What is alopecia? Alopecia, or hair loss, is characterised by a noticeable shedding, thinning or…
Female pattern hair loss
What is female pattern hair loss?
Female pattern hair loss is a common type of hair loss that affects nearly all women to some degree. Although it can start any time after puberty, most women experience pattern hair loss as a general thinning around the line where their hair parts at the onset of menopause. Hair may continue to thin with age, but the appearance of bald patches is rare.
Hair loss occurs when the follicles shrink and the hairs inside them become shorter and finer over time. In female pattern hair loss, this process is influenced by genes and androgen hormones. Androgens are often associated with male development, but they also play an important role in several other functions in both sexes, such as sex drive and hair growth.
Men also experience pattern hair loss influenced by genes and androgens. However, as they produce and respond to androgens in a different way to women, the pattern of hair loss is different. In both men and women, pattern hair loss is also known as androgenetic alopecia.
Treatment options for female pattern hair loss include camouflage techniques, medications and surgery, but in most cases, hair loss is permanent. Treatments tend to slow or hide the progress of hair loss, rather than produce new hair growth.
Signs and symptoms
As the name suggests, female pattern hair loss occurs in a particular pattern. It usually starts on the top of the scalp and progresses as a gradual widening of the centre hair part. Apart from a natural receding that affects everyone with age, there is usually no loss from the front hairline.
Female pattern hair loss generally occurs in cycles, rather than being constant. For example, there may be shedding periods of three to six months followed by stable periods of up to about 18 months. Although female pattern hair loss can affect women of any age, it is most common after menopause and tends to become more noticeable over time.
On the average scalp, there are around 100,000 hairs that are constantly growing, resting and shedding. Hairs grows at about one centimetre each month and stay on the head between 3-5 years. In total, around 100 hairs are shed each day. The stages of hair growth are: anagen, where active hair growth occurs; catagen, a phase of transition, and; telogen, where the hair rests and eventually falls out.
Usually, healthy new hairs continue to grow in place of those that are lost and no difference in thickness is seen. Female pattern hair loss occurs when thick, healthy hairs are replaced by short, fine hairs that cycle through the phases of hair growth more quickly than normal. The reason why this occurs is not as well understood in women, as it is in men, but it is thought to involve both genes and androgen hormones.
Several genes are thought to play a role, but it is unknown exactly how they are passed down from parent to child. These genes could be inherited from either or both parents.
Androgens have a direct effect on individual hairs by interacting with receptors on each follicle. Although women with pattern hair loss do not show increased androgen levels in the blood, they may have more receptors on each follicle instead. Another theory is that androgens last in the blood for longer than usual, allowing for a more powerful effect.
Either way, the influence of androgens helps to explain why female pattern baldness occurs more often after menopause, when there are less female hormones (oestrogens) present.
Factors that increase the chances of developing pattern baldness include:
- Increasing age;
- One or both parents with pattern hair loss, and;
- Sensitivity of hair follicles to androgens.
Methods for diagnosis
Your doctor will most likely diagnose female pattern hair loss by looking at your scalp and asking questions about your family history and rate of hair loss. A blood test may also be done to confirm or rule out an underlying medical condition, such as an overactive thyroid gland (hyperthyroidism), low iron levels (anaemia) or changes in hormone levels.
Types of treatment
If you are concerned about hair loss, there are a number of available options to slow or cover hair loss, stimulate regrowth or replace damaged hair. Although there is no cure for hair loss, the following options are available:
Your doctor may recommend a balanced diet containing plenty of protein, fruit and vegetables to maintain the health and thickness of the remaining hair. Avoiding tight hairstyles, harsh styling and vigorous brushing is usually also recommended.
Cosmetic options to hide the appearance of hair loss include wigs or hairpieces, lightly brushing mascara into the roots, or colouring the scalp to match existing hair.
The most widely-used medication for female pattern hair loss is minoxidil. Available over the counter as a foam or liquid, minoxidil is applied directly to the scalp for a minimum of 12 months. Side effects can include skin irritation or unwanted hair growth on the face, particularly when used at a high dose.
Alternatively, your doctor may prescribe a hormonal medication such as spironolactone or cyproterone acetate. In most cases, treatment is continued for at least six months or more. These medications work by blocking the effects of the androgen hormones. Side effects may include weight gain, tiredness, depression and low libido.
Results vary from person to person, but these medications are not commonly known to stimulate hair regrowth. Instead, they tend to slow or decrease the progress of hair loss. Once treatment is stopped, hair loss usually continues.
Hair transplant surgery
In the past, hair transplant surgery was largely considered as a treatment for male pattern baldness. However, the procedure is now becoming more widespread among women.
During hair transplantation, a surgeon removes 'donor grafts' of healthy hair and transplants them to areas of hair loss. Each graft contains one or more hairs still attached to a small patch of skin. Surgery can take up to several hours and may need to be repeated more than once.
In most cases, the transplanted hair falls out after surgery and then regrows over a period of 1-3 months. For this reason, improvements may only be seen with time. Sometimes though, transplanted hair may appear unnatural, not grow as expected, or not grow at all. Results vary depending on a number of factors, including the extent of hair loss and individual recovery.
As with most surgery, side effects of hair transplant surgery may include pain, scarring, swelling, bleeding, numbness or infection. Sedative and local anaesthetic medications are administered to help prevent pain and discomfort during the surgery.
As hair loss affects the appearance, widespread or early thinning may lead to psychological issues such as embarrassment, social withdrawal, low self-esteem or depression.
Female pattern hair loss is also linked to an increased risk of developing polycystic ovarian syndrome (PCOS). During PCOS, a hormonal imbalance can lead to irregular periods, acne, weight gain and excess body hair. Seek medical attention if you experience any of these symptoms.
Female pattern hair loss is usually permanent, but it does not cause any other physical symptoms or health problems. Treatment results vary from person to person, depending on the option chosen and amount of hair remaining. Generally though, medications tend to slow the progress of hair loss, rather than stimulate new growth.
As female pattern hair loss is largely caused by genetic and hormonal factors, it is generally considered to be a natural part of ageing that cannot be prevented. However, eating a balanced diet and looking after the scalp may help to improve the health and thickness of remaining hair.