstrual cycle and can also cause acne and oily skin. However, if your hair follicles are sensitive to androgens they can also decrease the growth of hair on your scalp and increase the growth of hair on your body. This is especially true if you have excessive amounts.

Follicle sensitivity is not simply ‘caught’ or randomly acquired. It’s genetically inherited and has been there since birth. If you have little or no hair follicle sensitivity, your hair may not be very affected by extra androgens. But normal or even sub-normal amounts of circulating androgens can cause hair loss if your follicles are very sensitive to them.

TREATMENT FOR HAIR LOSS CAUSED BY PCOS

Treatment for PCOS can be complicated, depending on symptoms other than thinning hair. However, if hair loss is the only or predominant symptom, it’s relatively straightforward. Hair thinning from PCOS is treated by orally and/or topically taking anti-androgens. Topically applied solutions usually contain an anti-androgen as well as a stimulant. The most common oral anti-androgens used for hair loss are combination oral contraceptives such as Spironolactone or Dianette, but oral and topical solutions used together are most effective.

Telogen Effluvium

Telogen effluvium is a form of diffuse hair loss that occurs during the ‘telogen’ or ‘resting’ phase of the hair growth cycle. Telogen effluvium can be either acute or chronic depending on the cause and the severity of the disturbance. Diffuse hair loss usually takes place 8 – 12 weeks after the event that triggered it, so you may not always connect the two. If you notice excessive hair shedding, look back a couple of month for possible causes.

On average, it is ok to lose up to 100 hairs a day provided they are growing back. However, telogen effluvium can result in as many as 300 hairs being shed in a 24 hour period.

 

What Causes Telogen Effluvium?

Telogen Effluvium can be caused by a wide range of factors including, but not limited to, iron deficiency, ferritin (stored iron) deficiency, protein deficiency, shock, rapid weight loss, stress, a high fever, the stomach flu and pregnancy.

 

Treatment for Telogen Effluvium

Telogen effluvium resulting from short-term illness, such as a high fever or stomach upset, will usually resolve itself. However, chronic telogen effluvium due to nutritional deficiencies often needs to be treated with appropriate nutritional supplements. Blood tests can be very helpful in diagnoses and should always be carried out if you have noticed increased hair loss for longer than 4 weeks.

Hair lost during telogen effluvium almost always grows back once the underlying issue has been resolved.

 

Hair Loss Caused by Hormonal Imbalance

By far the most common type of hair loss experienced by women is that caused by the effect of certain hormones upon the hair. These hormones enter the hair cells and pre-vent them from growing as well as they should, this results in the characteristic thinning on the front and top of the scalp. The scalp begins to grow finer hairs and the scalp becomes more visible. There is usually a general loss of “condition” resulting in the hair becoming lank and difficult to control.

This form of hair loss affects 10% of women between the ages of 18-40, 25% by the age of 50 and a staggering 60% by the age of 70. In many women it is a minor problem and is easily disguised, but other women find it very distressing and lose their self confidence and self esteem.

In the past nothing could be done to prevent this problem occurring but now there are substances which can stop the hair from thinning and can produce a better quality of hair in most women. The treatment consists of using a very low level (and perfectly safe) hormone cream and lotion which are applied externally to the affected region of the scalp.

As with most disorders, the earlier the treatment is started the better the results are likely to be. Approximately 30% of people visiting the Trichological Centre are women who suffer from this hair loss problem.

 

Patchy Hair Loss

This is a hair loss condition which is caused by a fault in the immune system of the body. It can be associated with stress. The symptoms are a sudden increase in hair fall associated with patches of baldness. Although this disorder is alarming it rarely spreads to total hair loss and treatment for this condition can be effective. In clinic treatment would include ultra-violet and infra-red therapy combined with the use of stimulating creams and lotions. A holistic assessment is made rather than just treating the symptoms so recommendations for herbal and/or homeopathic therapy are invariably instituted. When the hair grows back it is usually white initially but the natural Colour usually returns within a short period of time.

 

Diet & Hair Loss

“We are what we eat,” as the saying goes.

 

This is particularly true when it comes to our hair. our hair is affected by what we eat, or do not eat. At the Trichological Centre we constantly see the results of poor diets and crash dieting.

Basically, hair has no useful function. The body can work just as well whether it has hair or not. So if the body is short of any nutrient, protein, mineral, iron etc; it will divert these from the hair to nourish the more important body organs. The result can be a Diffuse Hair Loss.

Low iron levels (which may not be true clinical iron anemia) can cause a marked thinning of hair and women are more susceptible to this because of the loss of iron in the blood due to menstruation. Vegetarian diets can cause hair loss unless specific attention is given to the balance of proteins and iron rich foods.

The best advise for producing healthy hair is eat a well balanced diet, of protein, carbohydrates and minerals. Go easy on processed and convenience foods.

A Hair Expert can help you in this area by making sure there are no specific foods in your diet which are causing problems.

 

Hair Loss After Child Birth

Post natal hair loss affects 50% of all women who have given birth. A marked increase in hair fall is experienced between the second and seventh month after the child is born. It can be a very frightening and distressing experience and is due to fluctuating hormone levels.

Usually the hair loss stops as suddenly as it started and in time all the hair will be replaced. Treatment is not usually given unless the hair loss is excessive or if it continues after month eight.

 

Stress Related Hair Loss

Stress is blamed for causing all types of problems, some times this is true, sometimes it is not. We all suffer from “highs and lows,” in our lives. It is important that body stress levels are kept as low as possible. It may not be possible to remove the cause of our stress but there are ways that we can learn to cope with it successfully. Hair loss and stress are inexorably linked.

There is reasonable scientific evidence to show that stress can alter the uptake of certain trace elements and amino acids essential for hair growth. This accounts for about 30% of hair loss in women but it can re-grow if the nutritional imbalance is corrected.

There is experimental data to show that high stress levels can increase levels of the hormone prolactin in women and this appears to influence the uptake of testosterone and its metabolism. This can lead to thinning of the hair by varying degrees.

Stress can also cause narrowing of the arteries, restricting blood flow to the scalp. This can induce a temporary shedding of hair in the short term or a permanent loss if the condition continues.

Stress can show itself in different ways in different people but the most common symptom is excess hair loss. There are ways to stop this type of hair loss. The first rule is “don’t panic if you experience a heavy hair fall” This in itself will create more stress which in turn will cause more hair fall.

 

Hair Loss Due to Breakage

Hair becomes dry and brittle when there is loss of moisture. This usually leads to the hair splitting and breaking. Causative agents are usually poor chemical treatments i.e. perming, bleaching, colouring, although ill health can also be the cause.

If breakage of the hair shaft is suspected it is important to see a Hair Expert who will carry out a microscopical analysis to determine the true cause.