Female Hair Loss and PCOS
About 15% of American women have hair loss, also known as alopecia or baldness. Loss usually develops gradually and may be patchy or diffuse (all over). In women, androgenic alopecia is probably the most common.
Loss of hair is more than a minor cosmetic problem. It has the potential to make you feel vulnerable (naked), and can cause unfavorable changes in how you feel about yourself.
Roughly 100 hairs are lost from your head every day. The average scalp contains about 100,000 hairs. Hair grows from its follicle at an average rate of about 1/2 inch per month. Each hair grows for 2 to 6 years, then rests, and then falls out. A new hair soon begins growing in its place. At any one time, about 85% of the hair is growing and 15% is resting.
Loss of hair or baldness occurs when hair falls out but new hair does not grow in its place.
Causes of Hair Loss in Women
The cause of the failure to grow new hair is not well understood, but in the case of women with PCOS (polycystic ovarian syndrome), excessively high levels of androgens (male hormones) are thought to be primarily responsible.
A male hormone called dihydrotestosterone (DHT), which is converted from testosterone, binds to sites on hair follicles and appears to make the follicles go into their "resting" phase sooner, which in turn starts to cause the hairs produced by those follicles to become thinner and thinner with each growth cycle.
Women with high or increasing levels of androgens, such as women with PCOS or who are menopausal, may find that the hair on the head is thinned, while facial hair is coarser. Although new hair is not produced, the follicles remain alive, suggesting the possibility of new hair growth.
It appears that sex hormone imbalances or fluctuations are responsible for most female hair loss, including those who have PCOS, recent pregnancy, menopause, postmenopausal trauma, or birth control side effects.
"Androgenic alopecia" is hair loss due to a male hormone imbalance, and is probably the most common cause for hair thinning and loss in PCOS women.
However, androgenic alopecia is not to be confused with estrogenic alopecia, which is due to a fall in estrogens.
In contrast to testosterone, estrogen helps hair grow faster and stay on the head longer, resulting in thicker hair. This is the reason women’s hair gets fuller during pregnancy when estrogen levels are quite high, then sheds several weeks after the baby is born. Estrogen-deficiency alopecia generally starts around menopause. Because estrogen levels start to fall before periods stop, this form of female hair loss can be the first sign of approaching menopause. But sometimes the alopecia does begin until a few months or even a few years after menstruation has ended. Not all women get noticeable alopecia after menopause but most have at least mild thinning.
Many PCOS women also have thyroid problems, usually hypothyroidism (low thyroid function). Not only does hypothyroidism contribute to weight problems, it can also contribute to hair thinning. Some women with PCOS have both an excessively high level of testosterone and an underactive thyroid. It's not uncommon to have multiple factors involved in female hair loss.
Insidious poisoning with heavy metals such as lead, mercury or cadmium can show up as hair thinning. Sources are everywhere in the environment. Be particularly interested in this if you have lived near a mining site, or worked or lived with someone who works in an industry that uses metals. If you smoke tobacco, you get a lot of cadmium. A hair analysis can indicate abnormally high levels of these heavy metal toxins. If you want a hair analysis, or have high levels of metals showing up in a hair analysis, consult with a naturopathic physician.
Other possible contributors to female hair loss or hair thinning in women may include:
- Anemia
- Any hypothalamic or pituitary disorder (glands in the brain)
- Any thyroid, liver, adrenal or ovarian disorder
- Childbirth
- Drug toxicity - anesthesia, chemotherapy
- Eating disorder - anorexia, bulimia
- Essential fatty acid deficiency
- Protein deficiency (common with vegetarian diets)
- Severe infection
- Severe stress
- Starting or stopping birth control pills
- Various medications, including bromocriptine, beta blockers, ACE inhibitors, amphetamines, anticholesterol agents
- Mineral or vitamin deficiency - zinc, manganese, iron, vitamin B6, biotin
- Perms, hair color, bleach, improper brushing/combing, hair styles that pull on the hair
- Autoimmune disease such as lupus
- Any sex steroid imbalance such as low progesterone, estrogen dominance
- Allergies
- Recent hepatitis B shot.
