Hair Loss in Women
Although many people think that hair loss occurs mostly in men, it actually affects many women, too. In fact, it’s estimated that 40–50% of women experience some hair loss during their lifetime. While it’s normal to lose about 50 to 150 hairs each day, losing larger amounts of hair is not. The medical term for abnormal hair loss is alopecia.
Depending on the cause, alopecia may be temporary or permanent. It’s more common in people over age 40 and is more likely to affect Black and white women than other races. Causes of hair loss include genetics, stress, medications, and conditions such as psoriasis.
Thinning hair & other symptoms
The pattern of hair loss you have often depends on the underlying cause. Some conditions trigger hair loss only on your scalp, but others can affect other parts of your body. Hair loss types may be irregular and patchy, more widespread all over the scalp, or it may occur in a particular pattern.
Three types of hair loss
Hair loss is classified into three different groups:
This is the most common type of hair loss in women. It’s typically reversible. Types include:
- Female pattern hair loss: This is the most common type of alopecia. It causes hair loss in the front and top of your scalp, often causing the part in your hair to widen. Female pattern hair loss is more common in older women. Doctors use the Ludwig scale to categorize the amount of hair loss you have at your part and front of your scalp. It ranges from I (noticeable thinning on the top of your head) to III (full baldness of the crown).
- Traction alopecia: Hair loss occurs in areas where there is excessive tension on the hair follicles, typically from certain hairstyles, such as tight ponytails and braids.
- Alopecia areata: This is an autoimmune disease in which your immune system attacks your hair follicles, causing hair loss. It occurs in patches on the scalp and sometimes all over the body.
- Telogen effluvium: This develops when many hair follicles shift from the growth phase of the hair cycle (anagen phase) to the resting phase (telogen), causing widespread, significant hair loss. It can happen to women with certain nutritional deficiencies or restrictive diets, after childbirth, during periods of high physical or emotional stress, or from taking certain medications.
- Skin conditions that cause inflammation of the scalp, such as psoriasis, can also cause alopecia.
Inherited and structural hair disorders
These affect the integrity of your hair and can make it more fragile, leading to thinner hair and breakage. Genetically inherited hair disorders typically do not get better, but structural hair disorders may improve when you modify your hair care. Examples include:
- Trichorrhexis nodosa: This is a common hair problem in which the protective outer layer of your hairs (cuticles) become damaged, causing breakage. It may be inherited or caused by excessive chemical and heat exposure to the hair (perms, blow-drying, etc.). In some cases, it’s caused by a disorder, such as hypothyroidism, or deficiencies in iron and biotin.
- Trichoptilosis (split ends): This is damage to the ends of your hair. It can be caused by extreme weather exposure, chemical and heat damage, and teasing or harshly combing wet hair.
- Genetic disorders: Hair that breaks easily is also a symptom of certain genetic disorders, including Menkes disease, trichothiodystrophy, and trichorrhexis invaginata.
This group of rare disorders cause permanent hair loss from inflammation and scarring of the scalp. Conditions include:
- Cicatricial centrifugal cicatricial alopecia (CCCA): This causes hair loss at the top and sides of the scalp. It most commonly affects Black women.
- Discoid lupus erythematosus: This is an autoimmune disease that can cause circular patches of inflammation on the scalp, leading to scarring and hair loss in some women.
- Secondary cicatricial alopecia. You may develop this if you have scarring on your scalp from skin cancer, or had radiation therapy on your head/neck or surgery on your head.
What can cause women to lose hair?
“Try not to use heat on your hair without heat protectants; limit how often you do tight ponytails, braids, or other tension-creating hairstyles; avoid roughly combing your hair when wet or teasing it frequently; and decrease how often you do chemical treatments or apply other harsh hair treatments. Some of my patients have noticed an improvement in their hair health and volume with just some simple changes.”—Dr. Priyanka Gimbel
Why is my hair falling out?
There are several reasons why you may lose an abnormal amount of hair. See your dermatologist or primary care doctor to determine the cause. Some of the more common reasons for hair loss in women include:
- Older age
- Certain medications, such as some antibiotics, mood medications, acne medications, etc.
- Chemotherapy and radiation to the head/neck
- Recent childbirth
- Stress or illness
- Frequent harsh hair treatments
- Tight hairstyles that pull on your scalp
- Polycystic ovarian syndrome (PCOS)
- Scalp infections or inflammation
- Pulling your hair
- Thyroid disease
- Nutritional deficiencies, such as too little biotin, zinc, protein, or iron
What causes hair loss in Black women?
Black women can be at risk for traction alopecia, which is when certain hairstyles place excessive tension on the hair follicle. Braids, weaves, extensions, and dreadlocks can all cause it.
To decrease this type of hair loss, see a professional stylist who is knowledgeable about these hairstyles and ask them to create loose braids or dreadlocks. To decrease stress on your hair, consider removing extensions, weaves, and braids after 2 to 3 months; limiting the use of hot tools (such as curling irons or flat irons); and avoiding chemical treatments.
Central centrifugal cicatricial alopecia (CCCA) is another type of hair loss that is more common in Black women. Unlike traction alopecia, it can cause scarring and permanent hair loss.
