Hair loss in women

Reviewed by our clinical team

Hair loss can be upsetting no matter what your age or gender – but for women, it can be particularly distressing, because of societal norms, peer and media pressure. It is simply not expected for a woman to lose her hair.  In contrast to this, hair loss in men is not thought to be unusual.

In women, there are several different things that can cause hair loss. Some types of hair loss are related to stress or medical treatment and might only be temporary. Other types might result in permanent loss.

The good news is that most types of hair loss are only temporary, and your hair is likely to grow back once the underlying cause or stress has been dealt with. Start by visiting your GP who will be discussing with you what your hair loss might be caused by and what to expect.

In this article we’re going to take a look at the causes of hair loss in women, symptoms and potential treatments available.  

Causes of hair loss in women

There are lots of different types of hair loss that women might experience, here we’ll go through some of the most common types.  

Female pattern baldness

Female pattern hair loss is unusual in women in their 20s and 30s, but about 40% of women over the age of 50 are affected by this and about 45% of all women over 80 have some degree of female pattern hair loss. Women of with Asian heritage tend to be less affected.

Female pattern hair loss can run in families, and it's probably related to hormones. 

Telogen effluvium

Telogen effluvium is another type of hair loss. This type of hair loss is common after childbirth or other events that are stressful for body or mind. Nutritional deficiencies, for example iron deficiency anaemia, lack of Vitamin B12, folic acid or zinc might also contribute to excessive hair loss.  Sometimes a thyroid problem or other hormonal imbalances can be the reason for the hair loss.  Excessive sun exposure can also contribute to telogen effluvium- so wearing a hat or headscarf might be a good idea during the summer months or when having a holiday in the sun. Because sometimes there is a treatable cause for the hair loss it's worthwhile talking to your GP about this- they might suggest running a few blood tests.

Normally, we shed around 100 hairs a day, but telogen effluvium causes the shedding of around 300. This is because more hairs than normal have moved from the growing phase into the resting phase.

The good news is that this type of hair loss is usually temporary. Your hair should return to normal within six to nine months once any imbalance has been rectified or the stressful event or time is over.

Alopecia areata

Alopecia areata (patchy hair loss) is a condition thought to be related to the immune system. It can be triggered by emotional or physical stress, trauma, hormonal changes and sometimes even viral infections.

The milder, patchy forms of alopecia areata are normally temporary, and hair usually grows back within six months. The more extreme forms that cause widespread hair loss tend to be permanent (3).

Traction alopecia

Traction alopecia is hair loss caused by damage to or strain on the hair follicles, normally due to one of the following:

• Wearing your hair pulled back in a very tight style (e.g. braids, dreadlocks, or a tight ponytail) 
• Wearing tight headwear (e.g. a cycling helmet) that puts pressure on the scalp 
• Wearing hair extensions that pull on the hair follicles 
• Using chemical relaxers to straighten your hair 

If traction alopecia is diagnosed early enough you can take steps to avoid further damage and prevent permanent hair loss. 

Chemotherapy

Chemotherapy commonly causes hair loss. This can be anything from gradual hair thinning to going completely bald and losing all your body hair. The hair usually starts falling out two-four weeks after the start of the treatment. However, a few weeks after you have completed your chemo your hair will usually start to grow back.

What do different types of hair loss look like?

As there are so many types of hair loss in women, the appearance of hair loss can be varied. Let’s take a look at these differences now. 

What does female pattern baldness look like?

Female pattern baldness tends to be less noticeable than male pattern hair loss because the hair loss usually starts from the centre parting which can be disguised more easily in longer hair. A receding hair line, like seen in men, is not common at all.

What does telogen effluvium look like?

Typically, the hair falls out evenly across the scalp - there are no obvious bald patches. You may notice more hairs in your hairbrush or on your pillow than normal. 

What does alopecia areata look like?

Patchy alopecia areata usually starts with a round-ish patch. The hair loss is sudden and sometimes goes unnoticed.  The eyebrows or eyelashes can also be affected. The patch can get bigger before the hair starts growing back. You can have one or more patches in different stages. 

Other types of alopecia areata are alopecia totalis (loss of all hair on the scalp) or alopecia universalis (loss of all hair on the head and body). 

What does traction alopecia look like?

You may notice patches of thin or broken hair where the scalp and follicles have been under strain. You may also notice redness, itching, pimples, or areas of scarred or shiny skin.  

