The Causes of Hair Loss in Women

Women's Hair LossAre you suffering from the effects of thinning hair?

Women’s hair loss is relatively common with about 25% – 40% of women experiencing at least some degree of thinning hair in their lifetime.  Although most of the time the loss is very gradual it does speed up during pregnancy and menopause.  With some creative styling and a good can of hairspray the underlying area can be concealed quite effectively.  This is because female hair loss tends to be diffused, which means less hair all over, as opposed to excessive loss in one spot.  Women also rarely loose the hair in their frontal hairline, which makes it easier to mask the effects of thinning hair.

But don’t think this makes it any easier on them.  The psychological effects of hair loss can be significant, and many women are emotionally affected even when thinning is in its very early stages.  This is due, in part, to the assumption that few women lose their hair and female hair loss is socially unacceptable.  To add to the problem, the widely used medication Propecia is not indicated for women, so there is a perception that medical progress in treating female hair loss is not as advanced, or that the medical community does not take the treatment of female hair loss as seriously.  Lastly, because hair loss in women can so often be disguised with existing hair, many women choose to hide their hair loss from others. Not sharing their problem tends to isolate them and makes the ability to deal with their hair loss more difficult.

What’s a gal to do?

Well, first, you need to understand that there are many more reasons women to lose their hair than men.  A good place to start is with your doctor.  Get a complete physical to see if there is an underlying medical condition which may be a contributing factor.  If one is found and treated, the hair loss can often be reversed.  Beyond that it is good to know the classifications of hair loss so that you will have a better understanding of the issues involved.

The medical community has created three different categories of hair loss causes.  The are:

Localized Hair Loss

Although there are a host of dermatologic conditions that can cause hair loss, they produce a pattern that is different from the diffuse thinning seen in female pattern balding.  The following are the more common causes of local alopecia.  A dermatologist should be consulted if any of these conditions are suspected.  (Please note: the term alopecia is synonymous with hair loss.)

Scarring from injuries, local medical problems, or dermatologic conditions such as Lupus, Lichen Planus, or radiation therapy can cause balding.

Alopecia Areata is a genetic, auto-immune disease that is identified by the sudden appearance of discrete, round patches that are completely devoid of hair.  Occasionally, the entire scalp may be involved (alopecia totalis) and even the entire body hair including the eyebrows and eyelashes (alopecia universalis).  It can be treated with local injections of steroids.  Generalized alopecia is more difficult to treat.  The prognosis is better the older the age of onset.  Alopecia areata can sometimes be associated with other conditions such as thyroid disease.

Hairstyles that exert constant pull on the hair, such as “corn rows” or tightly woven braids produce a characteristic pattern called “Traction Alopecia” that can be identified by a rim of thinning or baldness along the frontal hairline and at the temples.  This is easily prevented by changing one’s daily hair-care habits, but once the hair loss occurs, it may be permanent.

Trichotillomania, or Traction Alopecia, is a condition seen more commonly in young females where the person twists, tugs or pulls out her hair. This can be scalp hair, eyebrows or eyelashes.  The hair loss can also be permanent if the habit persists for a long period of time. The diagnosis is made by observing short, broken hairs in the area of hair loss.

Face-lift and brow-lift procedures commonly result in hair loss in the vicinity of the incision, such as along the frontal hairline, in the temples, or adjacent to a surgical scar.

Tinea Capitis is a fungal infection of the scalp. It appears as irregular, red and scaly patches and/or small bald patches with broken hairs. The diagnosis is made by scraping a small piece of scale from the scalp and obtaining a bit of hair for testing. The specimens are sent for special fungal stains and cultures.

Pseudopalade is a non-specific scarring alopecia that generally starts on the top of the scalp and extends into the surrounding hair bearing areas with finger-like extensions. The areas look smooth and white due to the scarring and loss of hair follicles.

Lichen Plano-pilaris is an inflammatory condition of the scalp that presents with redness, scale and localized areas of hair loss. There is a characteristic scaling at the edge of each balding patch.

Discoid Lupus Erythematosus (DLE) is the localized form of Systemic Lupus Erythematosus (SLE), a potentially serious autoimmune disease. It appears as red, scaly, pigmented patches of scarred skin and is mostly a cosmetic problem, but patients must be evaluated for the systemic disease as well with specific blood tests such as an ANA.  Systemic Lupus Erythematosus can cause diffuse (generalized) hair loss and both the local and systemic forms of the disease may cause sensitivity to the sun.

Patterned Hair Loss

Women with this type of hair loss have a pattern similar to what is seen in men.  The thinning occurs in the front or on top of their scalp with little hair loss around the back and sides of the head.  Thus, the balding is in a characteristic “pattern” rather than generalized.

Diffuse Hair Loss

A third category of hair loss in women is a generalized thinning that affects all parts of the scalp.  This is the most common type and is most often hereditary, but it can also be caused by underlying medical conditions, medications, and other factors.  In this situation, much of the hair remains, but the thickness of the hair shaft is smaller than normal hair.  The medical term for this type of thinning is “Diffuse Unpatterned Alopecia”.  These women have a relatively large area that has been subjected to thinning.

Common or “hereditary” baldness in women, also called female pattern alopecia, is genetic and can come either the mother’s or father’s side of the family.  It is caused by the actions of two enzymes; aromatase (which is found predominantly in women) and 5-a reductase (which is found in both women and men).

The action of 5-a reductase is the main cause of androgenetic alopecia in men, as this enzyme converts the hormone testosterone to DHT.  DHT is responsible for the miniaturization (shrinking) and gradual disappearance of affected hair follicles.

