Hair loss and thinning
In the words of Madam CJ Walker, “Hair is power. You can’t imagine what it is like to lose it.” For many women hair is an expression of our identity and personality. Noticing big chunks of hair in your brush or in the drain after washing your hair can certainly be distressing, let alone when you notice bald spots on your head. Generally speaking, anyone can experience hair loss regardless of age, but for most women, Female Pattern Hair Loss (FPHL) begins in her 40s, 50s, or 60s. It is very common with roughly two-thirds of postmenopausal women experience significant thinning hair or hair loss. There are several factors that can cause hair loss during menopause, one of which is the lowered production of estrogen and progesterone; and the increase in the production of androgen. Other reasons include, increased stress levels, deficiency in certain nutrients, or even some medications.
up to 52% of women over the age 50 experience hair loss
Hair loss is not permanent, most times, it can be resolved by addressing the root cause like hormonal imbalance, stress, or nutrient deficiency. There are also prescription medicines available to help you prevent hair loss or stimulate growth, although most treatments require long term use. If you do not want to use conventional medicines, there are other OTC products you can try to make your hair look better.
Why is this happening?
Despite Female Pattern Hair Loss (FPHL) happening to the vast majority of women it is remarkably understudied and it is still not fully understood by the medical community. What we know is that a combination of all hormones play an important role in promoting thick and full hair. As a woman enters peri-menopause two key hormones (estrogen and progesterone) decrease, allowing for another set of hormones called Androgens (this includes testosterone) to be at relatively higher levels which increases their natural effect. Although there is no consensus on the exact role that Androgens play in hair loss, the working theory is that they cause the hair follicles to shrink which in turn leads to actual thinner hair and to hairs falling out more quickly. Androgens also seem to increase the time it takes for a hair to start growing back. Having said all of this, there is still a lot that we don’t know about how hormones including Androgens work in women, how it causes or contributes to hair loss and why some women are more susceptible to it than others.
- In a study by Thai Researchers published in Menopause, it was found that over 52% of women over 50 experienced hair loss; out of these women, 60% also had low self-esteem.
- According to an article published in the British Medical Journal, hair loss most commonly begins at or soon after menopause.
- According to Harvard researchers, about two-third of post-menopausal women suffer from hair thinning and bald spots.
There are a few more things that you should know about hair loss in women:
Other types of hair loss. Aside from hormonal hair loss there are two other types of hair loss that are fairly common for women in this stage of their lives:
- Telogen effluvium: here, too many hair follicles reach the telogen phase, which is the resting phase of the hair follicle cycle. This form of temporary hair loss is usually triggered by stress, shock, or trauma. In many cases, once the stress is removed, your hair will resume growing again.
- Anagen effluvium: this is an abnormal loss of hair in the anagen or growth phase of the hair. Often referred to as chemotherapy-induced alopecia, as it can be triggered by the use of medications like cancer or immunosuppressive drugs that poison a growing hair follicle. This type of hair loss is reversible, and your hair will most likely regrow once therapy is stopped.
Hirsutism. The change in your hormones and possibly the resulting imbalance may also lead to hair growth in unwanted places - thick chin hairs and increased facial vellus hair (peach fuzz) are common. The medical community does not yet understand why triggers this in some women and not in others.
Lastly, there are a slew of non-hormonal factors that may further compound hair loss: stress, illness, medications, poor diet, and a nutrient deficiency. These will be discussed in more detail in sections to follow.
Other impacted areas
In a world where society has an unrealistic standard of beauty that can be very hard to measure up to, battling with hair loss can lead to low self-esteem, which can take a toll on our social life and work.
Diagnosis
It is common to lose up to 100 strands in a day, which may seem like a lot so when do you speak to a doctor? Everyones hair density is different, but in general if you start noticing bald spots or you can see your scalp more clearly through your hair it may be a good time to speak to your GP and ask for a referral to a dermatologist who specializes in hair loss.
