Female hair loss is a phenomenon that should not be ignored, as it often affects the physical health, self-esteem and self-image of the individual. It is not unusual for women to feel unattractive as a result of hair loss, and this can lead to non-socialisation, isolation and psychological damage that affects emotional well-being.

It is important to mention that Alopecia (excessive hair loss) in women is usually temporary and due to either an underlying medical condition or a short-term condition that might include a period of stress, taking some medications (eg, contraceptives), pregnancy, etc. Usually, once the temporary issue that caused it is over, the hair loss will stop and the hair will grow back.

Female Alopecia can generally be divided into two types: temporary and long-lasting. If the correct cause is identified and the issue is solved with appropriate treatment, the hair will grow back in the majority of cases. Incorrect or late treatment can lead to long-lasting Alopecia.

Common conditions that can lead to female hair loss can include one of the forms of Alopecia Areata, a disease or complex of diseases (anaemia, thyroid disorders, hormonal imbalances, menopause, polycystic ovaries syndrome, etc), a short-term condition as mentioned above, or being predisposed to a gene of Male or Female-Pattern Baldness. It is absolutely normal to lose around 100 hairs per day, but more than this is considered a condition that needs investigation.

Main causes of Female Hair Loss:

• Androgenetic Alopecia (Male or Female-Pattern Baldness): With the aid of an enzyme in the oil gland of a hair follicle – Type II 5-Alpha Reductase – Testosterone converts to DHT (Dihydrotestosterone). DHT kills the hair follicles as it causes them to shrink. In fact the main issue is not the level of testosterone but the amount of DHT that binds to the receptors of the hair follicles. Typically, in women, the testosterone is present in small amounts and the female Androgenetic Alopecia is provoked by testosterone action. Another cause can be hereditary background. Moreover, Androgenetic Alopecia may be caused by multiple factors connected with hormonal actions such as menopause, taking oral contraceptives of high androgen levels, polycystic ovarian syndrome, and so on. Subsequently, what’s common in most women is diffuse thinning in the whole top of the head. Research indicates that 25% of women can suffer from Androgenetic Alopecia between the ages of 35 to 40, and around 60% between the ages of 50 to 60.

• Anagen Effluvium: Describes the occurrence of sudden hair loss resulting from the effects of chemical, radioactive and toxic agents such as after chemotherapy and radiation therapy. Hair loss usually occurs after one to three weeks of exposure to any of the aforementioned factors. If the issue causing the Anagen Effluvium is stopped, hair regrowth will usually resume.

• Telogen Effluvium or Diffuse Alopecia: Describes a type of hair loss that appears as a diffuse thinning of hair over the whole scalp that is caused by an interruption of the normal growth hair cycle. In this condition the majority of the hair that is the anagen or catagen phase will shift into the shedding phase.

There are three types of Diffuse Alopecia:

• Acute, in which hair is lost suddenly

• Subacute, whereby the hair loss takes several months

• Chronic, in which the cycle of dilution tends to repeat and lasts longer than six months.

The interruption of the normal development cycle of hair is usually a result of metabolic stress (chemotherapy, pregnancy, puberty, surgery, severe stress or severe chronic diseases), emotional trauma, or a systemic physical attack. Dilution occurs about three months after experiencing the intense incident and in rare cases, the process may involve as much as 50% of the hair.

Causes of Diffuse Alopecia are commonly related to one of the following:

• Diseases, or severe physical or psychological trauma

• Menopause

• Pregnancy

• Strict diets

• Post-operative stress

• Anaemia

• Thyroid Problems

• Chronic diseases – eg, Lupus Erythematosus, liver or kidney problems

• Poisoning by heavy metals

• Immunisations

• Various medications – eg, NSAIDs, retinoids, anti-coagulants

• Starting or ending a course of contraceptive pills

• Childbirth. Many women can experience Diffuse Alopecia approximately three months after the birth of a child due to changes in their hormone levels. However, this is a reversible phenomenon, completely restored about nine months after birth. The effects are usually reversible and in a few months to a year the hair loss is restored and the hair follicles remain healthy. In some cases, Diffuse Alopecia may function as a precursor to Androgenetic Alopecia. The hair regrows, but is thinner and shrivelled. In rare cases the Diffuse Alopecia persists and tends to become chronic. It is recommended to visit your GP in order to identify the pathological cause which might be sustaining the phenomenon.

• Traction Alopecia: Caused by repetitive hair-pulling, and happens to women who keep their hair in a tight style for a long time or use extensions, wigs, etc. In some cases the traction can cause irreversible damage and inflammation in the hair follicles and as a result the hair will not grow. Traction Alopecia is very common in Afro-Caribbean women.

• Using a skin patch, a vaginal ring, hormone injections, or some oral contraceptives and progestin implants can also affect the hair.

Diagnosis: The correct diagnosis of the cause is key to successful treatment of female hair loss as it can be triggered by a variety of circumstances and conditions. Therefore it is recommended to seek professional advice when significant hair loss has occurred.