Alopecia, or hair loss, affects about one-third of women at some point in their lives. After menopause, as many as two-thirds of women have thinning hair or bald spots. Women often feel worse about losing their hair than men do, because it’s less socially acceptable for women. Alopecia can hurt a woman’s emotional health and quality of life in a big way.
The most common type of hair loss in men and women is the same. It’s called female (or male) pattern hair loss or androgenetic alopecia. Men’s hair loss usually starts above the temples, and as the hairline recedes, it forms an “M” shape. The hair on top of the head also thins, and most men eventually go bald. In women, androgenetic alopecia starts with gradual thinning at the part line. Then, hair loss spreads out from the top of the head and becomes more diffuse. Rarely does a woman’s hairline recede, and women rarely lose all of their hair.
Many things, like medical conditions, medications, and physical or emotional stress, can cause hair loss in women. If you lose hair in a way that isn’t normal, you should see your primary care provider or a dermatologist to find out why and what to do about it. You may also want to ask your doctor or nurse for a referral to a therapist or support group to help with your feelings. Losing hair can be frustrating for women, but in recent years there have been more ways to deal with it.
Patterns of Female Hair Loss
Clinicians use the Ludwig Classification to explain why women lose their hair in a certain way. Type I is a small amount of thinning that can be hidden by how you style your hair. Type II is marked by less volume and a noticeable widening in the middle. Type III is a general thinning that makes the top of the scalp look transparent.
How Does Androgenetic Alopecia Happen?
Female pattern hair loss happens to almost every woman at some point. It can start at any time after puberty, but most women notice it around the time of menopause when hair loss gets worse. The risk goes up with age, and it’s higher for women whose parents or grandparents had hair loss.
Androgenetic alopecia, as the name suggests, is caused by the hormones called androgens. Androgens are important for normal male sexual development and have other important roles in both men and women, such as controlling sex drive and hair growth. The condition may be passed down from parent to child and involve more than one gene. It can also be caused by an endocrine problem like too much androgen or a tumor on the ovary, pituitary, or adrenal gland that makes androgen. In either case, alopecia is probably caused by more androgens being in the body. But the exact role of androgens in androgenetic alopecia in women is harder to figure out than in men. When a woman has clear female pattern hair loss, it’s important to measure her androgen levels in case it’s caused by a tumor that makes androgen.
Androgenetic alopecia causes hair loss in both men and women because the hair’s growing phase, called anagen, gets shorter and it takes longer for a new anagen phase to begin after a hair falls out. This is caused by a person’s genes. (See “How a hair grows.”) That means it takes longer for hair to start growing back after it falls out during the normal growth cycle. The hair follicle also changes. It shrinks, which makes the hair shaft shorter and thinner. This is called “follicular miniaturization.” Because of this, “terminal” hairs, which are longer, thicker, and colored, are replaced by “vellus” hairs, which are shorter, thinner, and not colored.
How Hair Grows & Dies
Each hair grows from a follicle, which is a small pocket in the skin. Each hair grows in three stages. The active growth phase (A) lasts between two and seven years. The transitional phase, called catagen (B), lasts about two weeks. During this phase, the hair shaft moves up toward the surface of the skin, and the dermal papilla, which feeds the cells that become hair, starts to pull away from the follicle. The hair shaft falls out at the end of the Telogen (C) phase, which lasts about three months.
A doctor can tell if a woman has female pattern hair loss by asking about her health and looking at her scalp. She or he will look at the pattern of hair loss, look for signs of inflammation or infection, and may order blood tests to look into other possible causes of hair loss, such as hyperthyroidism, hypothyroidism, and iron deficiency. A hormonal evaluation is usually not needed unless there are signs of too much androgen activity, such as irregular periods, acne, or hair growth in places it shouldn’t be.
How to Stop Hair Thinning: Women Hair Loss Treatment Solutions
The most common way to treat hair loss in women is with medicine. These are some of them:
Minoxidil (Rogaine, generic versions). This drug was first made to treat high blood pressure, but people who took it noticed that hair started growing back in places where it had been lost. Studies showed that applying minoxidil directly to the scalp could make hair grow faster. Based on the studies, the FDA first let 2% minoxidil be sold over-the-counter to treat hair loss in women. Since then, when a stronger solution is needed for a woman’s hair, a 5% solution has also become available.
Minoxidil is not a miracle drug, that much is clear. Some, but not all, women can get fine hair to grow back, but it can’t make up for all the hair that was lost. It’s not a quick fix for women who are losing their hair, either. You won’t see results for at least two months after taking the drug. Most of the time, the effect peaks after about four months, but it could take longer, so plan on a six- to 12-month trial. If minoxidil works for you, you’ll need to keep using it to keep the results. If you stop, your hair loss will start up again.
Make sure your hair and scalp are dry before you use minoxidil. Use the dropper or spray pump that comes with the over-the-counter solution to put it on your thinning hair twice a day. Use your fingers to massage it into the scalp so it can get to the hair follicles. Then let your hair dry naturally, wash your hands well, and wash off any solution that gets on your face or forehead. Don’t shampoo again for at least 4 hours.
Some women find that the minoxidil solution leaves a residue on their scalp that dries it out and makes it itch. This irritation, called contact dermatitis, is probably not caused by the minoxidil itself, but by the alcohol that is added to help the hair dry faster.
Side effects and worries: Minoxidil is safe, but it can cause unpleasant side effects in addition to the skin irritation caused by alcohol. Sometimes the new hair is a different color and feels different than the hair around it. Hypertrichosis is another risk. This is when hair grows in the wrong places, like on the cheeks or forehead. (The stronger 5% solution makes this problem more likely.)
Since the patent on Rogaine, which was a brand name for minoxidil, has expired, many generic versions of minoxidil are now on the market. All of them have the same amount of minoxidil, but some have extra ingredients, like herbal extracts, that could cause allergic reactions in some people.
Anti-androgens. Androgens are hormones like testosterone and other “male” hormones that can make women lose their hair faster. For some women with androgenic alopecia who don’t get better with minoxidil, adding the anti-androgen drug spironolactone (Aldactone) may help. This is especially true for women with polycystic ovary syndrome (PCOS), who tend to make too many androgens. Women of childbearing age usually get spironolactone along with an oral contraceptive from their doctor. (A woman who takes one of these drugs shouldn’t get pregnant because they can cause birth defects in a boy’s genitalia.) Some of the possible side effects are weight gain, loss of libido, depression, and feeling tired all the time.
Iron supplements. Some women might lose their hair because they don’t get enough iron. If you are a vegetarian, have a history of anemia, or have heavy periods, your doctor may check your blood iron level. If you don’t have enough iron, you’ll need to take a supplement, which may stop your hair from falling out. But if your iron level is normal, taking extra iron won’t help. Instead, it will make you sick to your stomach and make it hard to go to the bathroom.
Hair Transplantation
In the United States, hair transplantation has been used to treat androgenic alopecia since the 1950s. During this procedure, a strip of the scalp is taken from the back of the head and used to fill in a bald spot. Follicular unit transplantation is a method that has been used by 90% of hair transplant surgeons since it was first used in the mid-1990s.
During this procedure, surgeons cut out a thin strip of scalp and cut it into hundreds of tiny grafts, each with just a few hairs. Each graft is placed in a cut made on the scalp in the area where hair is missing with a blade or needle. This is how hair grows on its own, in small groups of one to four follicles. These groups are called follicular units. So, the graft looks better than the bigger “plugs” that used to be used in hair transplants.