For many women hair is a defining feature, we choose how to colour it, style it and wear it, it is often something that is the subject of many conversations with ladies known for their iconic hair, so when a hair problem occurs it can be a real issue in terms of identity and self-confidence as well as challenging our perception of femininity, particularly when it happens alongside the Menopause.
Hair loss in women is very common, although it is still a somewhat “taboo” subject. In clinic I see many women with the same or similar conditions that can be treated, improved or managed, but through no fault of their own they have been advised otherwise, with the Menopause often given as a reason for hair loss issues with no hope of any improvement, which I find not to be the case in most of my patients.
Definition of Hair Loss in Women:
Hair loss in women can start as early as 13 / 14 with the onset of puberty and can occur as late as your 60’s or 70’s. There are different types of hair loss and the key to managing or treating successfully always lies with an accurate diagnosis.
Excessive hair shedding is something that is very common, in many cases it with be either an acute or chronic telogen effluvium, and can have multiple underlying causes, once we identify what these are, we can usually treat this very successfully and the hair can be returned to normal. Diet, lifestyle, hair care regime and general health are all factors in this very common condition and if all are causing a problem all need to be addressed.
Hair thinning is also very common and can be due to a combination of conditions, most commonly telogen effluvium and female pattern hair loss. With telogen effluvium the hair sheds more than is normal causing a lack of overall hair density, with female pattern it is miniaturising usually with a thinning pattern that starts around the central parting and spreads around the top of the head and can thin the temple areas, making the scalp more visible.
Changes in the scalp and hair condition can become issues with the hair and scalp becoming very dry or very oily making it difficult to manage the hair and scalp, especially if there is lots of flaking falling onto clothing and chairs.
Current statistics show that around 8 million women in the UK are affected by hair loss, 1 in 2 women will have found a hair thinning issue by the age of 30 with around 40% of Women by the age of 50 suffering with female pattern hair loss rising to some 50% of Women suffering this over the age of 65.
As a clinical Trichologist I see around 300 patients every month with many of these patients being women who are peri menopausal, menopausal or post-menopausal, many have multiple conditions that when diagnosed and treated improve considerably giving back not only better hair but also recognition of their condition and hope that it can be improved which has often been taken away with mis-information.
Hair loss related to the menopause can have many different underlying causes which can range from hormonal to dietary, lifestyle and stress.
Hormonal impact on hair loss:
Oestrogen and progesterone are hormones that help to keep the hair in the growing phase for longer and can therefore help the hair to feel and look thicker. At menopause often these hormone levels drop, and the hair becomes noticeably thinner. HRT can help to replenish these hormone levels and can therefore help with maintaining hair density.
Testosterone also has a role to play in female hair loss, too much can be a cause of hair thinning in female pattern hair loss, with too little also causing general hair thinning not related to female pattern. Balancing low testosterone, again often found at menopause can have a supportive effect in hair growth if a testosterone deficiency is present.
Genetics and Hair Loss:
Our genetics influence our hair immeasurably, we can inherit the genetic trait for female pattern hair loss and for autoimmune conditions that cause hair loss. The length of the hair’s growth cycle can last from 2 – 7 years and this is genetically inherited and influences how long our hair can grow.
Some medications can adversely influence the hair, however in some cases the conditions being treated have a much more damaging effect on the hair than the medication and essential medications should never be stopped when having concerns about hair loss.
Diet and Lifestyle:
Our diet and our lifestyle play a massive role in the health of our hair, what we eat, when we eat and how we absorb the nutrients from our diet is so relevant to our hair health. Our hair is made of protein and requires protein to be healthy, our diets vary so much, and this can cause the daily protein intake to be less than ideal. The hair follicle is the second fastest dividing cell in the body, but is non-essential, therefore the body really does not give it any priority. Protein manages every essential bodily function, so you really do need to have enough each day, if the non-essential hair is going to be able to utilise it.
Directly related to dietary intake is our stored vitamin and mineral levels, these again can be an issue with hair thinning or loss, especially around the time of menopause. At peri menopause often monthly periods become more frequent and heavier and this can deplete our iron stores, (serum ferritin), ferritin is used by the hair as a protein and if levels fall too low the hair can shed. Vitamin B12 is also used by the hair for cell regeneration, this vitamin is only in animal proteins, so if your diet is mostly plant based you should be supplementing it.
When the diet or stored vitamin and mineral levels are causing a hair problem, blood tests are required to find out what is happening, just buying off the shelf multi vitamins or certain vitamins and minerals will not target your individual problem and may not solve the issue, but will incur unnecessary costs.
HRT can be supportive in menopausal hair loss, as Trichologists we are looking for those treatments that are the most supportive and generally recommend the following Premique and Indivinia (both of these products contain the antiandrogen medroxyprogesterone acetate).
Minoxidil can be used very effectively to treat and manage female pattern hair loss as can Low Level Laser Light Therapy.
Some women prefer not to commit to a long-term treatment plan and opt for camouflage products instead, such as hair fibres, thickening sprays or scalp creams. These can give the impression of thicker hair without any commitment (the products wash out easily).
Frontal Fibrosing Alopecia, (FFA), this is an autoimmune condition causing hair to be lost around the hairline, in front of the ears and behind the ears moving as far back as the crown. It is a scarring permanent loss that with early intervention can be managed. FFA has become far more prevalent in recent years and often affects post-menopausal women.
In summary if you are worried about any aspect of your hair health early intervention by a hair and scalp specialist is always advised, the sooner we see and treat a condition, often we get a much better outcome.