Hair Loss in Women: Recognizing and Treating the Causes.

In women, hair loss usually shows differently than in men. Instead of a receding hairline or bald patches, the hair slowly becomes thinner across the whole head. The middle part looks wider, the ponytail thinner, the fullness decreases. Over the course of life (up to around age 70), hereditary hair loss affects around 40% of women¹, and alongside it there are further, often temporary causes.

In my consultations I often see how much thinning hair weighs on women and how much uncertainty comes with it about whether anything helps at all. In many, the trigger can be narrowed down well, and many forms are treatable, especially when you look early. Which causes are possible, when a medical assessment makes sense and what actually helps, you can read here.

How hair loss shows in women

Unlike the typically male pattern, clearly defined bald patches rarely develop in women. Instead the hair thins diffusely, usually most strongly in the area of the middle part. A good everyday sign is the part itself: when it gets wider and the scalp shows through more, an incipient thinning is often behind it. The hairline at the forehead usually remains intact.

This also explains why hair loss in women is often recognized late. Where in men a receding hairline or a bald spot at the back of the head catches the eye early, women's hair slowly loses fullness across the whole area. A complete loss like in the pronounced male pattern is the absolute exception in women. All the more helpful, then, to take your own observations seriously and not wait for a clearer sign.

A certain daily loss is completely normal, as long as fallen hairs are replaced by new ones. Around 50 to 100 hairs per day are considered normal.² It becomes noticeable when significantly more falls out over weeks, when you have handfuls of hair in your hand while washing or combing, or when the ponytail and part visibly lose fullness. It is precisely these everyday observations that first alert most women, often long before others notice anything.

The most common causes in women

Hair loss in women rarely has just a single cause. Often several factors come together, for example a genetic predisposition plus a hormonal change or a nutrient deficiency. For treatment it is decisive which cause is in the foreground, because that determines what helps.

Telogen effluvium: diffuse, usually temporary loss

In telogen effluvium, many hairs switch prematurely into the resting phase at the same time and fall out together some weeks to months later. The loss is diffuse, spread across the whole head, and often sets in with a time lag from the actual trigger. Typical triggers are:

• After childbirth: The drop in estrogen levels after pregnancy leads in many women to increased loss in the postpartum period and the months afterward.
• Severe stress or distressing events: ongoing psychological or physical strain.
• Illness, fever or an operation: In such phases the body scales back other functions; hair growth often reacts with a delay.
• Thyroid disorders: an overactive or underactive thyroid.
• Strict diets: above all one-sided crash diets with rapid weight loss.
• Certain medications and stopping the pill: hormonal changes or individual active ingredients can shift the hair cycle.

A telogen effluvium is, as a rule, temporary. Once the trigger is resolved, the hair usually grows back on its own, often over several months.

Hereditary hair loss in women

Hereditary hair loss, medically androgenetic alopecia or female pattern hair loss, is genetically determined. With the corresponding predisposition, the follicles react sensitively to androgenic hormones; unlike in men, the androgen levels are often normal. The follicles shrink over the years and produce finer, shorter hair. In women this affects above all the crown area, while the forehead hairline usually remains. This form progresses slowly and increases in many women around menopause, when the protective influence of the female hormones wanes.

Nutrient deficiencies and hormonal factors

The nutrient balance also plays a role. Best documented is a pronounced iron deficiency, readable among other things from the storage iron ferritin, which is linked to increased hair loss. For vitamin D the data is weaker and contradictory. In both cases the same applies: a correction helps above all when a deficiency is actually proven. A special diet, on the other hand, cannot stop hereditary hair loss.¹

In addition there are hormonal changes. Besides the time after childbirth and menopause, polycystic ovary syndrome (PCOS) with elevated male hormones can play a role. Such connections can only be clarified with a medical assessment and, if necessary, a blood test.

Less often, scarring forms of hair loss or diseases of the scalp are behind it. They destroy the hair follicles permanently and should always be clarified medically without delay, because here every month counts.

When should you see a doctor?

Not every increased loss needs treatment straight away; many temporary phases settle on their own. A medical assessment is advisable, however, when the loss persists over several weeks, when the part or hair density visibly decreases, when the loss sets in suddenly and heavily, or when additional complaints such as fatigue, weight changes or menstrual cycle disturbances come on top.

In the assessment, the first aim is to narrow down the cause. A blood test is often part of it in women and looks at, among other things, iron and ferritin, the thyroid values and, depending on the situation, the hormonal picture. This makes it possible to identify a treatable deficiency or a thyroid disorder that can be tackled in a targeted way.

What helps in women

Which treatment makes sense depends on the cause. This is why the assessment always comes before therapy, and with us too every treatment begins with this medical assessment. A rough overview of the routes:

• Treat the cause: If an iron deficiency or a thyroid disorder is present, correcting it comes first. After a telogen effluvium the hair usually grows back on its own once the trigger is gone. Here patience is often the most important treatment.
• Topical minoxidil: This solution or foam for applying to the scalp is approved in women for hereditary hair loss and available without a prescription. Minoxidil extends the growth phase of the hair and can improve density in some users.³ It requires regular use and several months of patience before anything shows. In pregnancy and breastfeeding, use is to be clarified medically and is generally not recommended.
• Oral minoxidil: The tablet form of the same active ingredient is used off-label in affected women, that is, outside the official approval, and is prescription-only. It belongs in medical hands. In pregnancy and breastfeeding it is not used.⁵ You can read more about this in the article Oral minoxidil.
• Antiandrogens: Active ingredients that counteract the effect of male hormones are considered as a systemic option, off-label and only under medical supervision. In pregnancy there is a risk to a male fetus because of the antiandrogenic effect, so reliable contraception is necessary; in breastfeeding too they are not used. The medical health questionnaire clarifies this in advance.

One active ingredient frequently used in men is explicitly not the standard solution for women: finasteride. For women who are pregnant or could become pregnant, the active ingredient is contraindicated, because it can disrupt the genital development of a male fetus.⁴ How finasteride works is explained factually by the article Finasteride and how it works. Which option is right in your case is not a decision for a questionnaire, but a medical judgment that takes into account your cause, prior illnesses and your life situation. A broader overview of causes and treatment routes is given by the article Understanding hair loss.

How long does it take for something to work?

Hair grows slowly, and even the best treatment changes nothing about that. First visible changes usually appear only after three to six months; a reliable assessment often succeeds only after six to twelve months of regular use. In the first weeks the loss can even temporarily increase, while older hairs make way for new ones.

In hereditary hair loss, the drug therapies work as long as you use them. They maintain the condition and can often improve it, but are not a one-time cure. If you stop them, the effect achieved wears off again over several months. With telogen effluvium it is different: once the trigger is resolved, the recovery usually carries itself.

How we approach it

With us you answer medical questions about your health and your hair loss online, at your own pace. Our doctors review your information for suitability and possible contraindications and assess which clarification or treatment fits your situation. They only prescribe a treatment if it is medically suitable; a prescription is not guaranteed. Dispensing is handled by a pharmacy; on request the partner pharmacy delivers discreetly to your home, but you can just as well fill a prescription at a pharmacy of your choice. How the medical review works exactly and which information is important for it, you can read in the article How the health questionnaire works.