Hair Loss in Women

Hair loss is relatively common in women with about 30% experiencing at least some degree of thinning in their lifetime. However, because female hair loss tends to be diffuse (less hair all over) and because women often maintain their frontal hairline their hair loss may not be noticeable, particularly in its early stages.

Hair loss in women is generally very gradual, with the rate accelerating during pregnancy and at menopause. It can also show seasonal variations and it is more easily affected by hormonal changes, medical conditions, and external factors.

Common Causes Of Hair Loss In Women

Common or “hereditary” baldness in women, also called female pattern alopecia, is genetic and can come from either the mother’s or father’s side of the family. It is affected by the actions of two enzymes; aromatase (which is found predominantly in women) and 5-alpha reductase (which is found in both women and men). However, since the diffuse pattern of hair loss typically seen in women can be caused by a number of medical conditions other than common genetic hair loss, a thorough evaluation is particularly important for female patients. If an underlying medical cause can be found and treated, the hair loss can often be reversed.

Classification of Female Hair Loss

The common diffuse pattern of female hair loss caused by heredity is organized by the degree of thinning. This system of classification for hair loss in women is called the Ludwig Classification. Hair loss in the Ludwig system is labeled as being mild, moderate and extensive.

Female hair loss can be classified into three different types using the Ludwig Scale.
Type 1: Hair loss is the least severe with thinning on the top of the scalp.
Type 2: Hair loss is more severe with several areas of the scalp showing significant thinning
Type 3: Patient has complete hair loss of the crown of the scalp. Donor hair will be required to obtain full hair coverage.
 

Diagnosis of Hair Loss in Women

The diagnosis of “female pattern” hair loss is relatively straightforward when there is a history of gradual thinning in the front and/or top of the scalp, a relative preservation of the frontal hairline, a positive family history of hair loss and the presence of miniaturization in the thinning areas. Miniaturization, the progressive decrease of the hair shaft’s diameter and length in response to hormones, can be identified using a hand-held device called a densitometer.
Besides densitometry, two other common diagnostic tests that can be performed in the physician’s office are the hair-pull (a test for shedding) and the hair pluck (a test for hair damage). If common causes are ruled out, a more thorough diagnosis is called for, which may include blood work, a biopsy, or other laboratory testing.

Treatment

Medication

Rogaine (minoxidil), a topical hair loss medication, has a 2% solution that is approved for women. Although Propecia (finasteride), is not indicated for women, some female patients with hair loss may benefit from using the oral medication spironolactone (used mainly to control blood pressure).

Laser Therapy

Low-Level Laser Therapy (LLLT) is a treatment for hair loss based on the principle of photo-biotherapy where a laser stimulates hair follicles on the scalp producing thicker hair shafts and a fuller appearance. LLLT is most useful in patients with diffuse hair loss (the most common pattern seen in women) although the benefits are generally modest. Two commonly used forms of laser treatment for hair loss are the Laser Comb and the Laser Cap. Both products can be used at home.

Surgical Hair Restoration

The development of surgical hair transplant techniques, particularly Follicular Unit Transplantation (FUT), allows many women to have a completely natural hair restoration. When performed on a good candidate, hair transplantation can produce a dramatic change in a woman’s appearance. It is particularly important for any women considering a surgical solution, to have a careful physical examination to make sure that the diagnosis is correct and to determine that they have an adequate donor hair supply.