Brief overview
- Treatment: In case of hereditary hair loss mostly Minoxidil, in case of circular hair loss for example cortisone therapy; in case of diffuse hair loss treatment of existing underlying disease or discontinuation of triggering drugs, supplements.
- Causes: Hereditary (androgenetic alopecia), autoimmune disease (circular hair loss), hormonal (for example, after pregnancy) or due to medication, infections, metabolic disorders (for example, nutrient deficiencies) or chronic underlying diseases (for example, hypothyroidism or lupus erythematosus).
- When to see a doctor: In case of persistently severe hair loss (more than 100 hairs per day) or thinning of the scalp hair.
- Diagnosis: Patient interview (anamnesis), examination of the hair and thinning areas, trichogram, blood test.
What is hair loss in women?
Losing about 70 to 100 hairs a day is normal and initially no cause for concern. In the case of increased hair loss, doctors also speak of effluvium. Alopecia refers to hairlessness per se.
Many women suffer from hair loss in the course of their lives, and the causes are varied. Sometimes it occurs only temporarily, for example as a result of hormonal changes after pregnancy or during menopause (climacteric). Certain medications or simply a too-tight braid can also be triggers for hair loss – in which case it can be remedied relatively easily.
Frequently, however, the so-called androgenetic alopecia is the cause, i.e. a hereditary hair loss. However, sometimes other diseases are hidden behind hair loss in women.
What can be done against hair loss in women?
The treatment of hair loss in women depends on the cause.
If diseases (such as hyperthyroidism or tuberculosis) or poisoning are the trigger for hair loss, it is crucial that these are treated professionally. As a result, this usually stops the hair loss.
The therapy of scarring hair loss is difficult and protracted. In the case of lupus erythematosus, the doctor often prescribes cortisone and other active substances to treat the inflamed areas on the scalp, which stop the inflammatory processes and thus the hair loss. Hair that has already been lost will not grow back because the hair follicles are irreparably damaged.
Mechanically induced hair loss in women can be prevented by not subjecting the hair roots to excessive traction. This means, for example, tying a ponytail only loosely or wearing the hair loose more often.
Temporary hair loss in women after childbirth, surgery or infections usually does not require therapy, but returns to normal on its own. With a little patience and an adequate supply of nutrients (especially in breastfeeding women), the hair gradually fills in again.
Minoxidil is considered the most effective remedy for hereditary (androgenetic) hair loss in women. It is applied as a two-percent hair tonic twice a day locally on the thinning areas. In many cases it stops the progression of hair loss and sometimes even stimulates new hair growth. The mechanism of action is believed to be that minoxidil stimulates blood flow in the small blood vessels.
Sometimes doctors also prescribe tablets containing anti-androgens (such as cyproterone acetate) for hereditary hair loss in women. These are substances that cancel out the effect of male sex hormones. Before menopause, anti-androgens are used in combination with estrogens as contraceptives. This is because pregnancy must be avoided at all costs during treatment: In a male fetus, the active substances would otherwise interfere with genital development.
If a hormonal disorder such as PCO syndrome is behind the androgenetic alopecia in women, the treatment of the underlying disease is the main priority.
Treatment of circular hair loss in women
Various options are available for the treatment of circular hair loss in women (and men). These include, for example, local applications of cortisone or dithranol (cignolin, anthralin). Cortisone inhibits the immune system. Dithranol is a skin irritant that may stimulate new hair growth.
For larger bald patches, topical immunotherapy may be used. Here, an allergic contact dermatitis is specifically triggered on the affected skin areas, which in the best case “distracts” the misdirected immune system from attacking the hair root cells.
The chances of success of the individual treatment options for circular hair loss in women (and men) are rather modest overall. In addition, relapses occur more often.
In some cases, circular hair loss in women (as well as men and children) also heals on its own.
Treatment of diffuse hair loss
Sometimes diffuse hair loss is caused by infections or other diseases such as thyroid disorders. If these are treated, the hair loss usually improves as well.
If a nutrient deficiency is the cause of hair loss, a balanced diet or certain dietary supplements can help.
For the supportive treatment of diffuse hair loss, preparations from the pharmacy are also helpful. B vitamins and certain amino acids (L-cysteine) strengthen the hair roots and stimulate the formation of new hair cells.