Female Pattern Baldness
The typical pattern of female pattern baldness is different from that of male pattern baldness. The hair thins all over the head, but the frontal hairline is maintained. There may be a moderate loss of hair on the crown, but this rarely progresses to total or near baldness as it may in men.
Symptoms of Female Hair Loss
The main symptoms are:
- Thinning of hair over the entire head
- Mild to moderate hair loss at the crown or hairline.
The hair loss of female pattern baldness or severe thinning may be permanent.
Female Hair Loss Treatments
Minoxidil (Rogaine)
The only drug or medication approved by the FDA to treat female pattern baldness is minoxidil, used topically on the scalp. For women, the 2% concentration is recommended. Minoxidil may help hair to grow in 20% to 25% of the female population, and in the majority it may slow or stop the loss of hair. Expect to wait 6 months before you see results. Treatment is expensive. Hair loss recurs when minoxidil is stopped.
Finasteride (Propecia, Proscar)
Finasteride is effective for treating hair loss in some men. It has a testosterone-blocking action similar to saw palmetto. Some women may take finasteride for female hair loss or hirsutism. Several studies have shown that saw palmetto is as effective as finasteride in men.
Hair Transplants
Hair transplants consist of removal of tiny plugs of hair from areas where the hair is continuing to grow and placing them in areas that are balding. This can cause minor scarring in the donor areas and carries a modest risk for skin infection. The procedure usually requires multiple transplantation sessions and may be expensive. Results, however, are often good and permanent.
Suturing of hair pieces to the scalp is not recommended as it can result in scars, infections, and abscess of the scalp. The use of hair implants made of artificial fibers was banned by the FDA because of the high rate of infection.
Hair weaving, hairpieces, or change of hairstyle may disguise female hair loss and improve cosmetic appearance.
Natural Hair Loss Remedies
A recent experiment with human hair at the University of Lubeck in Germany showed that l-carnitine promotes hair growth. Exposure to carnitine stimulated hair shaft elongation and reduced hair cell death in this study. The authors of this study conclude, "Our findings suggest that L-carnitine stimulates human scalp hair growth..." They further encourage one to explore l-carnitine "…as a well-tolerated, relatively safe adjuvant treatment in the management of androgenetic alopecia and other forms of hair loss."
B-vitamin deficiencies are common. Some people, especially people who are blood type A, do not absorb B vitamins very well from food. In particular a vitamin in the B family called biotin is crucial for proper hair and nail growth. In high doses, 5-8 grams (5000-8000 mg) daily of biotin can be effective in restoring head-hair growth, with no known side-effects. Some specialty shampoos feature biotin for this reason.
Saw palmetto is a natural substance that inhibits the action of testosterone, the hormone primarily responsible for female hair loss and hirsutism.
Frequent shampooing is advised if you have an oily scalp with thinning hair. These surface oils contain high levels of testosterone, which can re-renter the skin and affect the hair follicle.
A deficiency in essential fatty acids may result in dry, brittle hair, and possibly hair thinning or loss. The omega-3 fatty acids are especially important, such as those found in fish oil.
A deficiency in manganese or other minerals may contribute to hair loss, so you'll want to make sure you're eating a very healthy diet or taking a multi-vitamin/mineral supplement.
A healthy diet, as described in The Natural Diet Solution for PCOS and Infertility, is crucial for correcting the underlying hormonal imbalances that lead to hair loss and hirsutism.
Get Help from a Knowledgeable Physician
The final component of your natural approach to dealing with hair loss and PCOS is to consult with a qualified and knowledgeable physician.
A knowledgeable medical or naturopathic doctor will also want to carefully evaluate your organ systems, since any disorder of the ovaries, adrenals, pituitary, hypothalamus, liver, thyroid or GI tract may contribute to female hair loss.
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