Other types of hair loss

There are some other types of hair loss that can affect women, including trichotillomania, a compulsive condition where you feel the urge to pull out your own hair and eyelashes.

To learn more about this condition and other rarer forms of hair loss, consult this guide from Alopecia UK.

How do I know what type of hair loss I have?

It’s not always easy to work out what’s causing your hair loss, but as a general guide: 

• Thinning on top of the head, particularly over the age of 65, is likely to be female pattern baldness. 
• Widespread shedding of the hair, particularly after a stressful incident or period of illness, is likely to be telogen effluvium. 
• Patchy hair loss is likely to be alopecia areata. 
• Broken hair and sore skin is likely to be traction alopecia.

The best way to work out what type of hair loss you have is to visit your GP.

Treatments for hair loss in women

Many types of hair loss are only temporary, which means you may be advised to simply wait for your hair to return. For permanent or persistent forms of hair loss, there are some treatment options you can try.

Minoxidil

One treatment option for women experiencing female pattern hair loss is minoxidil. This is usually used by women with female pattern baldness, although it’s sometimes recommended for other types of hair loss, including telogen effluvium.

Minoxidil is a topical treatment – in other words, it should be applied directly to affected areas of the scalp. Applying minoxidil every day, as directed, can halt hair loss and in some cases encourage regrowth. It normally takes about six months of daily use for any effects to be seen.

Minoxidil isn’t prescribed on the NHS, but you can buy it through LloydsPharmacy. For women, a 2% concentration is usually recommended, rather than the stronger 5% concentration used by men.

Wigs

Hair extensions, hair pieces, and full wigs can be an option for women struggling with hair loss – whether on a temporary or permanent basis. Depending on the nature of your hair loss, you may be eligible for a free wig on the NHS.

Click here to find out how you can get a wig through the NHS.

Hair transplants

Hair transplants can be an effective solution for female pattern baldness. They involve taking hair from healthy areas of the scalp (normally the back and sides) and transplanting them to areas that are balding.

However, hair transplants aren’t available on the NHS and can be very expensive. There may also be a need for more than one procedure if you have progressive hair loss. You can learn more about hair transplants by consulting this guide from the NHS.

Can women use finasteride?

Finasteride (branded as Propecia) is a hair loss treatment for men that comes in tablet form. It’s not suitable for women because it can harm a baby if you get pregnant. No studies have been done on older women, so it is not known what negative effects it might have in this age group.

Treatment for alopecia areata in women

In severe cases of alopecia areata, when the hair isn't growing back as expected or it's causing distress, some of the following treatments might be suggested: 

Steroids 

Given in the form of a cream/solution applied to the bald patches, injections administered into the bald patches, and in some cases a tablet.

Dithranol ointment 

This is a treatment usually used to treat psoriasis. There isn’t much evidence to support it treating hair loss, but sometimes it does appear to stimulate hair growth.

Immunotherapy 

This is usually a chemical applied to bald patches.   

Ultraviolet light treatment 

This involves taking a tablet or using a cream that makes the skin sensitive to light. The bald patches are then exposed to ultraviolet light, which can stimulate hair regrowth.

Minoxidil 

This is an over-the-counter treatment, mainly used to treat hereditary hair loss. Known by the brand name Regaine, it can help some people’s hair grow back if you have alopecia.   

You can learn more about treatments for alopecia areata at the Alopecia UK website.

How to cope with hair loss in women 

If you’re struggling with your hair loss, just know that you’re not alone, and there are resources available to help you cope.

In this guide for women coping with hair loss, the NHS advises the following: 

• Joining an Alopecia UK support group 
• Talking about your hair loss with friends and family 
• Getting therapy or couples counselling 
• Using wigs, hair extensions, scarves, and make-up 
• Being patient, as hair will often grow back!

References

https://www.alopecia.org.uk/androgenetic-alopecia-pattern-hair-loss
https://www.alopecia.org.uk/telogen-effluvium
https://www.alopecia.org.uk/alopecia-areata
https://www.alopecia.org.uk/traction-alopecia-hair-loss
https://www.alopecia.org.uk/chemotherapy-induced-alopecia-anagen-effluvium
https://www.nhs.uk/conditions/hair-loss/
https://dermnetnz.org/topics/female-pattern-hair-loss/ 
https://dermnetnz.org/topics/telogen-effluvium/
https://sussexcds.co.uk/patient-information/alopecia-areata/