There are numerous reasons why women might experience hair loss. Anything from medical conditions to hormonal changes to stress may be the culprit. It’s not always easy tracing the root cause, but here are some of the possibilities and what you can do.
Hair loss may present in different ways depending on the cause. You may notice sudden hair loss or a gradual thinning over time. It may be helpful to keep a diary to track any changes you notice or symptoms you experience, and to look for patterns.
Certain signs include:
- Overall thinning. Gradual thinning on the top of the head is the most common type of hair loss. It affects both men and women. While men tend to see a receding hairline, women generally notice that their part broadens.
- Bald spots. They may be circular or patchy. They may resemble coins in size and usually appear on the scalp. Your skin may even feel itchy or painful immediately before the hair falls out.
- Handfuls of hair. You may experience very sudden hair loss, particularly after emotional or physical trauma. The hair may come out quickly while you’re washing or combing it, leading to overall thinning.
- Full loss. In some medical situations, particularly with medical treatments like chemotherapy, you may notice hair loss suddenly and all over your body at once.
Next we’ll look at major types of hair loss and causes.
Alopecia simply means “hair loss.” It’s not contagious or attributed to nerves. There are a variety of types caused by anything from genetics to hair care practices or anything that triggers the immune system to attack hair follicles.
- Androgenetic alopecia is female-pattern baldness or hair loss caused by genetics, or family history. It’s the leading cause of hair loss in women and generally begins between the ages of 12 to 40 years old. While men tend to notice balding as a receding hairline and specific bald spots, women’s hair loss appears more as overall thinning.
- Alopecia areata is patchy hair loss that happens suddenly on the head or body. It typically begins with one or more round bald patches that may or may not overlap.
- Cicatricial alopecia is a group of conditions that causes irreversible hair loss through scarring. Hair falls out and the follicle is replaced with scar tissue.
- Traumatic alopecias cause hair to fall out as a result of hair styling practices. The hair shaft may break after using hot combs, blow dryers, straighteners, or certain chemicals to dye or straighten hair.
Some medical conditions lead directly to hair loss, whether through disruption to hormones, like with thyroid issues; scarring from skin conditions, like ringworm; or autoimmune disorders, like celiac disease, where the body attacks itself.
Conditions that may lead to hair loss include:
- Hodgkin’s disease
- Hashimoto disease
- systemic lupus erythematosus
- Addison’s disease
- celiac disease
- Lichen planus
- trichorrhexis invaginata
Learn more about conditions that cause hair loss.
Other symptoms that help with diagnosis
You may also experience a range of other symptoms if your hair loss is caused by an underlying condition.
- Hypothyroidism may cause anything from fatigue to weight gain, muscle weakness to joint swelling.
- Ringworm may cause scaly and painful gray or red patches on the scalp.
- Celiacdisease may cause anything from mouth ulcers to headaches, skin rashes to anemia.
- Hodgkin’sdisease may cause symptoms like fever, night sweats, and swelling of the lymph nodes.
Your doctor will take into account the other symptoms you’re experiencing besides hair loss to help pinpoint the cause. This may involve anything from a physical examination to blood tests to scalp biopsies.
Some conditions, like celiac disease, may be genetically inherited. If you have a family history of a condition that leads to hair loss, be sure to mention it to your doctor.
Women may experience hair loss during menopause due to reduced production of the hormones estrogen and progesterone. These changes also lead to symptoms like menstrual cycle irregularity, dry skin, night sweats, weight gain, and vaginal dryness. This added stress on the body may also worsen hair loss.
Some women may even notice thinning and loss after going off hormonal birth control pills. Why? Again, hormonal changes of any kind, particularly falling estrogen levels, can temporarily disrupt the hair lifecycle.
If you’ve been under emotional or physical stress, it may lead to hair loss. Things like a death in the family, major surgery, or a serious illness may cause the body to shut down certain processes like hair production.
There’s around a three-month delay between when a stressful event happens and when you might see hair loss, so you may not pinpoint the trigger right away.
However, if you are experiencing thinner hair, consider different events or situations in your life that may have caused you considerable stress. Hair loss due to stress is generally temporary. Hair may begin growing again after the event has passed and the follicle starts producing again.
The second most common cause of hair loss is called telogen effluvium (TE). It’s temporary and happens when there’s a change in the number of follicles that grow hair and are in a resting state.
For example, women may lose hair in the months after childbirth or another stressful event. You can sometimes identify TE hair loss by looking at the strand. Telogen hairs have a bulb of keratin at the root.
