Hair Loss in Women

Hair Loss in Women

By Suzanne Fenske, MD, FACOG, ABOIM, MSCP

It’s normal to have some hair loss each day, and with millions of hairs on your head, losing 50 or even 100 hairs daily doesn’t have much impact. But when a few hairs on your brush turn into handfuls, and your drain starts getting clogged, it doesn’t take long for hair loss to affect how you look and feel.

Hair loss doesn’t mean you need the latest supplement or shampoo (although sometimes changing these can be helpful); it’s often a symptom that something deeper is going on. Think of it as a message from your body.

In integrative medicine, we take a root cause approach. By understanding the root cause (or causes) of each woman’s hair loss, we can tailor the treatment approach to her specific needs, restoring a natural hair cycle.

Today’s article will discuss some of the root causes of hair loss in women and help you take action if or when you experience this symptom. Keep reading as we explore:

• The hair cycle explained
• Hair loss and nutrient deficiencies
• Hair loss and hormonal shifts or imbalances
• Hair loss and stress
• Hair loss and autoimmunity
• Integrative solutions for hair regrowth

Hair Structure and Cycle

Each strand of hair has two structures: the shaft and the follicle. The shaft is non-living and composed of keratinized epithelial cells (keratin is a protein). The hair follicle is part of the skin’s structure from which new hair grows.

In a normal hair pattern at any given time, most of your hair is growing, and some of it has stopped growing and sheds as new hair grows below. This cycle happens in three primary phases:

• Anagen phase – This is the phase of active hair growth. Most of your hair follicles, around 85%, are in this phase at any given time, and can remain in the anagen phase for 2 to 7 years.

• Catagen phase – This is a transitional phase following the anagen phase, where the follicle detaches from the blood supply. It only lasts a couple of weeks, and less than 1% of hair is in this phase at a time.

• Telogen phase – This is the resting phase. Hair isn’t actively growing; the follicle is dormant. At the end of the phase hair sheds, as new hair grows from the follicle below. The telogen phase lasts 3 to 4 months, and about 10-15% of hair is in this phase at any given time.

Understanding hair structure and its cycle helps us understand why certain factors increase shedding and hair loss.

Hair Loss and Nutrient Deficiencies

Vitamin and mineral deficiencies can be a cause of hair loss, and this is what you’ll find targeted in all the hair growth supplements marketed to women online. But don’t be fooled. A specific nutrient (like biotin) will likely only support hair growth if your body needs more of that nutrient.

Biotin gets the most attention for its role in hair growth because biotin deficiency causes hair loss (and skin rashes and brittle nails), but all B vitamins are essential for follicle support. Biotin is widespread in protein-rich foods and is not a common deficiency in Western countries. Deficiency may occur for genetic and dietary reasons, and in these cases, supplementation may be supportive.

Note: Biotin supplementation can interfere with hormone lab testing. Discontinue biotin supplements (found in B complexes, multivitamins, and hair growth formulas) a few days before blood tests.

Iron deficiency, on the other hand, is a common worldwide deficiency that primarily affects women. Without enough iron, the hair follicle may not receive an adequate supply of oxygen required for cellular function, leading to hair loss. Iron is a nutrient that you don’t want to supplement unless you need it because too much can be inflammatory and harmful.

Vitamin D is another nutrient to consider for hair loss, as it’s required for the growth of keratinocytes (cells that produce keratin, the protein that forms hair). Vitamin D is also essential for immune regulation, playing a role in autoimmune hair loss (see below).

Hormone Changes or Imbalances

Hair loss often coincides with times of hormonal changes, such as postpartum and perimenopause. During pregnancy, hair growth accelerates, but the postpartum drop in hormones can increase the telogen (resting) phase and increase hair shedding. In this case, hair loss tends to be temporary.

Let’s explore a couple of hormonal patterns that may be the root cause of hair loss in women.

First, elevated or imbalanced androgens contribute to female pattern hair loss (female androgenic alopecia), in which hair thinning occurs at the crown of the head or temples. Typically, the front hairline remains intact, but the hair part may become wider.

Female pattern androgenic hair loss can occur in polycystic ovary syndrome (PCOS) when testosterone and other androgens are high. One study found this type of hair loss in 22% of subjects with PCOS.

Second, thyroid hormones play a role in hair growth and maintaining a healthy hair cycle. Both hypothyroidism (low thyroid hormone levels) and hyperthyroidism (high thyroid hormone levels) can contribute to widespread hair shedding on the head and other parts of the body, including the eyebrows. Up to 50% of people with thyroid conditions may experience hair loss. Thyroid disorders disproportionately affect women.

Perimenopausal Hair Loss

Perimenopause is another life phase that affects hair. It’s a time of estrogen fluctuation, decline, and recalibration, which can affect other hormonal systems, including the thyroid.

While perimenopause isn’t characterized by high testosterone, as estrogen and progesterone fall, there can be a relatively higher amount of testosterone or other androgens. This shift towards “androgen dominance” may drive hair loss in women and can occur even when hormone testing looks “normal.”

Additionally, perimenopausal hormonal changes, especially declining estrogen levels, can alter  hair follicle function and growth cycles. It’s common for women to experience changes in hair texture and volume during this time.

Autoimmune Hair Loss

Alopecia areata is a condition where the immune system attacks hair follicles, causing sudden hair loss that may occur in patches or cause total hair loss on the head (alopecia totalis) or body (alopecia universalis).

Autoimmune diseases are multifactorial and caused by a combination of genetic and environmental factors that differ from person to person. In autoimmune cases, we want to address the root causes and support a balanced immune system. The treatment approach may be quite different from that for other causes of hair loss.

Stress Triggers Hair Loss

Stress can disrupt the hair cycle leading to excessive hair shedding called telogen effluvium. Telogen effluvium involves an increase in the amount of hair in the telogen (resting) phase and less hair in the anagen (growth) phase. Furthermore, increased levels of the stress hormone cortisol also contribute to hair loss.

Telogen effluvium is triggered by significant stress on the body, such as metabolic stress, hormonal changes, medication use, poor sleep, and inflammation. Viral infections can also trigger stress-related hair loss, as many women have experienced after a Covid infection. One study reports 61% of patients experienced increased hair loss after a Covid infection.

The good news is that this type of hair loss is temporary.

Integrative Approach to Healthy Hair

From an integrative perspective, we not only want to identify the root cause of hair loss, but also prevent it in the first place by adopting healthy lifestyle behaviors, including personalized nutrition, stress management, and hormonal support. Annual check-ins and lab work with TārāMD can help detect imbalances early, even before symptoms arise.

If you are experiencing hair loss now, the next step is to uncover the root cause through a detailed health history and lab testing. We’ll look at a full thyroid panel, estrogen, progesterone, androgens, a full iron panel with ferritin, vitamin D, and other relevant nutrients and markers.

With the information we gather, we can target treatment strategies to address your specific cause(s) of hair loss. It can take some time for hair to regrow; however, with an integrative approach, you’ll get much faster and better results than blindly throwing new supplements, shampoos, or other products at the issue.

Let TārāMD help you on your journey back to lush, radiant hair!

References

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