Female Pattern Hair Loss
Female-pattern hair loss is the main type of hair loss that occurs in women. It is more common after menopause, although it can start any time after puberty. Another name for it is androgenetic alopecia. The risk of developing female-pattern hair loss increases with age (affecting approximately 40% of women aged 50, and 55% of women aged 80) and in women with a family history of hair loss (in either men or women in their family).
Female-pattern hair loss is thought to be caused by an increase in the activity of androgens. Although androgens are essential for normal male development, they also have important functions in females, such as regulating sex drive and hair growth. A tendency for high androgen levels can be inherited, and it can also result from an underlying endocrine condition that causes an overproduction of androgens.
In female-pattern hair loss, there is a shortening of the anagen phase of hair growth (see hair loss for an explanation of the phases) and a lengthening of the time period following shedding of a hair and the start of a new anagen phase. This means that it takes longer for hair to grow back. The hair follicle also changes, becoming smaller and producing a shorter, thinner hair shaft. As a result, thick, pigmented, longer-lived hairs are gradually replaced with shorter, thinner, non-pigmented hairs.
Symptoms of Female-Pattern Hair Loss
The pattern of hair loss in females with female-pattern hair loss is different from that to males with male-pattern hair loss.
Female-pattern hair loss is characterized by a diffuse thinning of hair on the scalp or a widening of the center part, due to an increase in hair shedding. The frontal hairline usually remains intact.
Dermatologists and clinicians may use the following Ludwig classification to categorize the degree of hair loss:
- Type I: Minimal thinning of the mid-line part that can be camouflaged with hair styling techniques
- Type II: The volume of the hair across the entire scalp decreases and there is a noticeable widening of the mid-line part
- Type III: Diffuse thinning of hair across the entire scalp, resulting in a see-through appearance on top of the scalp.
The hair loss process is not usually constant, and it is not uncommon to have periods of accelerated hair loss for three to six months, followed by periods of stability lasting six to 18 months.
Female-pattern hair loss is permanent, although treatments may slow or prevent further loss. Other types of hair loss, both permanent and temporary, can also occur in women. Hair loss can also occur with excessive pulling or braiding of the hair, nervous habits or psychological conditions such as Trichotillomania where the individual has strong urges to pull out their own hair, or with excessive shampooing or blow drying.
For more information about hair loss and other types of hair loss in females see here.
See Your Doctor
See your doctor if:
- You are losing hair in an atypical pattern
- You are losing hair rapidly or at an early age (for example, in your teens or twenties)
- You have any pain or itching associated with hair loss
- The skin on your scalp under the involved area is red, scaly, or otherwise abnormal
- You have acne, facial hair, or menstrual irregularities
- Your hair loss is not typical of female-pattern hair loss (for example, your hairline is receding and you are losing hair from the crown of your head)
- You have been gaining weight, have muscle weakness, are intolerant to cold temperatures, or feeling tired all the time.
Diagnosis of Female-Pattern Hair Loss
Your doctor will take a detailed medical history and examine your scalp. She or he will check for signs of infection or inflammation and may order some blood tests to investigate other possible causes of hair loss, such as deficiencies or thyroid dysfunction. Your doctor may also ask questions such as:
- Are you losing hair only from your scalp or from other parts of your body as well?
- Is there a pattern to the hair loss like a receding hairline, thinning or bald areas on the crown, or is the hair loss throughout your head?
- Have you had a recent illness or high fever?
- Do you dye or blow dry your hair?
- Have you been under unusual stress lately?
- Do you have nervous habits that include hair pulling or scalp rubbing?
- Do you have any other symptoms like itching, flaking, or redness of your scalp?
- What medications do you take, including over the counter drugs?
Diagnostic tests that may be performed (but are rarely needed) include:
- Microscopic examination of a plucked hair
- Skin biopsy (if skin changes are present) or a skin scraping if a fungal infection is suspected.
Minoxidil applied topically, is the only medicine approved by the United States Food and Drug Administration (FDA) to treat female pattern baldness. Hair shedding may temporarily increase during the first few months of use and regrowth may take two to four months. Continued treatment is required otherwise the pattern of hair loss reverts back to what it was before. The exact way that minoxidil works is not known. Other brand names of minoxidil may be available.
It tends to work better in women who have a general thinning of the hair and can produce some new growth of fine hair in some women.
Other medications that may be tried for female pattern hair loss but are not FDA approved for this indication include spironolactone, low-androgen oral contraceptives, or hormone replacement therapy in postmenopausal women.
Hair transplants are a surgical technique that removes hair follicles from one part of the head to another. It is mostly used to treat male pattern baldness; however, some females have reported success. Most people see 60% of new hair growth after 6 to 9 months.
Hair pieces, hair weaves or changes of hairstyle may disguise hair loss. This is generally the least expensive and safest approach to hair loss.
Symptoms and treatments
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.