Deciphering Female Hair Loss: What To Do When It Happens

For both men and women, our hair is often a key part of our identity and how we enhance our physical appearance. When hair loss occurs, especially when it is significant, it can cause a detrimental effect on our self-image and self-esteem.

Studies have shown that the psychological impact of hair loss on females can be more severe and thus, should not be overlooked¹. While many of us have taken our hair for granted when we were younger, one study concluded that less than half of women will make it past 65 years old donning a full bed of hair².

While it is estimated that 50% of women will experience hair loss at some point in their life, with the majority experiencing it in their 50s or 60s – hair loss can happen at any age to anyone for a variety of reasons.

Some hair loss types are temporary and your hair will eventually grow back, while other types can lead to severe hair loss and become permanent. Thankfully, hair loss is mostly an explainable condition that can be managed and controlled by noticing the signs and symptoms and getting prompt treatment.

To begin, let us first take a look at normal hair physiology and what happens during hair loss.

A crash course on hair

Throughout our life, our hair is constantly in a cycle of growth, rest or transition. At any point of time, roughly 80-90% of our hair follicles are in the growth phase while 10% of our strands are in the rest or transitioning stage.

Unfortunately, there are a plethora of reasons that can interrupt the natural cycle; resulting in a shortening of the growth phase or lengthening of the rest or transition phase. And when the hair is regrowing at a slower rate than it is shedding, that’s when we start to notice hair loss.

Here are some of the first signs of hair loss to watch for:

Seeing more hair fall out during the shower, on your pillows or your brush;

Seeing noticeable patches of thinning hair or bald spots;
A widening part on the top of your head;
Noticing a smaller ponytail

If you are currently dealing with any of the above, the next step would be to try and identify which hair loss type you are suffering from and its underlying root cause.

The common culprits of female hair loss

The most significant cause of hair loss in women is female-pattern hair loss (FPHL), or commonly known as androgenetic alopecia. Affecting about one-third of susceptible women, this condition is primarily influenced by hormonal factors and genetics.

Below is a summary of the most common female hair loss types:

Androgenetic alopecia: Generally begins in women between the ages of 12-40. When it happens, the hair follicles undergo something known as miniaturization which leads to overall thinning of the hair. While men are more likely to suffer from this type of hair loss, women often notice overall hair thinning. However, females don’t see a receding hairline as in the case of men.
Alopecia areata: A condition that is associated with an overactive immune system that attacks healthy hair follicles. Starting as patchy hair loss, those experiencing this tend to see coin-shaped bald patches on their head. While this type of hair loss happens suddenly, it is mostly temporary and the majority of people will recover within a year, since the attack rarely destroy hair follicles.
Anagen effluvium: In this condition, hair loss happens quickly and drastically such that hair may fall out in clumps. It is commonly seen in those undergoing chemotherapy and can result in 90% or more of hairs falling out.

Telogen effluvium: Causes hair to shed more than usual and leads to hair thinning. It can be caused by many factors including stress, injury, medications or hormonal changes in the case of pregnancy. In women, it is common to see this type of hair loss due to a vitamin or mineral deficiency such as iron. It also tends to occur 6 weeks to 3 months after a stressful event.

Traction alopecia: Most related to hair practices such as chemical treatments or tight hairstyles; leading to patchy hair loss or thinning hair at the affected areas. This type of hair loss can involve scarring.

Cicatricial alopecia: A group of conditions where hair falls out and the follicle is replaced with scarring. Although it is more rare, hair is less likely to regrow. Symptoms include severe itching, swelling or red lesions that resemble a rash on the scalp.

To diagnose your hair loss, a dermatologist may decide to conduct a pull test, conduct a punch biopsy or blood tests to determine the cause and come up with an accurate diagnosis. Since the characteristics and underlying reasons behind each type differ, treatment options also differ.

Treating female hair loss

Here’s the good news: there are a plethora of treatment options available that tackle hair loss and encourage regrowth. While some require you to take medications daily, there are also other alternatives that can be done with a professional and experienced dermatologist.