In women with CCCA, hair loss starts at the top of the head and spreads outward. The scalp often looks shiny from the loss of hair follicles. Many women with CCCA have tenderness and itching on the scalp where the hair loss occurs.
Its cause is unknown, but experts believe that one culprit may be a mutation of a gene that helps form the hair shaft. Using certain hair care tools and treatments may also lead to CCCA, but this has not been proven.
What are the best treatments for hair loss in women?
“Rogaine or a hair transplant are not the only forms of treatment. Depending on your type of hair loss, your doctor may recommend certain medications, steroid injections, laser treatments, or other procedures.””—Dr. Gimbel
How to regrow thinning hair
The most effective treatment for hair loss depends on what caused it, so it’s best to talk to your doctor or dermatologist to get the correct diagnosis. In some cases, such as in postpartum hair loss, no treatment may be needed, since hair often regrows on its own.
Keep in mind that it may take weeks or months before you notice a difference, so be patient and work with your doctor to find alternative solutions if the treatment isn’t helping.
Minoxidil (Rogaine): Minoxidil is the recommended treatment for female pattern hair loss, and may also be used to treat alopecia areata, telogen effluvium, and some types of scarring alopecia. Minoxidil increases blood flow to the hair follicles and stimulates hair growth.
Minoxidil is available over the counter as a topical foam or solution. Women should use it 1 to 2 times a day for at least 3 to 6 months to get the best results. Once you stop using it, you may start losing hair again.
You shouldn’t use minoxidil if you’re pregnant or breastfeeding. The most common side effects are redness and itching of the scalp. If minoxidil comes in contact with other parts of your body, it can cause hair growth in those areas, so make sure to apply it only on the scalp. Immediately rinse any other areas it may have touched.
Spironolactone: This stops hair loss and increases hair thickness by decreasing male hormones (such as testosterone), which can lead to hair loss. Spironolactone may help women with PCOS, which causes excess testosterone. It’s effective in about 30–40% of women who take it. Expect it to take 6 months before you see noticeable changes.
Spironolactone can cause electrolyte abnormalities (such as high potassium) and can lower blood pressure, so your doctor will likely monitor these closely while you take this medication. You should avoid becoming pregnant while taking spironolactone because it can cause birth defects. Talk to your doctor about contraceptive options and what to do if you become pregnant.
Vitamins and supplements
Zinc, biotin, or iron supplements: You should only use these supplements after talking to your doctor because taking too much of them can be harmful. If tests reveal any deficiencies, your doctor will recommend taking a certain dosage to help with hair loss.
Multivitamins: Taking a regular multivitamin is generally safe, but be wary of supplements that boast about improving hair growth. They tend to have higher than normal levels of certain vitamins or minerals and may be harmful.
Can taking vitamins stop hair loss in women?
“In some cases, deficiencies in zinc, biotin, or iron may be contributing to hair loss, but this is not always the underlying cause and taking excessive supplementation can actually cause more harm than good. Make sure to speak to your doctor to determine the cause of hair loss or thinning and the best treatment.”—Dr. Gimbel
Steroid injections: A dermatologist injects steroids into areas of hair loss to reduce the inflammation that can interfere with hair growth. It’s done every 4 to 8 weeks as needed. It’s the most effective treatment for alopecia areata and may also be used for women with discoid lupus erythematosus. Many people notice improvement after about 3 months of treatments.
Side effects include scalp irritation that may lead to a rash, thinning skin on your head, and a red or puffy face.
Laser treatments: Laser treatments may stimulate hair growth in people with certain types of hair loss, including hereditary hair loss, alopecia areata, and hair loss caused by chemotherapy. Treatments are painless and considered safe. They are often needed a few times a week for several months before hair growth becomes noticeable.
Platelet rich plasma (PRP): Your doctor draws some of your blood, separates the platelets (clotting factors) from the other components of the blood, and then injects them into areas of hair loss. It’s a very quick procedure that’s done about once a month at first and then once every few months. PRP helps slow hair loss and may cause hair to grow back thicker. Studies suggest it can be helpful for people with female pattern hair loss and alopecia areata.
Hair transplant: A hair transplant is performed by a specially trained dermatologist. Typically, the best candidates for this surgery are women with a defined area of hair loss, such as from a surgical scar, burn, or trauma; women with traction alopecia; and some women with female pattern hair loss. Women with diffuse hair thinning or hair loss are not good candidates.
During the surgery, the doctor first injects numbing medication into the scalp, and then transfers healthy hair from certain parts of your scalp to areas where there is hair loss.
You will likely have some pain for a couple of days following the procedure. Your doctor may recommend over-the-counter or prescription pain medications. Some people are able to return to work in 2 to 3 days, but you should wait 2 to 3 weeks before doing more vigorous activity such as exercise and sexual intercourse.
In the first few weeks after surgery, you may notice hair loss or thinning—this is normal. Regrowth is typically seen within about 6 to 9 months after the surgery. Your doctor may also want you to take medications to help with hair growth.
Risks of a hair transplant include bleeding, infection, scarring, and unnatural-looking hair growth.