Clinicians use the Ludwig Classification to describe female pattern hair loss. Type I is minimal thinning that can be camouflaged with hair styling techniques. Type II is characterized by decreased volume and noticeable widening of the mid-line part. Type III describes diffuse thinning, with a see-through appearance on the top of the scalp. Even for a specialist it may be difficult to determine a singular reason for your hair loss or thinning. So your doctor may need to run a few (blood) tests to check your iron levels, thyroid function, hormone levels and use these results in combination with your medical history to determine treatment.
Possible triggers or risk factors
- Genetics: if your family has a history of hair loss (on either side of the family) you are at an increased risk
- Stress: A study by Harvard University researchers showed a link between stress and hair loss. Stress, anxiety, and trauma can cause you to lose your hair.
- Medical conditions such as celiac disease/ gluten intolerance,, hypothyroidism, iron deficiency, and polycystic ovary syndrome (PCOS)
- Medications: a range of treatments such as chemotherapy drugs, radiation, immunosuppressants, antidepressants and certain antibiotics can cause or contribute to hair loss/ thinning.
Want to speak with a Menopause doctor?
Treatments & remedies
When looking for (OTC) treatments for hair loss focus first on preventing any more hair falling out, otherwise you’re pushing water uphill. This is also what most treatment methods focus on. Once you have that handled you can start looking for products that will support regrowth of hair. To be frank, there are a LOT of products out there that claim to help but don’t have any clinical research backing it and the only thing these products are good for is making your wallet a bit lighter. Keep in mind, these products are poorly regulated by the government if at all. Which means manufacturers take a lot of liberty when making claims about the effectiveness of their products.
This section will explore the various therapies available to manage or treat hair loss ranging from cosmetic camouflages like colored hair sprays, hair transplantation, low-level laser therapy, and prescription or alternative medicines.
Click below to scroll to a specific section
Nutrition
Some studies suggest that deficiencies in vitamin B12 and D, biotin, iron, and zinc are associated with hair loss. It was also found that nutrient deficiency may affect your hair structure and growth. Eating a balanced diet rich in these vitamins may help your hair grow, especially if your hair loss results from poor nutrition.
Exercise
Although evidence is not sufficient, some experts believe exercise can help hair grow because it increases blood flow which can help nourish the hair follicle. In addition, exercise helps to reduce stress which causes a type of hair loss. 15-30 minutes of mild-moderate exercise at least three times per week may already help nourish your hair follicles and is good for your overall health.
Mindset
Researchers from Harvard University have confirmed long-standing research that stress may result in hair loss. Removing stress may help prevent hair loss and promote regrowth. You can practice yoga, exercise, or any other techniques that help you relax.
Supplements
Some common supplements marketed to manage hair loss include:
- Zinc sulfate + calcium pantothenate: this supplement is available over-the-counter and may help you grow your hair if your hair loss is caused by zinc deficiency. One study found that using topical minoxidil and combination zinc and calcium tablets gave better results than using minoxidil alone.
- Iron supplements: Supplementation with iron may restore hair growth in people with anemia and a deficit of iron. However, if your iron levels are normal, you do not need to use this supplement.
- Biotin: These products have been marketed to help grow and thicken hair by stimulating keratin production and also increasing follicle growth. However, findings on its benefits are mixed. While there is very limited evidence on its use in promoting hair growth, it appears to have slight benefits in preventing hair loss. Keep in mind that results are only evident in people who are biotin deficient.
OTC Products
- Topical minoxidil: Minoxidil is a popular drug for the treatment of FPHL. This product helps to slow down or stop hair loss. It may also stimulate new hair growth. However, continuous use of this product is required to continue to see results. Once you stop using it, your hair may start to fall out again.
- Cosmetic camouflages: There are also other ways to deal with hair loss, like using colored hair sprays to cover up thinning areas on the scalp, shortening your hair, using volumizers for bulking up your hair or using a wig and hair extension.
- Low-level laser therapy: These devices are usually available without prescription and are believed to release low-level laser light that helps stimulate hair growth. As with topical minoxidil, you must continue to use this device to see results.
Prescription
Please note that these are non-pharmaceutical treatments that require a doctor's referral, need to be done by an expert and may not be covered by your insurance.
