Undetected medical conditions can be to blame—but effective treatments are available.

The term “hair loss” often conjures up images of older, balding men. But women make up at least 40% of American hair loss sufferers.

What causes this problem in women? A combination of fluctuating hormone levels, drug side effects, stress, aging and general health issues are often to blame.

My story: My interest in hair loss stems, in part, from my own experience. After developing an incurable type of hair loss myself, I have dedicated myself to finding the most effective treatments possible for women.

WHAT’S NORMAL?

It’s normal for a woman to lose, on average, 50 to 100 strands of hair a day. However, if you notice any increase in hair loss that persists for more than a month, it’s time to visit your primary care doctor.

Blood tests will be given to check your iron stores and thyroid hormone levels (anemia and hypothyroidism or hyperthyroidism can trigger hair loss). If blood tests do not indicate an underlying medical condition, your doctor can refer you to a dermatologist.

TYPES OF HAIR LOSS

Common types of hair loss in women include…

  • Telogen effluvium (TE). At any given time, about 90% of the hairs on your head are in a growing phase. The rest of the hairs are in the “telogen,” or resting, phase—and that’s when they shed.

Sometimes, though, a stressful event (for example, the death of a loved one, a divorce, surgery or crash diet) causes more hairs to enter the resting phase. This rarely leads to true baldness but sometimes results in up to three times more shedding than usual.

This type of hair loss—which, at its peak, can cause you to lose handfuls of hair or, in less severe forms, clog the shower drain—typically occurs within a few weeks of the stressful event. In some cases, however, there can be a delay of up to three months.

Medication, such as blood pressure drugs (especially beta-blockers), cholesterol-lowering drugs and antidepressants, can cause TE. Over-the-counter products, including diet pills and excess vitamin A or zinc supplements, are also common culprits.

Diagnosis: TE is diagnosed with a “hair pull.” When performing this test, I give a gentle, yet firm, tug to about 40 of a patient’s hairs. In women with healthy scalps, no hairs—or just one or two—comeout. In women with TE, I might get six or seven.

Treatment: If there is an ongoing underlying medical condition, such as anemia or a thyroid problem, correcting it usually stops the hair loss. If medication is the cause, the dosage may be reduced or another drug may be substituted. If no underlying medical cause exists and it’s just stress, TE usually resolves on its own within six months. Getting support after a stressful event that triggered hair loss can sometimes help, too.

In the meantime, topical minoxidil 2% (Rogaine), applied twice a day, helps keep hair in the growing phase. Side effects may include an itchy rash on the scalp. Since most cases of TE are temporary, minoxidil can usually be stopped within a year. If excessive shedding lasts longer than six months, then long-term use may be necessary.

  • Androgenetic alopecia. Also known as female-pattern hair loss, this is a gradual, diffuse thinning of hair at the crown of the head.

As with male-pattern baldness, androgenetic alopecia in women often occurs when there is a family history of hair loss (in a female or male relative). Female-pattern baldness, which affects 20% to 40% of American women, may worsen after menopause due to declining levels of estrogen and a relative increase in testosterone (the condition is linked to male hormones known as androgens).

Diagnosis: In addition to taking a clinical history and asking about your family’s hair loss, your doctor may perform a scalp biopsy to look for smaller-than-normal hair follicles—a sign of androgenetic alopecia.

Treatment: Minoxidil, applied topically, twice daily. Because female-pattern baldness is progressive, continued treatment is usually required. Your doctor may also prescribe the diuretic spironolactone (Aldactone), which is typically used to treat high blood pressure. The pill, which is not FDA-approved for hair loss, blocks certain male hormones.

Caution: Talk to your doctor if you have a personal or family history of any type of cancer. Spironolactone has been shown in animal studies to significantly increase cancer risk.

  • Alopecia areata. This condition, which affects at least one million American women, is characterized by patches of hair loss that can affect the entire scalp or body. It is thought to be an autoimmune disorder in which the immune system attacks hair follicles. A certain combination of genes may predispose some people to alopecia areata. Hair usually grows back by itself within six months. However, women who lose their hair at an early age due to this condition are more likely to have extensive hair loss long-term.

Diagnosis: A clinical examination and possibly a scalp biopsy.

Treatment: Monthly cortisone injections or a topical steroid, applied to the skin daily, may halt the inflammation that usually accompanies alopecia areata and help the hair grow back.

For more diffuse hair loss caused by alopecia areata, contact immunotherapy can be used. With this procedure, a compound (squaric acid) is applied topically (initially by your dermatologist, followed up by you at home) to induce an allergic reaction (a mild, itchy, eczema-type rash) that is thought to “distract” your immune system from attacking your hair.

The procedure works in about 40% of cases, with new hair growth usually occurring in six months. Insurance typically covers the cost. Side effects may include an itchy rash and swelling.

Wigs, hair extensions and/or hair pieces are another option. There are also products that, when sprinkled on, stick to the remaining hairs and scalp to camouflage bald spots.

In cases of extensive hair loss, some women find it acceptable—and sometimes liberating—to go bald.