Hair Loss in Women
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 men, 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.
The Ludwig scale for female pattern hair loss.
Why Do I Notice a Sudden Increase in Hair Loss?
Female pattern hair loss 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.
What Causes Telogen Effluvium?
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. 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.