- Platelet-rich plasma (PRP) scalp injection: This treatment is gaining popularity in its use for treating hair loss. Here, platelets are injected deep into the scalp until it gets to the bottom of the follicle and stimulates the dermal papilla cells, which are very important for hair growth. PRP injections are said to be effective in both preventing further hair loss and promoting new growth. However, these Injections are very expensive and quite painful to your scalp. An important caveat to keep in mind is that PRP is still in its investigative stage and hasn’t been officially approved for use in FPHL.
- Hair transplant: Hair transplants have been used to treat hair loss and may be helpful in women with FPHL. However, a hair transplant is not suitable for everyone, especially if you do not have enough healthy hair for the transplant. A plastic hair surgeon will help you assess your suitability for this procedure.
Hormone Treatment
Finasteride: Finasteride is used off-label to treat FPHL, meaning the FDA has not approved it for this purpose. However, Finasteride prevents the conversion of testosterone to dihydrotestosterone, which has been linked to hair loss. One clinical trial found that postmenopausal women who combined minoxidil and Finasteride saw a significant increase in their hair diameter and hair density.
Spironolactone: This medication is a diuretic, also called a water pill, and has been prescribed by dermatologists for decades to treat hair loss. It helps restore hair growth and reduces hair loss in women living with FPHL by slowing down the production of Androgens. One study found that a combination of low dose minoxidil and spironolactone significantly improves hair growth, reduces your hair falling off, and improves your density. However, before using spironolactone, let your doctor know if you have kidney and adrenal gland problems, as this medication can worsen this condition.
Holistic Treatment
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FAQ
What are the symptoms of Menopause?
There are roughly 34 symptoms of Menopause with the most commonly experienced being:
- Irregular periods
- Vaginal dryness
- Hot flashes
- Night sweats
- Fatigue
- Sleep problems
- Mood changes and irritability
- Weight gain
- Thinning hair and dry skin
Medically reviewed and detailed symptom fact sheets can be found here, and a general overview of what (peri) menopause is and entails can be found here.
Is it common for women in Singapore to have hair loss?
Generally speaking, anyone can experience hair loss regardless of age, but for most women, Female Pattern Hair Loss (FPHL) begins in her 40s, 50s, or 60s. It is very common with roughly two-thirds of postmenopausal women experience significant thinning hair or hair loss.
References
Chaikittisilpa, S., Rattanasirisin, N., Panchaprateep, R., Orprayoon, N., Phutrakul, P., Suwan, A., & Jaisamrarn, U. (2022). Prevalence of female pattern hair loss in postmenopausal women: a cross-sectional study. Menopause (New York, N.Y.), 29(4), 415–420.
Choi, S., Zhang, B., Ma, S. et al. Corticosterone inhibits GAS6 to govern hair follicle stem-cell quiescence. Nature 592, 428–432 (2021). https://doi.org/10.1038/s41586-021-03417-2
Fabbrocini G, Cantelli M, Masarà A, Annunziata MC, Marasca C, Cacciapuoti S. Female pattern hair loss: A clinical, pathophysiologic, and therapeutic review. Int J Womens Dermatol. 2018 Jun 19;4(4):203-211. doi: 10.1016/j.ijwd.2018.05.001. PMID: 30627618; PMCID: PMC6322157.
Goluch-Koniuszy ZS. Nutrition of women with hair loss problem during the period of menopause. Prz Menopauzalny. 2016 Mar;15(1):56-61. doi: 10.5114/pm.2016.58776. Epub 2016 Mar 29. PMID: 27095961; PMCID: PMC4828511.
