Many women are at a loss as to what's causing their hair loss. And for good reason. The answer is complicated.
I have read and dissected all the research on the many possible causes of female hair loss. One thing seems certain: while there are some obvious causes such as medications and various auto-immune diseases, most often the cause is a combination of factors, which makes it very difficult for a woman or her doctor to pinpoint and solve the issue effectively.
Also known as female pattern hair loss (FPHL), baldness and alopecia, FPHL manifests in a variety of ways including telogen effluvium, androgenic alopecia (AGA), alopecia areata, anagen effluvium, yet hair loss in women remains one of the most puzzling issues plaguing women and doctors the world over. Further reading on the types of alopecia.
Female hair loss - more than one cause
According to a recent reivew published in the International Journal of Women's Dermatology, (Female pattern hair loss: A clinical, pathophysiologic, and therapeutic review), hair loss in women is polygenic which means it can be influenced by more than one gene. It's also multifactorial (dependent on a number of factors) with the additional influence of environmental factors.
So we know there are a broad a range of causes from the obvious (such as damaging it with peroxides and other chemicals), to hidden causes such as systemic inflammation and stress.
But since the cause can be multifactorial, there are literally dozens of combinations of factors contributing to the issue. Women join Facebook groups hoping to find the answer from other women, but the truth is, what is causing the problem for one woman, may only be half the story for another.
And even worse, is that women are prescribing OTC medications to one another online! I am horrified when I see women telling other women to start taking over the counter supplements like iron or Vitamin D when they have absolutely no knowledge of the overall health of the other woman, nor any real idea what could be causing the other woman's hair loss.
Female hair loss - trigger plus contributing factors
So while I have listed some of the most common causes below, it is becoming more and more evident as more research is done on this topic, that the real issue is likely to be a combination of factors.
A common combination is menopause and poor diet or low nutrition often caused by women in menopause taking on crash diets to eliminate their menopause weight gain. So menopause is not the direct cause of hair loss in all women during menopause, but when combined with crash dieting, poor nutritional input, or strong genetic predisposition, (all of which are known to contributors to female hair loss) it would appear on the surface that menopause is the sole cause.
I believe one of the main contributing factors (and not a cause of female hair loss on its own - necessarily), is stress. For the past sixty or seventy years, women have taken on professions once exclusively male dominated. Yet still women are child-bearing and child-raising. Combine this with the contraceptive pill and the resulting hormonal effect, full time work, family juggling as well as the long term stress effect, and you find women of all ages with all kinds of new ailments such as chronic weight gain, heart disease and hair loss. Not that these were unheard of previously, but they have become far more prevalent in the past thirty years than they ever were.
So as you read through these causes, look for contributing factors. Try to identify your initial trigger and then look to see if there is a secondary factor that is at play.
You hear of women who take iron supplements and their hair grows back, then you hear of a woman who changed her shampoo and her hair grew back. But there are equally as many, if not more, for whom those solutions did nothing. This is due to both the trigger and the contributing factor (or factors) working together.
Over styling - a contributing factor to female hair loss
A common contributing factor for many women is not taking good care of the hair and scalp. It’s probably not much of a surprise that heated styling products like straighteners, curling irons and hair dryers can damage hair, but did you know that hairspray, gel or even the type of shampoo used could also be causing hair to thin? Not to mention salon chemicals like peroxide and chemical straightening. Think of the scalp as the soil in the garden. You use good quality soil, feed it and condition it if you are working on new growth. Think of your scalp in the same way and avoid shampoo with harsh chemicals. Look at the list of ingredients on the products you use and go for the more natural products. Especially avoid silicones and surfactants.
Simple things like tight ponytails and harsh brushing can also cause your hair to break and/or thin. Click here for some simple styling tricks for thinning hair.
Low Iron, Vitamin D and B12
If you are also feeling tired and rundown, your problem could be low iron, Vitamin D or B12. But do not just go out and buy these over the counter products and start taking them. For one thing, you need to take them for a long time to replenish your body's stores and turn your body back into a hair growing machine, but more importantly, if you don't need these supplements, then taking them can do you massive harm (even cause hair loss).
So head to your doctor for a blood test first up to see if you are low in any of these vitamins which are known to trigger hair loss. The good news is that once the proper levels are restored with the help of supplements and/or diet changes, your hair growth should return to normal. But be prepared to take the supplements for a long time. It can take up to 18 months to turn around a severe iron (ferritin) deficiency that is causing hair loss.
Polycystic Ovary Syndrome (PCOS)
Although extra hair growth on the body is common in women with PCOS, in a cruel twist of fate the hormonal imbalances can also cause the hair on your scalp to thin. So, more hair where you don’t want it and less hair where you do. Unfair. There is a range of treatments for PCOS so best to start there.
As with PCOS, it’s the hormones, or rather a lack of or imbalance of hormones, that are responsible for this kind of hair fall. But as we've pointed out earlier, this can be in combination with something else. Not every woman has hair loss during menopause. So keep looking. To take care of menopause hair, spend a little extra on natural hair products and take care to keep your hair conditioned, as low oestrogen is also known to make hair dry and therefore more susceptible to breakage.
Many women try hair thickening shampoos which only make the problem worse! Hair thickening shampoos generally work by drying out the hair. Oily and conditioned hair always looks thinner, so dry and sometimes slightly frizzy hair can look thicker. But beware of these shampoo company tricks - they can really damage menopause hair. Click here for some more information on the causes hair loss in women during and after menopause.
