Hair Loss in Women

Causes of Hair Loss In Women

Hair loss patterns in women are typically different from those in men. Hair loss in women tends to be more diffuse than hair loss in men, but more typically male patterns do occur in some women. The more characteristic female pattern is diffuse thinning over a considerable area of scalp, or diffuse thinning in a “Christmas Tree” pattern over the central scalp. An advanced form of diffuse hair thinning is called diffuse unpatterned Alopecia.
In men, the most likely cause of hair loss is Androgenetic Alopecia, also known as male pattern hair loss. While Androgenetic Alopecia, an inherited condition, can also be a cause of hair loss in women it does not follow the patterns characteristic of Androgenetic Alopecia in men.

In general, there are three patterns of hair loss in female Androgenic Alo­pecia:

  1. Thinning hair on the central scalp
  2. Thinning hair and patches of greater scalp hair loss
  3. Male-pattern alopecia with hair loss at the front of the scalp to mid-scalp. However, female-pattern hair loss rarely progresses to the extensive balding characteristic of the most advanced patterns of hair loss in men.

Thus, although Androgenetic Alopecia is a frequent cause of hair loss in women, it is one of a number of causes to be considered. Some investigators believe that although male and female pattern hair loss both have ge­netic causes, different genes may be involved or the functioning of hair-loss genes may be different in men and women.

Conditions other than androgenetic alopecia that are frequent causes of hair loss in women include hormonal changes that may be associated with menopause. Hair loss may begin with onset of menopause and may be slowed with adequate medical management. Hypo and hyperthyroidism may cause hair loss and may be an early sign of thyroid dys­function, which could be halted or reversed when thyroid dysfunction is adequately treated. Polycystic ovarian syndrome, an inherited dysfunctional condition affecting the ovaries that occurs in some women in their reproductive years can also be linked to hair loss.

Often times, hair breakage can be mistaken for hair loss. Common causes of hair breakage include over treatment with hair straighteners, relaxers, permanent waving and frequent dyeing. Hair loss may occur as a result of plastic surgery that changes the configuration of the hairline. Hair transplantation is a successful solution to repairing hairline changes resulting from cosmetic surgery.

Hair styling that features corn-rowing or tight braiding can result in the condition called traction hair loss. Constant traction on hair follicles by tightly braided hair can damage hair follicles and eventually cause permanent hair loss. Hair loss may be halted or limited if tight braiding is abandoned as a hairstyle.

Unexplained hair loss may be due to conditions such as alopecia areata and telogen effluvium that require medical diagnosis. If hair loss is limited to one defined area of the scalp, a trial of minoxidil (Rogaine) may be worthwhile. If hair loss continues, consultation with a physician hair restoration specialist may be considered. Consultation can determine both the cause of hair loss and the best approach for treatment.

Lab Tests for Women’s Hair Loss

In order to make an accurate assessment of the causes of hair loss in women, extensive lab work should be completed. These tests consist of: blood count, tests for thyroid function, a urinalysis, a serological test for syphilis, and routine chemistry studies. Additional useful tests are: testosterone levels, sex hormone binding globulin (SHBG), dehydroepiandrosterone sulfate (DHEAS), androstendedione, lutenizing hormone, follicle-stimulating hormone (FSH), prolactin count, serum iron, total iron-binding capacity and ferritin levels.

There are also some additional supportive tests are available to evaluate or predict hair loss in women. These tests include:

Hair Pull Tests
Hair Density Test
The Daily Hair Loss Test
Hair Mount Test
Microscopic Trichogram Test

Female Hair Loss Classifications

Once the cause of hair loss in women is established, there are several classification scales available for female pattern hair loss. There is the Savin hair loss scale, but the most commonly used classification for women was defined by Ludwig in 1977.

Ludwig classification of female pattern hair loss:

Grade 1: Thinning of the hair in crown area, but the frontal hairline is preserved.

Grade 2: The crown thinning is advanced to the mid scalp, but the frontal hairline is preserved.

Grade 3: Advanced hair loss in the front, the mid scalp, the crown and the frontal hairline is not preserved.

Advanced Ludwig: A woman with extensive hair loss and little to no surviving hair in the alopecia affected area. This stage is very uncommon, and not that many women reach this stage. If a woman is in this stage then they may have a condition that causes significant, abnormally excessive androgen hormone production


Non-Surgical Treatment Options for Women

Each treatment option is customized to the patient’s cause of hair loss, concerns and needs. Not all women are good candidates for hair transplantation. Factors that most frequently rule out hair transplantation for women are diffuse thinning over a large area of scalp, where there is not enough donor hair to carry out acceptable hair transplantation.

Women who are NOT good candidates for hair transplantation may consider a series of oral and topical medications that have been used to treat hair loss in women such as the following:

  • Minoxidil is a U.S. approved medication that was originally used to treat blood pressure. It can be used by women who suffer from Androgenetic Alopecia.
  • Spironolactone has been shown in some clinical trials to slow down the hair loss process. It is an Aldosteron Antagonist and Antiandrogen widely prescribed to treat hair loss in women and should be carefully supervised by a physician. Spironolactone is a blood pressure medication, which decreases testosterone production in the adrenal glands, suppresses 5 alpha reductase and competes with DHT for androgen receptor. It should be used for 6-12 months to see its effectiveness.
  • Cyproterone Acetate (CPA) is an androgen or male hormone antagonist and a potent progestin used widely in Europe and Canada to treat Hirsuitism. This medication is not FDA approved in the US. It blocks Dihydrotestostrone (DHT) receptor.
  • Cimetidine is a H2 antihistamine commonly used for peptic ulcer disease. It is a competitive of DHT. It is considered a weak Antiandrogen that may slow the hair loss process. It is effectively used when treating children and adults with Alopecia Areata, and can also be given in combination with Minoxidil.
  • Retinoic Acid (Retin-A) is believed to shrink the sebaceous glands where DHT exists, therefore minimizing hair loss. Some people use this medication in conjunction with Minoxidil to increase its absorption.
  • Flutamide, approved for use in the treatment of prostate cancer, is a potent antiandrogen that blocks androgen receptors. Studies have shown some improvement and hair growth in women with androgenic alopecia.

There are some vitamins and shampoos that may help with the quality of the scalp and hair shaft. These products may be helpful for providing necessary nutrients to make the hair look fuller, thicker and reduce breakage. There is also option of using Low Level Laser to treat female hair loss. A hair specialist should assist and educate the client with an understanding of these hair products for preserving healthier hair.

Surgical Options For Women

With the Refined Microscopic Follicular Unit transplants that are available, more women are choosing to treat their hair loss using surgical hair restoration with satisfactory results. It should be understood that hair loss in women is progressive and so a comprehensive approach that includes surgery and medical hair regimens may be the best option to proactively manage female hair health and treat hair loss.

Before committing to a treatment plan, a woman should be satisfied that all relevant questions have been addressed regarding procedures, likely outcomes and cost. Both patient and physician should be confident that all other causes of hair loss have been ruled out before hair transplantation is undertaken. If surgical treatment is a viable option for the female client, Dr. Meshkin will explain the different techniques of hair transplant that are available and customize the surgical approach depending on the degree of hair loss and cause.