Guo, E. L., & Katta, R. (2017). Diet and hair loss: effects of nutrient deficiency and supplement use. Dermatology practical & conceptual, 7(1), 1–10. https://doi.org/10.5826/dpc.0701a01
Herskovitz, I., & Tosti, A. (2013). Female pattern hair loss. International journal of endocrinology and metabolism. Retrieved July 5, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3968982/
How chronic stress leads to hair loss. Harvard Stem Cell Institute (HSCI). (2021). Retrieved July 5, 2022, from https://hsci.harvard.edu/news/how-chronic-stress-leads-to-hair-loss
Kim KH, Kwon SH, Lee YJ, Sim WY, Lew BL. Efficacy of Finasteride in Female Pattern Hair Loss: A Meta-Analysis. Ann Dermatol. 2021;33(3):304-307. doi:10.5021/ad.2021.33.3.304
Lee, C. Y., Wei, C. C., Yu, M. C., Lin, C. C., Sheu, S. J., Yang, J. H., Chiang, C. Y., Huang, K. H., & Kuan, Y. H. (2017). Hair growth effect of traditional Chinese medicine BeauTop on androgenetic alopecia patients: A randomized double-blind placebo-controlled clinical trial. Experimental and therapeutic medicine, 13(1), 194–202. https://doi.org/10.3892/etm.2016.3935
Lucky AW, Piacquadio DJ, Ditre CM, Dunlap F, Kantor I, Pandya AG, Savin RC, Tharp MD. A randomized, placebo-controlled trial of 5% and 2% topical minoxidil solutions in the treatment of female pattern hair loss. J Am Acad Dermatol. 2004 Apr;50(4):541-53. DOI: 10.1016/j.jaad.2003.06.014. PMID: 15034503.
MEDIZIN, Kosmetische & Schoen, Christiane & Bielfeldt, Stephan & Reimann, Jürgen. (2006). Fenugreek+micronutrients: Efficacy of a food supplement against hair loss. Kosmetische Medizin. 27.
Neera Nathan, M. D., & Maryanne Makredes Senna, M. D. (2020). Platelet-rich plasma: Does the cure for hair loss lie within our blood? Harvard Health. Retrieved July 5, 2022, from https://www.health.harvard.edu/blog/platelet-rich-plasma-does-the-cure-for-hair-loss-lie-within-our-blood-2020051119748
Park SY, Na SY, Kim JH, Cho S, Lee JH. Iron plays a certain role in patterned hair loss. J Korean Med Sci. 2013;28(6):934-938. doi:10.3346/jkms.2013.28.6.934
Patel, D. P., Swink, S. M., & Castelo-Soccio, L. (2017). A Review of the Use of Biotin for Hair Loss. Skin appendage disorders, 3(3), 166–169. https://doi.org/10.1159/000462981
Robert A Schwartz, M. D. (2022). Anagen effluvium. Background, Pathophysiology, Etiology. Retrieved July 5, 2022, from https://emedicine.medscape.com/article/1073488-overview
Salam, A., Tziotzios, C., & Fenton, D. A. (2018). Hair loss is an important symptom of the menopause. BMJ (Clinical research ed.), 360, k245. https://doi.org/10.1136/bmj.k245
Suchonwanit, P., Iamsumang, W., & Rojhirunsakool, S. (2019). Efficacy of Topical Combination of 0.25% Finasteride and 3% Minoxidil Versus 3% Minoxidil Solution in Female Pattern Hair Loss: A Randomized, Double-Blind, Controlled Study. American journal of clinical dermatology, 20(1), 147–153. https://doi.org/10.1007/s40257-018-0387-0
Sinclair R. D. (2018). Female pattern hair loss: a pilot study investigating combination therapy with low-dose oral minoxidil and spironolactone. International journal of dermatology, 57(1), 104–109. https://doi.org/10.1111/ijd.13838
Thinning hair and hair loss: Could it be female pattern hair loss? American Academy of Dermatology. Retrieved July 5, 2022, from https://www.aad.org/public/diseases/hair-loss/types/female-pattern
Umar, S., & Carter, M. J. (2021). A Multimodal Hair-Loss Treatment Strategy Using a New Topical Phytoactive Formulation: A Report of Five Cases. Case reports in dermatological medicine, 2021, 6659943. https://doi.org/10.1155/2021/6659943
Hair loss and thinning
In the words of Madam CJ Walker, “Hair is power. You can’t imagine what it is like to lose it.” For many women hair is an expression of our identity and personality. Noticing big chunks of hair in your brush or in the drain after washing your hair can certainly be distressing, let alone when you notice bald spots on your head. Generally speaking, anyone can experience hair loss regardless of age, but for most women, Female Pattern Hair Loss (FPHL) begins in her 40s, 50s, or 60s. It is very common with roughly two-thirds of postmenopausal women experience significant thinning hair or hair loss. There are several factors that can cause hair loss during menopause, one of which is the lowered production of estrogen and progesterone; and the increase in the production of androgen. Other reasons include, increased stress levels, deficiency in certain nutrients, or even some medications.
up to 52% of women over the age 50 experience hair loss
Hair loss is not permanent, most times, it can be resolved by addressing the root cause like hormonal imbalance, stress, or nutrient deficiency. There are also prescription medicines available to help you prevent hair loss or stimulate growth, although most treatments require long term use. If you do not want to use conventional medicines, there are other OTC products you can try to make your hair look better.
