Although hair loss is more common in men, it is not uncommon in women either. Hereditary hair loss alone (also congenital hair loss) affects 20 to 30% of women.
Since a beautiful, full head of hair is considered an ideal of beauty, especially for women, hair loss is often a heavy psychological burden. Find out here what causes hair loss in women can have and what you can do about it.
What are the reasons for hair loss?
Hereditary hair loss in women
In most cases, hereditary hair loss in women (and men) is the reason for thinning of the hair on the head. It was long believed that excessive production of testosterone (the main male sex hormone) is the reason for increased hair loss in affected women. However, this is only occasionally the case, for example in polycystic ovarian syndrome (PCO syndrome).
In most women with hereditary hair loss, however, no increased levels of male sex hormones (androgens) can be detected. Rather, a reduced activity of the enzyme aromatase and a genetically determined hypersensitivity of the hair follicles to androgens seem to be the cause:
Aromatase causes the female hair follicles to convert from male to female sex hormones (estrogens). The reduced enzyme activity in hereditary hair loss in women thus causes, on the one hand, an increase in the concentration of male sex hormones at the hypersensitive hair follicles. On the other hand, fewer female hormones (estrogens) are produced locally, which are said to have a promoting effect on hair growth. Overall, this results in hair loss.
In affected women, the hair loss manifests itself in a general thinning of the scalp hair, mainly in the parting area. This causes the scalp to shimmer out more and more. In some women, the hair loss also preferentially affects the front part of the head, so that a bald forehead develops (as in men with this type of hair loss).
Circular hair loss in women
Some women get instead circular, bald spots on the head or other hairy parts of the body. Then there is a circular hair loss (Alopecia areata). It has other causes. In severe cases, all body hair can also fall out completely (Alopecia areata universalis).
The exact reasons for this form of hair loss in women, men, and children are not known. However, various factors play a role in the development of the disease, for example, an autoimmune reaction: antibodies of the immune system erroneously attack healthy tissue of the body – in this case, cells in the hair roots. This disrupts hair growth and ultimately leads to hair loss. A genetic predisposition and other factors can also contribute to the development of the disease.
Circular hair loss manifests itself particularly in the 2nd and 3rd decade of life. Menopause, or generally the 5th decade of life, is also often accompanied by this form of hair loss.
Diffuse hair loss in women
With diffuse hair loss, hair loss occurs evenly over the entire head. The possible causes are manifold. Here are the most important ones:
Often, certain drugs are the trigger for excessive hair loss. These include, for example, cytostatics (cancer drugs), remedies for hyperthyroidism (thyrostatics), beta-blockers (for heart disease), lipid reducers (for increased blood lipid levels), anticoagulants (anticoagulants), vitamin A preparations, and the gout medicine allopurinol. Especially important for women: Diffuse hair loss is often triggered by the pill (ovulation inhibitors).
In other cases, diffuse hair loss in women (and men) is caused by a metabolic disorder. This can, for example, be a protein or iron deficiency, for example as a result of malnutrition. Overactive and underactive thyroid glands can also be the reason for excessive hair loss.
In some cases, diffuse hair loss is caused by poisoning, for example with thallium or arsenic.
Infections with a chronic course (like tuberculosis) can also be the reason for diffuse hair loss. Even after acute, severe infection with a high fever such as flu, hair may temporarily fall out. The same applies to operations.
Many women complain of increased hair loss after giving birth.
Mechanically caused hair loss in women
Continued or frequent pulling on the hair roots can cause the affected hair to fall out prematurely. This can be observed, for example, in women who very often wear a taut ponytail: here, the hair loss preferentially affects the area of the forehead and temples. Doctors refer to this as traction alopecia.
Scarring hair loss in women
In women (and men) with inflammatory skin diseases or skin damage, hair loss is sometimes caused by damage to the hair roots or scarring of the scalp. This can happen, for example, with lupus erythematosus, psoriasis (lichen ruber planus), scleroderma (a connective tissue disease), or local infections with fungi or bacteria.
Treatments for hair loss
The treatment of hair loss in women depends on the cause. For example, if certain medications cause diffuse hair loss, those affected should talk to their treating doctor. It may be possible to reduce the dose or switch treatment to an alternative preparation that is less harmful to hair growth. If not, the hair loss usually returns to normal on its own after the drug therapy has ended.
If diseases (such as hyperthyroidism, tuberculosis, etc.) or poisoning are the triggers for hair loss, they must be treated professionally. This can then often also stop hair loss.
The treatment of scarring hair loss is difficult and lengthy. In the case of lupus erythematosus, for example, cortisone and other active ingredients can be prescribed to treat the inflamed areas of the scalp, which stop the inflammatory processes and thus the hair loss. Hair that has already been lost does not grow back because the hair follicles are irreparably damaged.
Mechanically induced hair loss in women can be prevented by not exposing the hair roots to excessive tension. This means, for example, tying a ponytail only loosely or wearing the hair open more often.
Temporary hair loss in women after childbirth, surgery, or infection usually does not require treatment but returns to normal on its own.
Treatment of hereditary hair loss in women
The most effective remedy for hereditary hair loss in women is Minoxidil. It is applied as a two-percent hair tonic twice a day locally on the areas that are thinning. This can stop the progression of hair loss and sometimes even trigger new hair growth. The exact mechanism of action of Minoxidil is not known. Presumably, it stimulates the blood circulation in the small blood vessels.
Sometimes doctors prescribe tablets with antiandrogens (such as cyproterone acetate) for hereditary hair loss in women. These are substances that counteract the effects of male sex hormones. Before menopause, antiandrogens are used in combination with estrogens as a contraceptive. Pregnancy must be avoided at all costs during treatment: In a male fetus, the antiandrogens would interfere with genital development.
If a hormonal disease such as PCO syndrome is behind hereditary hair loss in women, the treatment of the underlying disease is the main focus.
Extreme hair loss in women (and men) can often only be concealed by a hairpiece (toupee, wig). Some affected persons also decide to have a hair transplant.
Treatment of circular hair loss in women
There are several options 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-irritating substance that is supposed to stimulate new hair growth.
Topical immunotherapy can be tried for larger bald spots. In this case, allergic contact dermatitis is specifically triggered on the affected skin areas, which should “distract” the misdirected immune system from an attack on the hair root cells.
The chances of success of the individual treatment options for circular hair loss in women (and men) are generally rather modest. Furthermore, relapses occur more often.
In some cases, Circular Hair Loss in women (as well as men and children) heals on its own.