Hair loss in women: Causes
There are different forms and causes of hair loss in women. Here you will find the most important ones:
Hereditary hair loss in women.
In most cases, hereditary hair loss in women (and men) is the reason why the hair on the head thins. For a long time, it was believed that in affected women, excessive production of testosterone (the most important male sex hormone) was the reason for increased hair loss. This is why it is also called androgenetic alopecia. However, this is only occasionally the case, for example in polycystic ovary syndrome (PCO syndrome).
Aromatase ensures that male sex hormones are converted into female ones (estrogens) at the female hair follicles. In hereditary hair loss, the enzyme is less active, so that the concentration of male sex hormones at the hypersensitive hair follicles increases. On the other hand, fewer estrogens are produced locally, which are said to have a promoting effect on hair growth. Overall, this results in hair loss.
In affected women, hair loss manifests itself in a general thinning of the scalp hair, mainly in the crown area. As a result, the scalp becomes increasingly prominent. In some women, hair loss also preferentially affects the front of the head, causing a bald forehead to develop (as in men with this type of hair loss).
Circular hair loss in women
Some women instead develop circular bald patches on the head or other hairy parts of the body. This is called circular hair loss (alopecia areata). It has other causes. In severe cases, all body hair falls out completely (alopecia areata universalis).
Circular hair loss manifests itself especially in the 2nd and 3rd decade of life. Menopause, respectively the 5th decade of life in general, is also often accompanied by this form of hair loss.
Diffuse hair loss in women
In diffuse hair loss, hair loss occurs evenly all over the head. There are many possible causes for this. Here are the most important ones:
Often, certain medications are the trigger for excessive hair loss. These include, for example:
- Cytostatics (cancer drugs)
- Medications for hyperthyroidism (thyrostatic drugs)
- Beta-blockers (for heart disease)
- Lipid-lowering agents (against elevated blood lipid levels)
- Anticoagulants (for blood clotting)
- Vitamin A preparations
- The gout medicine allopurinol
Especially important for women: In many cases, diffuse hair loss is triggered by the pill (ovulation inhibitors).
In other cases, diffuse hair loss in women (and men) is due to a metabolic disorder. Sometimes the trigger is a protein or iron deficiency, for example in the context of malnutrition. Hyperthyroidism and hypothyroidism are also possible reasons for excessive hair loss.
Infections with a chronic course (such as tuberculosis) are also a possible cause of diffuse hair loss. Even after an acute, severe infection with high fever such as influenza, some people temporarily lose their hair. The same applies after operations.
Many women complain of increased hair loss after childbirth. You can read more about this in the article Hair loss after pregnancy.
Mechanically caused hair loss in women
In some cases, persistent or frequent pulling on the hair roots causes the affected hair to fall out prematurely. This is observed, for example, in women who very often wear a tight chignon or ponytail: Here, the hair loss primarily affects the area of the forehead and temples. Doctors refer to this as traction alopecia (traction = pulling, pulling force).
Scarring hair loss in women
Hair loss in women: When to see a doctor?
If you notice that an unusual amount of hair falls out when brushing, showering, overnight or in everyday life, observe this first. Every hair on the body has a certain growth cycle, and sometimes it happens that a conspicuously large number of hairs fall out at once. Even in the case of hair loss with a clear cause (for example, after pregnancy), a visit to the doctor is usually not necessary.
However, if the hair loss continues or if you notice that the hair on your head is already noticeably thinning in certain areas, a visit to the doctor is recommended. In this way, the doctor can clarify at an early stage whether there is possibly a disease behind it. Most forms of therapy are also more effective the earlier you start.
The right contact person for hair loss in women is the dermatologist. Alternatively, it is also possible to approach the family doctor or gynecologist for observation.
Hair loss in women: Examinations and diagnosis
This is followed by a physical examination that focuses on the scalp. The doctor examines the thinning or balding areas and assesses the pattern of hair loss. Using a small, illuminated magnifying glass (dermatoscope), he inspects the hair roots. He may lightly pull the hairs to test how easily they can be detached (epilation test).
Furthermore, he removes some hairs to examine them microscopically (trichogram). But other parts of the body (for example, the hands and fingernails) also give him clues about any underlying diseases.
In addition, the doctor may perform a blood test to rule out deficiencies or other underlying diseases (for example, of the thyroid gland).
