Hair loss in women can cause feelings of shame and greatly affect the self-esteem – often more than in men with thinning hair. What are the different causes of hair loss in women? What helps? Read the answers here!
Causes of hair loss in women
There are various forms and causes of hair loss in women. Here are the most important ones:
Hereditary hair loss
In most cases, hereditary hair loss in women (and men) is the reason that the scalp hair is thinning. For a long time, it was believed that excessive production of testosterone (the most important male sex hormone) in women was the reason for the increased hair loss. However, this is only occasionally the case, for example in polycystic ovarian syndrome ( PCO syndrome ).
In contrast, in most women with hereditary hair loss, no increased levels of male sex hormones (androgens) can be detected. Rather, they seem to be caused by a reduced activity of the aromatase enzyme and a genetically caused hypersensitivity of the hair follicles to androgens:
Aromatase on the female hair follicles converts male to female sex hormones (estrogens). The reduced enzyme activity in women with hereditary hair loss means, on the one hand, that the concentration of male sex hormones on the hypersensitive hair follicles increases. On the other hand, less female hormones (estrogens) are formed locally , which are said to have a beneficial effect on hair growth. Overall, this results in hair loss.
In the women concerned, the hair loss manifests itself in a general thinning of the scalp hair, mainly in the parting of the head. As a result, the scalp can be seen due to the thinning hair. In some women, hair loss also affects the front of the head, causing baldness to develop (as in men with this type of hair loss).
Instead, some women have circular, bald spots on the head or other hairy parts of the body. Then there is circular hair loss (alopecia areata). It has other causes. In severe cases, all body hair can 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 in the immune system erroneously attack the body’s own healthy tissue – 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
With diffuse hair loss, hair loss occurs evenly all over the head. There are many possible causes for this. Here are the main ones:
Certain medications are often the trigger for excessive hair loss. These include, for example, cytostatics (anti-cancer drugs), anti- thyroid drugs ( thyroid drugs), beta-blockers (for heart diseases), lipid-lowering agents (for increased blood lipid levels ), anticoagulants (anticoagulants), vitamin A preparations and the gout agent allopurinol . Particularly important for women: Diffuse hair loss is often triggered by the pill (ovulation inhibitor).
In other cases, diffuse hair loss in women (and men) is due to a metabolic disorder. This can be a protein or iron deficiency , for example, as part of malnutrition. Overactive thyroid and underactive thyroid can also be the reason that excessive hair falls out.
In some cases, diffuse hair loss is caused by poisoning, such as with thallium or arsenic.
Chronic course infections (such as tuberculosis ) can also cause diffuse hair loss. Even after an acute, severe infection with a high fever such as flu, your hair can temporarily fall out. The same applies after operations.
Many women complain of increased hair loss after giving birth. You can read more about this in the article Hair loss after pregnancy.
Prolonged or frequent pulling on the hair roots can cause the affected hair to fall out prematurely. This is observed, for example, in women who very often wear a tight ponytail: Here, the hair loss preferably affects the area of the forehead and temples. Here, doctors speak of traction alopecia.
Scarring hair loss
In women (and men) with inflammatory skin diseases or skin damage, hair loss is sometimes caused by damage to the hair roots or scarring on the scalp. This can happen, for example, in lupus erythematosus, lichen ruber planus, scleroderma (a connective tissue disease) or local infections with fungi or bacteria.
Treatment for hair loss in women depends on the cause. For example, if certain medications cause diffuse hair loss, sufferers should speak to their doctor. The dose may be reduced or the treatment switched to an alternative preparation that does less harm to hair growth. If not, hair loss usually returns to normal 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 properly. This can often stop hair loss.
The treatment of scarring hair loss is difficult and lengthy. In lupus erythematosus, for example, cortisone and other active substances that stop the inflammatory processes and thus hair loss can be prescribed to treat the inflamed areas of the scalp. Hair that has already been lost does not grow back because the hair follicles are irretrievably damaged.
Mechanically induced hair loss can be prevented by not subjecting the hair roots to excessive pulling. This means, for example, only tying a ponytail loosely or wearing the hair more often.
A temporary hair fall in women after childbirth, after surgery or infections usually requires no treatment, but returned to normal by itself again.
Hereditary hair loss treatment
Minoxidil is the most effective remedy for hereditary hair loss in women. It is used as a two percent hair tonic twice a day locally on the areas that are becoming lighter. This can stop the progress of hair loss and sometimes even trigger new hair growth. The exact mechanism of action of minoxidil is not known. It probably stimulates blood circulation in the small blood vessels.
Sometimes doctors also prescribe tablets with antiandrogens (such as cyproterone acetate). These are substances that cancel out the effects of male sex hormones. Before the menopause, antiandrogens are used in combination with estrogens as a contraceptive. Pregnancy must be avoided during treatment: in a male fetus, the antiandrogens would disrupt genital development.
If a hormonal disorder like PCO syndrome is behind hereditary hair loss in women, the treatment of the underlying disease is in the foreground.
Extreme hair loss in women (and men) can often only be covered with a hair piece (toupee, wig). Some sufferers also opt for a hair transplant.
Alopecia areata treatment
There are various options for the therapy 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 areas. An allergic contact dermatitis is specifically triggered on the affected skin areas, which is intended to “distract” the misdirected immune system from an attack on the hair root cells.
Overall, the chances of success of the individual treatment options for patchy hair loss are rather modest. In addition, relapses occur more often.
In some cases, the circular hair loss in women (as well as men and children) heals on its own.