Minoxidil

Minoxidil solution is currently the only drug approved by the FDA to treat female pattern hair loss. Available in 2% or 5% formulas, it is sprayed twice daily on the affected scalp to prolong the growth phase and encourage regrowth. It take about 3-4 months to see the effects and some side effects include redness, dryness and itching. Important to note is that women who are pregnant should avoid taking minoxidil.

Spironolactone

Otherwise known as Aldactone, spironolactone works to treat hair loss by addressing hormones – in particular, the androgens responsible for miniaturisation. Taken orally, some side effects include nausea, dry mouth and dizziness, tender breasts and irregular menstruation. Women who are pregnant should also avoid taking spironolactone due to a possibility that it might cause congenital disabilities. Both minoxidil and spironolactone need to be continued indefinitely to maintain their benefits.

Corticosteroids

Women with hair loss may consider treatment with corticosteroids that can be administered through local injections, topical ointment application, or orally. This is considered to be one of the most effective treatments for those who are dealing with patchy hair loss such as alopecia areata as it helps to suppress the immune system. Hair growth can be noticed as soon as 4 weeks, and treatment can be repeated every 4-6 weeks.

Laser therapy

Laser treatments has been supported by some studies to be a promising option for those who do not wish to risk the side effects of medications or more invasive therapies like a hair transplant. It works by using low-level laser light to nourish hair follicles and stimulate hair regrowth.

Hair transplant

Hair transplants are often the last treatment alternative for females experiencing hair loss. As the only permanent method of restoring hair to a balding scalp, it involves the harvesting of hair grafts from the back of the scalp and transplanting it to areas where hair growth is needed.

The hairs that are transplanted will continue to grow as per normal since they are taken from areas that are not affected by miniaturization. The two most common methods are the FUT (Follicular Unit Transplantation) and FUE (Follicular Unit Extraction) hair transplant that each differ in the way that hair grafts are harvested. Generally, the best results are seen within 10-12 months after the transplant. While it is mostly recommended for patients suffering from androgenetic alopecia, patients that are dealing with other forms of alopecia such as stable, quiescent scarring alopecia can also benefit from a hair transplant.

As it is a surgical procedure, potential issues include the usual risks of surgery like infections, shock loss and a longer recovery period. The best way to optimise your procedure is to work with a dermatologist and hair transplant clinic that specialises in hair transplantation surgery, as not all types of hair loss can be operated on. A FUE hair transplant costs a lot higher than other alternatives, so it is best to first consult with your dermatologist.

What is the best treatment option for you?

While some cases of hair loss will gradually resolve on their own (with the removal of the root cause), if your hair doesn’t return to its normal fullness within nine months, your next best step is to visit a dermatologist to figure out what is going on. Should hair loss be accompanied by other worrying symptoms such as itching, pain, burning or flaking, you should seek help immediately.

Ultimately, regardless of the type of hair loss, the majority of them can be effectively treated with early intervention. Once a hair follicle is destroyed or “dead”, it is difficult to revive it, so the sooner you take action, the more likely you will see great results with your treatment.

Dr Angeline Yong is a dermatologist in Singapore who possesses years of experience managing hair disorders. As a founding consultant and lead of the hair transplant service at the National Skin Centre prior to opening her private practice, she holds extensive expertise in the medical and surgical management of various types of hair loss.

Offering a range of hair loss treatments including medications, laser and immunotherapy, to hair transplants – you no longer have to go through hair loss alone – contact us to learn more about our hair transplant prices or book a consultation today.

References

Davis, D. S., & Callender, V. D. (2018). Review of quality of life studies in women with alopecia. International journal of women’s dermatology, 4(1), 18–22. https://doi.org/10.1016/j.ijwd.2017.11.007

Dinh, Q. Q., & Sinclair, R. (2007). Female pattern hair loss: current treatment concepts. Clinical interventions in aging, 2(2), 189–199.

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Deciphering Female Hair Loss: What To Do When It Happens