Hair Loss in Women

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:

Non-scarring alopecia

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.

Cicatricial alopecia

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.

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:

• Genetics
• 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.

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.

Medications

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.