Hair Loss in Women

Hair loss – Increased daily hair loss is called “effluvium”; visible hairlessness is called “alopecia”, which can be diffuse (all over the head) or focal (small patches), chronic or acute.  

Normal Hair Cycle

A hair follicle has a three-phase life cycle. A growing phase, which lasts 2-5 years (anagen), a dying off phase lasting 3-6 weeks (catagen), and a resting phase, lasting 3-5 months (telogen). Most of the hair is in an anagen phase. During the telogen phase the hair shaft matures into a club hair, and eventually sheds from the follicle. If the percentage of scalp follicles present in the telogen phase increases, this results in excessive shedding of hair.

Types of Hair Loss

Non-scarring types of alopecia refer to hair loss due to changes in hair cycle, hair follicle size, hair breakage or a combination of these, with preservation of the hair follicle.

• Female pattern hair loss – hormone related hair loss which can affect up to 30% of women before the age of 50. Related conditions are insulin resistance, polycystic ovarian syndrome and high testosterone levels.
• Alopecia areata – an autoimmune disorder characterized by transient, non-scarring hair loss and preservation of the hair follicle. Patchy alopecia affecting the scalp is the most common type, affecting nearly 2% of the general population at some point during their lifetime.  Alopecia areata is associated with several concurrent diseases (comorbidities) including depression, anxiety, and several autoimmune diseases including thyroid disease (hyperthyroidism, hypothyroidism, goiter ant thyroiditis), lupus erythematosus, vitiligo, psoriasis, rheumatoid arthritis and inflammatory bowel disease
• Drug related hair loss – Mostly seen in chemotherapy agents but other drugs can cause hair loss in susceptible people. Numerous drugs can cause hair loss and it usually starts after 12 weeks of dosage, these include antibiotics, antidepressants, oral contraceptive pills, androgens, retinoids, beta-blockers, gout medication, NSAID’s, lipid lowering drugs and anticoagulants.
• Telogen elffuvium – diffuse, non-scarring shedding of hair, that involves a sudden loss of 30-50% of hair three months after precipitating traumatic event. Several other factors such as drugs, trauma, and emotional and physiological stress can lead to the development of telogen effluvium. Can be acute, which in 95% of cases hair returns to normal, or chronic in that it has recurring incidences.  A variant of acute telogen effluvium is telogen gravidarum, which some women experience with pregnancy and usually occurs two to five months after childbirth.
• Hypothyroidism – sign of low thyroid function, occurs in approximately 20% of women
• Traction alopecia – Patchy hair loss, related to mechanical damage such as when styling or having too tight a ponytail, wearing a tight hat etc.
• Trichotillomania – Patchy hair loss, related to pulling hair, may have some scarring, defined as an impulse control disorder in which people fail to resist urges to pull out their hair, and is associated with psychological disturbance or distress.

Scarring types of alopecia refer to forms of hair loss in which hair follicles are destroyed owing to inflammation, or rarely, malignancy. Affected skin shows loss of follicular ostia (the openings of the hair follicle though which the hair fiber emerges through the skin), but the early stages might resemble alopecia areata.

• Lichen planopilaris – a chronic inflammatory disease that causes permanent hair follicle destruction typically characterized by patchy hair loss on the scalp, sometimes with non-infectious itchy rash.
• Frontal fibrosing alopecia – type of lichen planopilaris, but with a different pattern of hair loss (in the frontal and frontotemporal hair line and eye brows), typically affecting postmenopausal women.
• Chronic cutaneous lupus erythematosus -a subtype of lupus erythematosus that presents with a symptomatic patch that evolves into scaly, indurated papules and gradually forms ill-defined, irregular or round plaques with variable atrophy, follicular plugging, telangiectasia and depigmentation.

Common Causes of Hair Loss

• Nutrient deficiencies – Hair is considered to be a connective tissue similar in composition to skin, fingernails, toenails and other connective tissue.  Nutrients required for healthy hair are B-complex vitamins, vitamins A, C, D and E, biotin, sulfur, calcium, magnesium, zinc, bioavailable copper, selenium, iron, essential fatty acids, amino acids and antioxidants.
• Low protein in the diet – Protein malnutrition, can result in the body “sacrificing” the hair because it is a less essential tissue of the body resulting in hair thinning and hair loss
• A copper imbalance – Copper is required for connective tissue integrity, which includes the proper structure and function of the hair.
• Low thyroid– low thyroid causes dry, brittle and hair loss,
• Elevated tissue sodium, especially in relation to potassium – an observation seen on some HTMA (hair mineral analyses).  An elevated sodium level is associated with in inflammation, inflammation can damage the hair follicles which results in hair loss.
• Impaired circulation to the scalp – A good blood supply in necessary to keep the hair follicle healthy and nourished with the nutrients it needs.
• Oxidative stress – Preemergent hair can be negatively impacted by the oxidative stress that occurs with an unhealthy scalp.
• A toxin –  Numerous toxic agents have been implicated in alopecia, toxic levels of thallium and colchicine have long been established to cause alopecia, others include arsenic, selenium, and botulinum toxin.
• High androgens – Women should undergo further laboratory testing (DUTCH) depending on the history and other evidence of hormone dysregulation (acne, hirsutism, insulin resistance etc).
• Stress – Stress of any type such as lack of rest, fear, worry, financial problems or other can cause hair loss.

Correcting the factors above will usually stop hair loss.  The most reliable way to stop hair loss, in my experience, is with a properly designed nutritional balancing program based on the results from your HTMA (Hair tissue mineral analysis). Order your test here or book in to see Denise in clinic.