Dr. June Tan Sheren
Why this is happening
Despite Female Pattern Hair Loss (FPHL) happening to the vast majority of women it is remarkably understudied and it is still not fully understood by the medical community. What we know is that a combination of all hormones play an important role in promoting thick and full hair. As a woman enters peri-menopause two key hormones (estrogen and progesterone) decrease, allowing for another set of hormones called Androgens (this includes testosterone) to be at relatively higher levels which increases their natural effect. Although there is no consensus on the exact role that Androgens play in hair loss, the working theory is that they cause the hair follicles to shrink which in turn leads to actual thinner hair and to hairs falling out more quickly. Androgens also seem to increase the time it takes for a hair to start growing back. Having said all of this, there is still a lot that we don’t know about how hormones including Androgens work in women, how it causes or contributes to hair loss and why some women are more susceptible to it than others.
- In a study by Thai Researchers published in Menopause, it was found that over 52% of women over 50 experienced hair loss; out of these women, 60% also had low self-esteem.
- According to an article published in the British Medical Journal, hair loss most commonly begins at or soon after menopause.
- According to Harvard researchers, about two-third of post-menopausal women suffer from hair thinning and bald spots.
There are a few more things that you should know about hair loss in women:
Other types of hair loss. Aside from hormonal hair loss there are two other types of hair loss that are fairly common for women in this stage of their lives:
- Telogen effluvium: here, too many hair follicles reach the telogen phase, which is the resting phase of the hair follicle cycle. This form of temporary hair loss is usually triggered by stress, shock, or trauma. In many cases, once the stress is removed, your hair will resume growing again.
- Anagen effluvium: this is an abnormal loss of hair in the anagen or growth phase of the hair. Often referred to as chemotherapy-induced alopecia, as it can be triggered by the use of medications like cancer or immunosuppressive drugs that poison a growing hair follicle. This type of hair loss is reversible, and your hair will most likely regrow once therapy is stopped.
Hirsutism. The change in your hormones and possibly the resulting imbalance may also lead to hair growth in unwanted places - thick chin hairs and increased facial vellus hair (peach fuzz) are common. The medical community does not yet understand why triggers this in some women and not in others.
Lastly, there are a slew of non-hormonal factors that may further compound hair loss: stress, illness, medications, poor diet, and a nutrient deficiency. These will be discussed in more detail in sections to follow.
Other impacted areas
In a world where society has an unrealistic standard of beauty that can be very hard to measure up to, battling with hair loss can lead to low self-esteem, which can take a toll on our social life and work.
Diagnosis
It is common to lose up to 100 strands in a day, which may seem like a lot so when do you speak to a doctor? Everyones hair density is different, but in general if you start noticing bald spots or you can see your scalp more clearly through your hair it may be a good time to speak to your GP and ask for a referral to a dermatologist who specializes in hair loss.
Clinicians use the Ludwig Classification to describe female pattern hair loss. Type I is minimal thinning that can be camouflaged with hair styling techniques. Type II is characterized by decreased volume and noticeable widening of the mid-line part. Type III describes diffuse thinning, with a see-through appearance on the top of the scalp. Even for a specialist it may be difficult to determine a singular reason for your hair loss or thinning. So your doctor may need to run a few (blood) tests to check your iron levels, thyroid function, hormone levels and use these results in combination with your medical history to determine treatment.
Possible triggers or risk factors
- Genetics: if your family has a history of hair loss (on either side of the family) you are at an increased risk
- Stress: A study by Harvard University researchers showed a link between stress and hair loss. Stress, anxiety, and trauma can cause you to lose your hair.
