Hair Loss in Women

 

Female Hair Loss Singapore

Difference Between Male and Female Pattern Hair Loss

The term ‘androgenetic alopecia’, used to describe hair loss in women, was recently abandoned for a more appropriate name: female pattern hair loss. This highlights the complex nature of treating a woman with hair loss conditions.

Although excess androgen (male hormone) and genetic predisposition (family history) contribute to female pattern hair loss (FPHL), there are many other significant factors, including:

  • Nutritional status – special diets e.g. weight loss crash diets, vitamin D deficiency
  • Hormonal changes – pregnancy, contraceptive hormone pills
  • Stress – can elevate cortisol levels and reduce melatonin levels, both related to hair loss
  • Medications – certain painkillers, anti-depressants, some anti-convulsants, some blood pressure medications

While a scalp examination shows the same miniaturisation* process as that seen in male hair loss, women tend to lose hair in different areas.

*Miniaturisation is the phenomenon of a hair shaft getting progressively shorter, finer and less pigmented due to long-term damage from androgens (male hormones also found in women)

The Ludwig Scale

In female pattern hair loss, you’ll typically notice thinning most along the natural parting of the hair. As the condition progresses, further thinning occurs in an outward pattern, as seen in the Ludwig scale.

As there are many contributing factors to female hair loss, we’ll take a detailed medical history, conduct a physical examination, and carry out a few special tests on the hair and scalp. These include a test for hair breakage and gauging how many hair follicles are in a resting/shedding phase.

We’ll also carry out blood tests to assess certain hormonal, nutritional, inflammatory and metabolic processes in the body.

This detailed evaluation will help not only with treating your condition aesthetically, but also correcting the underlying cause of hair loss, allowing you to maintain and improve the quality of the currently remaining hairs.

Ludwig Classification System

The Ludwig scale for female pattern hair loss.

Why Do I Notice a Sudden Increase in Hair Loss?

Female hair loss in Singapore is most highly associated with a condition called telogen effluvium.

A normal hair follicle undergoes a cycle of growth, rest and shedding. The telogen phase is where the detached hair from the dermal papilla (base of hair follicle) sheds. In normal circumstances, 10 – 15% of hair follicles are in the telogen stage at any given time.

When you suffer from telogen effluvium, you have a higher proportion of telogen follicles. You’ll notice an even distribution of hair loss over the entire scalp and not just the parting line. You may even notice shedding when brushing your hair or clumps of hair in your shower floor trap.

A woman pulls hair out of a brush

What Causes Telogen Effluvium?

Most common causes for hair loss in women

Telogen effluvium can be caused by severe emotional or physical stress such as a recent major surgery, drugs that suppress the immune system, sudden changes in hormones (e.g. post-pregnancy hair loss) and physical damage to the hair follicles through the use of hair bleach or other unsanctioned scalp and hair treatments. The event that causes telogen effluvium often pre-dates the start of noticeable hair shedding by 2 – 4 months.

In most cases, by the time you notice significant hair loss, you may have already had a 50% decrease in hair volume. Female hair loss treatment would involve stopping further hair shedding, maintaining the current hairs that are not in the telogen phase and increasing the growth potential of the hair follicles that have just undergone shedding.

The first intervention is to immediately stop the cause of the effluvium where possible. Secondly, based on your doctor’s assessment, treatment may involve topical treatment, oral medication or infusions and in some extensive non-reversible cases, a surgical intervention. (Read more about female hair transplants here)

There are times that telogen effluvium resolves on its own without any treatment.

 

How Do I Know Which Type Of Hair Loss I Have?

Female Pattern Hair Loss (genetics)

Hair shedding remains relatively stable but may increase at early stages

Visible scalp along centre parting line

Each hair strand feel finer

Hair volume feels less

Parents, uncles, aunties may have the same condition

Telogen Effluvium (temporary)

Increased amount in daily shedding

E.g: in the shower, on the bed, when sweeping through with fingers

No visible spaces, hair loss is all over

No difference in strand thickness

Hair volume feels less

No obvious pattern in the family

 

Like any other organ in your body, there are different diagnoses when it comes to the hair organ and it would be a mistake to attempt female hair loss treatment without fully understanding your condition.

Female Pattern Hair Loss (also known as Androgenetic Alopecia in women) and Telogen Effluvium are the 2 most common types of hair loss in women. One often gets confused with the other.

Female Pattern hair loss affects many women and around 40% of women by age 50 show signs of hair loss and less than 45% of women actually reach the age of 80 with a full head of hair.

Female Hair Loss Treatment Options

Treatment for Female Pattern Hair Loss in Singapore differs according to how extensive one’s condition is. At the earlier stages, results from Regenerative Medicine have been seen to work positively in reversing the fine hairs, allowing more scalp coverage.

Oral medications and supplements are prescribed to maintain the positive effects. However, as this type of genetic hair loss is progressive, as it gets towards the later stages, a surgical intervention may be needed.

While this condition is caused by a genetic predisposition and worsens over time, Telogen Effluvium is temporary.

Main Causes

In Singapore, the most common external stressors we see in our female patients are work-related, big exams in children, crash diets, domestic problems and moving home.

Internal ones range from hormonal changes to the most common unknown and unnoticed Vitamin D deficiency.

While only 10% of the scalp hair is normally in the resting phase, this amount increases to 30% or more when Telogen Effluvium takes place.

The shedding typically occurs suddenly but approximately 3-6 months after a trigger. Telogen Effluvium that remains untreated for more than 6 months is considered chronic and may cause permanent hair loss. The best reversal is early diagnosis and treatment.

Do note that at times, these 2 conditions may overlap and that is why only a dedicated hair restoration doctor/specialist will be able to confirm your condition for you.

How Will The Doctor Determine My Condition?

Our doctor and specialist will start by…

  • Assessing your medical history & lifestyle e.g: diet, stress, sleep pattern
  • Discussing your symptoms
  • Assessing your family history of Androgenetic Alopecia

If your family history and symptoms point towards the direction of Androgenetic Alopecia, the next steps would be to…

  • Look at the condition of your scalp and hair and assess if spaces can be seen along the centre parting line.
  • Look out for hair strands that are finer and less pigmented compared to the surrounding ones using a follicular scope. There is usually a demarcation of weaker hairs within 1cm to the left and right of the parting line.

Using the Ludwig scale for Female Pattern Hair Loss our doctor will diagnose your condition according to the following stages.

Female Pattern Hair Loss

However, if they point towards Telogen Effluvium, we will… 

  • Carry out a “pull-test” . During a pull test, a clump of approximately 50-60 hair strands is gently tugged at and pulled firmly in an upward direction in 6 different areas of your scalp. If 10% or more of the hairs end up pulled free, then we have a positive pull test. The bulb of these hair strands are then looked at under a microscope to ensure they are the bulbs of resting hairs, which confirms Telogen Effluvium as a diagnosis.
  • We may perform a hair loss specific blood test to ensure you are not nutritionally deficient, where we deem it necessary.

5 Ways To Keep Your Hair Health In Check!

  • Ensure you eat a well balanced varied diet so that your hairs are not deprived of any nutrients such as iron, zinc and vitamin B12.
  • Get 10 mins of afternoon sun daily to ensure you get sufficient Vitamin D. Alternatively, you can take Vitamin D supplements.
  • Give your scalp a thorough cleanse with a clarifying hair loss shampoo daily.
  • Manage your stress well
  • Consult a hair loss expert or hair loss clinic when you notice an increased amount of shedding or a widened visible space along the centre parting line!

Questions? How can we help you today?
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