Hair Loss in Women

Hair loss is a clinical problem that’s increasingly observed these days in women. When the cause is high androgen level, it’s called female androgenetic alopecia. When it occurs with normal androgen level, it’s called female pattern hair loss [1].

There can be numerous causes of hair loss in women, and a dermatologist is the best specialist to identify the cause and treat it. Hair loss also occurs in children, wherein it’s more frequent in girls, and is seen in girls at an earlier age compared to boys. Menopausal women don’t necessarily have hair loss, but when it occurs suddenly, it needs to be investigated. High hormone level during pregnancy protects from hair loss, but following delivery, almost all women experience hair loss as estrogen hormone levels decrease.  Blood loss during delivery could trigger further hair loss from iron deficiency [2]. Even in women with heavy periods, and who don’t eat red meats or have vegetarian diets, iron deficiency related hair loss can occur. This happens because iron from hair follicles is diverted to support the function of other important organs.

Worry and depression can also cause hair loss. Deficiency in Vitamin B12 can indirectly cause hair loss by causing depression [3]. Excessive dieting in women can also cause hair loss as proteins and lipids are required for healthy hair. This is apparent in the clinical case of anorexia nervosa [4]. Seasonal hair loss in women is seen in autumn [6].

Non-hormonal loss of hair in women can occur with nutritional deficiencies of aging. It has been observed in women ages 60 and older, and has some genetic predisposition, though not always [1].

Topical Minoxidil is a commonly used pharmacological therapy for hair loss. It has several side effects, such as facial hypertrichosis, irritation dermatitis, contact exzema, pleuritis, scaling, dryness, and headaches. It’s not recommended during pregnancy or lactation.

While there are several pharmacological treatments for hair loss, there are other ways in which hair loss in women can be dealt with. For example, weight loss has been found to improve hair loss in women with high androgen levels; even a weight loss as low as 2% to 7% has helped regain lost hair [6].Supplemental Vitamin B12 and Biotin will be required in vitamin deficient women and those at risk of such deficency  from being treated with pharmacological hormone therapy (i.e.cyproterone acetate and ethinyl estradiol). Iron therapy will be required in those with low iron. Botanic products like Saw Palmetto has shown increased hair growth in 60% of men with moderate hormonal hair loss. This product inhibits conversion of testosterone to 5alpha-DHT (a testosterone byproduct responsible for hair loss) in hair follicles [7]. Other botanical compounds like phytoestrogens which is similar to the hormone estrogen also helps in preventing hair loss. The primary food sources for phytoestrogens are soy, soy products, cereals, flaxseeds, and berries.

References:

  1. F. Camacho. Hair Loss in Women, Semin Cutan Med Surg. 2009 Mar; 28(1):19-32.
  2. J. Kantor, L.J. Kessler, D.G. Brooks, G. Cotsarelis.Decreased serum ferritin is associated with alopecia in women. J Invest Dermatol, 121 (2003), pp. 985–988.
  3. F. Camacho, M.J. García-Hernández.Psychological features of androgenetic alopecia.J Eur Acad Dermatol Venereol, 16 (2002), pp. 467–480.
  4. C. Hediger, B. Rost, P. Itin.Cutaneous manifestations in anorexia nervosa.Schweitz Med Wochenschr, 130 (2000), pp. 565–575.
  5. Androgens The main regulator of human hair growth.F. Camacho, V.A. Randall, V.H. Price (Eds.), Hair and Its DisordersBiology, Pathology and Management, Martin Dunitz Ed, London, England (2000), pp. 70–82.
  6. R. Pasquali, R. Fabbri, S. Venturoli et al.Effect of weight loss and anti-androgenic therapy on sex-hormone blood levels and insulin resistance in obese patients with polycystic ovary syndrome. Am J Obstet Gynecol, 154 (1986), pp. 139–144.
  7. N. Prager, K. Bickett, N. French et al.A randomized, double-blind, placebo-controlled trial to determine the effectiveness of botanically derived inhibitor of 5-alpha-reductase in the treatment of androgenetic alopecia. J Altern Complement Med, 8 (2002), pp. 142–152.

 

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