- Medical conditions such as celiac disease/ gluten intolerance,, hypothyroidism, iron deficiency, and polycystic ovary syndrome (PCOS)
- Medications: a range of treatments such as chemotherapy drugs, radiation, immunosuppressants, antidepressants and certain antibiotics can cause or contribute to hair loss/ thinning.
Treatments & Remedies
When looking for (OTC) treatments for hair loss focus first on preventing any more hair falling out, otherwise you’re pushing water uphill. This is also what most treatment methods focus on. Once you have that handled you can start looking for products that will support regrowth of hair. To be frank, there are a LOT of products out there that claim to help but don’t have any clinical research backing it and the only thing these products are good for is making your wallet a bit lighter. Keep in mind, these products are poorly regulated by the government if at all. Which means manufacturers take a lot of liberty when making claims about the effectiveness of their products.
This section will explore the various therapies available to manage or treat hair loss ranging from cosmetic camouflages like colored hair sprays, hair transplantation, low-level laser therapy, and prescription or alternative medicines.
Products
Some common supplements marketed to manage hair loss include:
- Zinc sulfate + calcium pantothenate: this supplement is available over-the-counter and may help you grow your hair if your hair loss is caused by zinc deficiency. One study found that using topical minoxidil and combination zinc and calcium tablets gave better results than using minoxidil alone.
- Iron supplements: Supplementation with iron may restore hair growth in people with anemia and a deficit of iron. However, if your iron levels are normal, you do not need to use this supplement.
- Biotin: These products have been marketed to help grow and thicken hair by stimulating keratin production and also increasing follicle growth. However, findings on its benefits are mixed. While there is very limited evidence on its use in promoting hair growth, it appears to have slight benefits in preventing hair loss. Keep in mind that results are only evident in people who are biotin deficient.
- Topical minoxidil: Minoxidil is a popular drug for the treatment of FPHL. This product helps to slow down or stop hair loss. It may also stimulate new hair growth. However, continuous use of this product is required to continue to see results. Once you stop using it, your hair may start to fall out again.
- Cosmetic camouflages: There are also other ways to deal with hair loss, like using colored hair sprays to cover up thinning areas on the scalp, shortening your hair, using volumizers for bulking up your hair or using a wig and hair extension.
- Low-level laser therapy: These devices are usually available without prescription and are believed to release low-level laser light that helps stimulate hair growth. As with topical minoxidil, you must continue to use this device to see results.
Please note that these are non-pharmaceutical treatments that require a doctor's referral, need to be done by an expert and may not be covered by your insurance.
- Platelet-rich plasma (PRP) scalp injection: This treatment is gaining popularity in its use for treating hair loss. Here, platelets are injected deep into the scalp until it gets to the bottom of the follicle and stimulates the dermal papilla cells, which are very important for hair growth. PRP injections are said to be effective in both preventing further hair loss and promoting new growth. However, these Injections are very expensive and quite painful to your scalp. An important caveat to keep in mind is that PRP is still in its investigative stage and hasn’t been officially approved for use in FPHL.
- Hair transplant: Hair transplants have been used to treat hair loss and may be helpful in women with FPHL. However, a hair transplant is not suitable for everyone, especially if you do not have enough healthy hair for the transplant. A plastic hair surgeon will help you assess your suitability for this procedure.
Lifestyle
Some studies suggest that deficiencies in vitamin B12 and D, biotin, iron, and zinc are associated with hair loss. It was also found that nutrient deficiency may affect your hair structure and growth. Eating a balanced diet rich in these vitamins may help your hair grow, especially if your hair loss results from poor nutrition.
Although evidence is not sufficient, some experts believe exercise can help hair grow because it increases blood flow which can help nourish the hair follicle. In addition, exercise helps to reduce stress which causes a type of hair loss. 15-30 minutes of mild-moderate exercise at least three times per week may already help nourish your hair follicles and is good for your overall health.
Researchers from Harvard University have confirmed long-standing research that stress may result in hair loss. Removing stress may help prevent hair loss and promote regrowth. You can practice yoga, exercise, or any other techniques that help you relax.
Holistic
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