Female pattern hair loss in women: Understanding, Causes and Treatments

Female pattern hair loss (FPHL) is a common form of non-scarring hair loss in adult women. This condition is often characterized by the progressive loss of hairs over the front and top regions of the scalp – resulting in a visible reduction in hair density. This condition is often very distressing to women, and often induces depression, poor body image, and low self-esteem.

The clinical term for this condition is ‘androgenetic alopecia’ – and is often caused by the excessive action of male hormones known as androgens. 

What's Inside?

Mechanics – Life Cycle of Hair

Each hair develops from a follicle — a narrow pocket in the skin — and goes through three phases of growth. 

Anagen (A), the active growth phase, lasts two to seven years.

Catagen (B), the transition phase, lasts about two weeks. During this phase, the hair shaft moves upward toward the skin’s surface, and the dermal papilla (the structure that nourishes cells that give rise to hair) begins to separate from the follicle. 

Telogen (C), the resting phase, lasts around three months and culminates in the shedding of the hair shaft.

Androgenetic Alopecia is often determined by the shortening of the anagen – a hair’s growing phase, and lengthening of the time between the shedding of a hair and the start of a new anagen phase. In easier words – it takes longer time for new hair to grow and replace the shed hair in the course of the normal hair-growth cycle.

The hair follicle itself changes – shrinking and producing a shorter, thinner hair shaft. This process is called ‘follicular miniaturization’. Thicker, pigmented, durable ‘terminal’ hairs are replaced by shorter, thinner, non-pigmented hairs called ‘vellus’.

Causes and Diagnosis

The condition may be inherited or genetic. Certain endocrine conditions can also be the cause – such as excessive androgen production, due to an androgen-secreting tumor on the ovary, pituitary, or adrenal gland. Some other causes maybe hyperthyroidism, hypothyroidism, and iron-deficiency. 

A clinician diagnoses this condition by making note of the patient’s medical history and examining the scalp-condition. He/She/They will observe the pattern of hair-loss, and check for signs of inflammation or infection, and possibly order blood-tests to investigate other causes based or thyroid-malfunction or iron deficiency. If there are signs of excessive androgen activity (menstrual irregularities, acne, hirsutism, etc), a hormonal evaluation will be necessary.

Hair Loss Treatment for Women

  • Minoxidil: Initially introduced as a treatment for high blood pressure, this drug actually stimulates hair-growth when directly applied to scalp. As a result, the FDA has approved a 2% over-the-counter solution for hair loss treatment in women. A 5% solution is also available.
  • Anti-Androgens: Drugs such as spironolactone (Aldactone) can cause anti-androgenetic effect to manage excess androgens such as testosterone in women with hyperandrogenism or PCOS. 
  • Iron Supplements: Iron deficiency could be a reason for hair-loss issues in women and can be remedied to a certain extent by using iron supplements. Your doctor may test your blood’s iron level, particularly if you are a vegetarian, have a history of anaemia, or have heavy menstrual bleeding.
  • Hair Transplantation: This is a cosmetic therapy – quite expensive in range. It involve removing a strip of scalp from the back of the head and use to fill a bald patch.