Women have half the amount of 5-a reductase compared to men, but have higher levels of the enzyme aromatase, especially at their frontal hairline.  Aromatase is responsible for the formation of the female hormones estrone and estradiol.  It also decreases the formation of DHT.  Its presence in women may help to explain why the presentation of female hair loss is so different than in males, particularly with respect to the preservation of the frontal hairline.  It may also explain why women have a poor response to the drug finasteride (Propecia), a medication widely used to treat hair loss in men that works by blocking the formation of DHT.

Women’s hair seems to be particularly sensitive to underlying medical conditions.  Since “systemic” problems often cause a diffuse type of hair loss pattern that can be confused with genetic balding, it is important that women with undiagnosed hair loss, be properly evaluated.

Medical conditions that can cause diffuse hair loss in women

  • Obstetric and gynecologic conditions such as post-partum and post-menopausal states or ovarian tumors
  • Anemia – iron deficiency
  • Thyroid disease
  • Connective tissue diseases such as Lupus
  • Nutritional – crash diets, bulimia, protein/calorie deficiency, essential fatty acid or zinc deficiency, malabsorbtion, hypervitaminosis A
  • Stress – surgical procedures, general anesthesia, and severe emotional problems

A relatively large number of drugs can cause “telogen effluvium,” a condition where hair is shifted into a resting stage and then several months later shed.  Fortunately, this shedding is reversible if the medication is stopped, but the reaction can be confused with genetic female hair loss if not properly diagnosed.  Chemotherapy causes a diffuse type of hair loss called “anagen effluvium” that can be very extensive, but often reversible when the medication is stopped.

Drugs that can cause diffuse hair loss in women

  • Blood thinners (anti-coagulants), such as warfarin and heparin
  • Seizure medication, most commonly dilantin
  • Medication for gout, colchicines and alopurinol (Xyloprim)
  • Blood pressure medication, particularly the b-blockers (such as Inderal) or diuretics
  • Anti-inflammatory drugs such as prednisone
  • Medications that lower cholesterol and other lipids
  • Mood altering drugs – lithium, tri-cyclics, Elavil, Prozac
  • Chemotherapy
  • Thyroid medications
  • Oral contraceptive agents, particularly those high in progestins
  • Diet pills
  • High doses of Vitamin A
  • Street drugs (cocaine)

Once you understand what is causing your hair to thin you will be able to create a course of action to reverse it.

Additional Information

12 Responses to “The Causes of Hair Loss in Women”

  • Jeni from Hair Loss Hell:

    Female hair loss is a nightmare! I’ve been to probably 10 doctors over the past 10 years, and they are still confused what’s going on in my case. I have diffuse hair loss that has progressively gotten worse over the years – esp. the last few months.

  • I get my hair braided and it can be very tough on the hairline and the temples. You can’t keep picking at it and try not to have the braids too tight around the hairline. Also, don’t yank too hard on the braids when styling.

  • Always check you meds for side effects. Those can definitely cause hair loss.

  • Just want to ask, does using shampoo everyday can cause hair loss? Is just that shampoo’s are made up of many chemicals as an ingredient such as Sodium Lauryl Sulfate (SLS) which I’ve heard have been singled out as the offending culprit for hair loss is there a significant true with this?

  • hair care:

    Maintain your look by visiting your professional stylist every 4–6 weeks. You will keep your split ends from ruining the texture of your do and touch up grown-out roots. Don’t abandon your hair. Revive it with a clean, gleaming look. Your hair is your crown. Let Major Salons hair care make your locks shine like precious jewels.

  • Hair loss in Women is something that is commonly not known but it happens and it is a problem for those who experience this. As you mentioned cocaine is causing it as well. Another reason for not taking drugs at all.

  • It’s interesting that “stress” is often not considered when discussing the causes of hair loss.

  • laura from HairLossTreatment:

    I find that I suffer from Hair loss through stages. It tends to come when I am stressed, change of season or feeling hormonal. Chunks will come out when I am in the shower and brush my hair. At first his really stressed my out even more, and made me quite afraid as I was only 19 when it first happened.

    I realised I was over doing it, working 2 jobs and not eating proper meals. When I went on a long backpacking trip the hair loss stopped and my hair grew back.

    I now know when I start loosing hair that I need to readjust my lifestyle as my body is obviously not healthy or happy.

  • I thought that I excersised enough and ate well. I don’t really know that much about lower cholesterol diets or medications so I appreciate this article being here!

  • With the daily grind of long work hours, having to give time to the kids and partner and the rest of your family it’s no surprise that the resultant stress, tiredness, eating on the go, menopause etc have an effect on the body including womens hair. Guys can just about get away with hair loss but for women it’s still very much a stigma. Sad but true…
    .-= thinning hair women´s last blog ..Hair Loss Solutions – Know About the Possible Solutions =-.

  • Hair loss in Women is something that is commonly not known but it happens and it is a problem for those who experience this. As you mentioned cocaine is causing it as well. Another reason for not taking drugs at all.
    .-= Nicky@Massachusetts drug rehab centers´s last blog ..Drug Rehab – Pennsylvania =-.

  • I’ve always found it interesting that as we age, we both lose hair in some places and gain hair in others. And a lot of times, it’s related to exact same hormonal changes, e.g., changes of androgenic hormones, which happens in both men and women.

    I agree with you that one of the first steps is to visit a doctor or medial specialist (an endocrinologist is a doctor specializing in hormones).