TE is generally caused by anything that may shock the body and disrupt the hair lifecycle. There may be a considerable delay — up to three months — before you notice the effects of the change.
Possible triggers of TE hair loss:
- high fever
- serious infection
- chronic illness
- emotional stress
- crash diets, lack of protein, eating disorders, and so on
Taking certain medications, like retinoids, beta blockers, calcium channel blockers, antidepressants, and nonsteroidal anti-inflammatory drugs (NSAIDS) may also lead to TE. The good news is that this type of hair loss is typically reversible, and eventually the TE hairs will start growing again on the scalp.
Lacking certain vitamins and minerals may also lead to thinning hair or hair loss in women. Some dermatologists believe that not eating enough red meat or following a vegetarian diet may affect hair loss.
Red meat and other animal foods are rich in iron, a mineral that supports hair and body growth. Women are already prone to iron deficiency due to blood loss during menstruation, so not taking in enough iron in the diet may lead to deficiency.
Eating disorders, like anorexia nervosa, may also lead to vitamin deficiencies and thinning hair. In particular, deficiencies thought to affect hair include those in zinc, amino acid L-lysine, B-6, and B-12.
Hair loss caused by stress or hormonal changes, like pregnancy or menopause, may not require any treatment. Instead, the loss will likely stop on its own after the body adjusts.
Nutrient deficiencies also don’t often require medical treatment beyond supplements, unless the deficiency is caused by an underlying health condition. And any medical conditions that lead to hair loss should be treated directly to address the full condition, not just its symptoms.
That said, there are a number of possible medications and treatments for hair loss caused by female-pattern baldness and other alopecias. You may need to use one or a combination of treatments for months or years to see the full results.
Minoxidil is an over-the-counter (OTC) drug that comes in liquid and foam forms for topical use. It’s meant to be rubbed on the scalp daily and usually needs to be used long-term for months and years to effectively prevent hair loss and promote hair growth.
While not used as widely as in previous years, hormone replacement therapy can be a treatment for androgenic alopecia. It focuses on supplying the hormone estrogen to support a woman’s decreasing levels. Minoxidil is more effective, so it has taken over as the treatment of choice.
Women in their childbearing years should speak with their doctor if they take this medication and wish to also take oral contraception. They may need to choose a pill with the least progestin, like Ortho Tri-Cyclen.
Otherwise known as Aldactone, the drug spironolactone works to treat hair loss by addressing hormones. Specifically, it binds to androgen receptors and decreases the body’s processing of testosterone. Not all researchers agree that it works effectively and the Food and Drug Administration (FDA) has not labeled it as a treatment for androgenic alopecia.
Topical tretinoin, also known by the brand name Retin-A, is sometimes used as a combination therapy with minoxidil for androgenic alopecia.
It’s important to use this type of medication under the guidance of your doctor. Some people who have used it at home report that topical retinol creams, serums, and lotions may make hair loss worse.
Women with hair loss due to alopecia areata may consider treatment with corticosteroids injected at multiple sites in the affected area. Hair growth may be noticeable in as soon as four weeks, and treatment can be repeated every four to six weeks. Side effects with injections include skin atrophy or a thinning of the scalp.
Topical corticosteroids are also available, but they aren’t necessarily as effective. And oral corticosteroids may lead to unpleasant side effects.
In women with alopecia areata, anthralin is both safe and effective. It can be applied at home, once a day, starting with just five minutes and working up to periods as long as an hour.
After application, the scalp should be rinsed with cool water and cleaned with soap. New hair growth may sprout up in two to three months.
Some hair loss treatments are specifically more effective for women than men, and some, like finasteride, are not advised for women.
Finasteride (known by the brand name Proscar) is a drug used for alopecia in men. Finasteride is not recommended for use in women especially those of reproductive age because it may cause issues with fetal growth and development.
It’s also considered an unsuitable choice for postmenopausal women.
In hair transplant surgery, pieces of scalp with the hair attached are typically taken from one area of the scalp and moved to areas of baldness.
Hair transplants aren’t common treatments for female pattern baldness because of the way hair loss usually presents itself in women: dispersed hair loss and less volume rather than concentrated bald spots.
There are also risks, including infection or shock that can causes hair to fall out of the transplanted areas. And surgery may not help large areas of baldness.
If you notice or suspect you’re losing more hair than you should, figuring out the cause and starting on treatment sooner than later is best.
While over-the-counter medications like minoxidil may help address certain types of hair loss, because other health conditions can cause hair loss it’s important to consult a doctor.
Speak to a family doctor or dermatologist about your symptoms so that they can diagnose the cause of your hair loss and come up with a treatment plan with you.