Post-partum hair loss is extremely common and is a very common trigger for female hair loss.
During pregnancy, a lot of women will actually experience thicker hair due to the peak in oestrogen levels. This ceases, however, once your baby is born so it is common to experience hair loss after childbirth. If it is your only trigger then, once your hormones return to normal, your hair should also return to normal. However, if you have another underlying cause such as low vitamin D or poor quality hair, then it is possible that post partum hair loss may result in a longer term problem.
While you wait for your hair to grow back, you can hide a widening part or visible scalp with the use of Boost N Blend. This will provide much needed volume and being made from natural cotton, allows your hair to continue on the path to a return to normal cycles, if it is going to.
Some Medications Can Cause Hair Loss in Women
Both illness and some medications can cause hair loss. It’s important not to overlook any medications you may have been on long term (specifically contraceptives, HRT, blood pressure, cholesterol lowing) where you have altered your dosage or recently stopped taking them altogether. Check with your GP.
Again, look for the trigger. It could be a diet or stress that has triggered your hair loss and then a medication change that has exacerbated it.
There is no doubt that female hair loss can be seen across the generations in some families. But a mother or grandmother with hair loss does not necessarily mean you will have hair loss. This is largely due to the other contributing factors that appear to be needed for hair loss in a woman to manifest.
If you do have a family tendency for female hair loss, and you are concerned it may eventually catch up with you, then do your best to address the causes listed here and try to avoid these becoming your trigger.
Extreme Weight Changes
Putting yourself on a restrictive diet can mean you miss out on some essential nutrients which could cause your hair to fall. Likewise, gaining a significant amount of weight quickly can also put your body out of whack and mean that your hair begins to thin. So stay away from the fad diets if you don’t want to lose more than weight.
Bariatric surgery (stomach stapling, gastric bypass etc) is a common cause of hair loss in women. This is usually due to the extreme weight loss and the resulting stress on your body, but can also be due to a lack of certain nutrients that may have been borderline low prior to the diet. Again, look for more than one cause.
Because hair is viewed by the body as non-essential, it is often the first thing the body stops assigning resources to, so an illness can trigger a bout of hair fall. Hair loss is a common symptom of a lot of illnesses e.g. autoimmune diseases, but what you may be surprised to learn is that even acute illnesses like gastroenteritis, or dental surgery can put enough temporary stress on your body that your hair can begin to fall out. The good news is that this type of hair loss will usually right itself without intervention.
But stay vigilant. If you have had anything seriously wrong and you know you are prone to hair loss, then write down the time you had your illness/surgery/ flu and keep track of where you are in three months time. You may be surprised to find that, especially if you have had hair loss before, your hair starts to shed again three months after something as simple as the flu.
Stress is a major contributing factor to hair loss in women
According to an article published by the National Centre for Biotechnology Information Hair and stress: A pilot study of hair and cytokine balance alteration in healthy young women under major exam stress (1), stress, as in during a high tension exam period, can cause an interruption to the natural growth of hair. Another study performed by the Department of Dermatology, University Hospital Hamburg-Eppendorf, University of Hamburg, Martinistrasse 52, 20246 Hamburg, Germany Burden of hair loss: stress and the underestimated psychosocial impact of telogen effluvium and androgenetic alopecia (2) states that "stress has long been implicated as one of the causal factors involved in hair loss".
It also states that the stress caused by hair loss is a significant contributing factor to hair loss. Further reading and a real life story on this exact cause of hair loss in a woman in her forties can be found here.
Stress seems to cause hair loss in a variety of ways. Stress, and in particular chronic stress, leads to a sustained increase in the body's cortisol levels. Long term raised cortisol levels can lead to chronic inflammation. It can also lead to the suppression of the immune system which can also lead to disease (such as cancer and auto-immune for example). Due to this Cortisol effect therefore, it can be said that lifestyle, poor diet and stress, all over time, can lead to systemic inflammation. Systemic inflammation hyper-sensitizes the hair follicles to androgens which is why chronic inflammation can cause androgenic alopecia.
There is a viscous cycle between stress > raised cortisol > inflammation > female hair loss. There are other factors at play here such as type 2 diabetes, being over weight and oxidative stress affecting the mitochondria of the hair cell. However, I've tried to keep it simple in order to help you understand and try to identify your triggers and contributing factors.
So while some women may be in menopause or are taking medications that are known to cause or trigger hair loss, they may not have any form of hair loss if they are otherwise healthy. However if a women has systemic inflammation then the medication may cause hair loss in that woman. This is why when women ask on Facebook groups if others have found hair loss caused by a certain medication or trigger, there will always be a number of women who also have also taken that medication successfully for many years, with no hair loss.
I suffer hair loss myself and you can read my story here.
If hair loss is a problem for you, it’s a good idea to visit your local GP. In the meantime, use a women’s hair loss concealer like Boost N Blend to keep your hair loss a secret. It is easy to apply and gives an instant result.
About the Author:
Bambi Staveley is a trained nurse, author of How to Make Thin Hair Fat - Causes and Solutions of Unexpected Thinning Hair in Women (published by Barrallier Books 2016) and herself a female hair loss sufferer. Following her own hair loss journey which began in 2008, Bambi dedicated her life to female hair loss research and to finding some way to solve the mystery and at the very least, cover up the problem so it was her own secret. Naturally, once she was able to both cover up her hair loss and eventually, grow her hair back, she was driven to share that information with female hair loss sufferers the world over.
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