One of the most frequently seen forms of hair loss in women is a condition called Diffuse Alopecia. It is called this because there is a diffuse or distributed shedding of hairs across the scalp. It is also known as Telogen Effluvium (CTE) or shedding.
This type of hair loss can occur at any age but is most commonly noticed post pregnancy. Its onset can be quite sudden and is often noticed by an increase in the shedding of hairs in the washing or grooming process. It frequently occurs together with a widespread decrease of hair density rather than a bald patch. The cause of this ‘increased shedding’ can be as a result of intense stress on the body's physical wellbeing, severe illness, a problem with the hormonal system or as a reaction to medication. Dieting and nutritional deficiencies can also be a contributing factor to this type of hair loss.
Generally, the shedding develops around 6-8 weeks after its initial trigger. Often the condition rectifies itself within about 6-12 months, although for some it can become a chronic problem or even be the early indication of a more long-term hair loss problem, such as Androgenic Alopecia.
Diffuse Alopecia is an occurrence related to the growth cycles of hair. Hair growth cycles alternate between the following:
During the telogen phase, the hair remains in the follicle but is no longer ‘anchored’. It remains here until it is pushed out by the growth of a new hair in the anagen phase or removed by washing or grooming.
At any one time, around 85% of hairs are in anagen, around 1% in catagen and around 14% telogen. However, a sudden change on the body can trigger large numbers of hairs to enter the telogen phase at the same time. Then, about 6-12 weeks later, this large number of hairs will be shed. It is normal to shed around 50 to 100 hairs each day. Women with the condition are often considered as either imagining it, overanxious or even neurotic! Fortunately, most cases rectify themselves in time and there are ways of dealing with the condition.
Treating the condition is to initially establish the cause. This is done primarily by taking a detailed case history. Blood testing and microscopic hair analysis is also important and should be conducted in order to establish that the shed hairs are indeed in the telogen phase. Once the cause is established the treatment can commence, however, the type of treatment will differ dependent upon the cause. Nutrition, on the other hand, is always an important aid to recovery and should be used in conjunction with whatever treatment is required.
Androgenetic Alopecia in females (Female Pattern Thinning)
Another common type of hair loss in women is Androgenetic Alopecia. This is the most common form of hair loss generally associated with men, though some females can also be affected. The condition is also known as pattern hair loss or thinning.
The following narrative explains ‘Female Pattern’ hair thinning.
Female pattern hair thinning can affect up to 30% of women. Some experts believe this figure could even be higher. Research shows that up to 13% of women have some degree of this type of hair loss before the menopause and afterwards it becomes far more common. One piece of research suggests that over the age of 65 as many as 75% of women are affected.
It is caused by physiological changes in the hair follicle, the place where the hair is produced. In certain areas of the scalp hair follicles begin to produce hairs of a shorter growth cycle and, with each succeeding cycle, thinner hairs are produced.
Such hair loss is induced by the hormone androgen. Androgen is a male hormone that all men and women, alike, produce. Androgen circulates in the blood stream, producing a chemical called dihydrotestosterone, or DHT, by the action of an enzyme called 5-alpha reductase. People with a higher level of this enzyme make more DHT, which in excess can cause the hair follicles to gradually diminish until eventually they can no longer be seen. Androgen hormones are used to stimulate growth, primarily a characteristic of the male, in order to increase masculine hair growth, on the face, trunk and limbs. To a lesser extent, androgens are produced by the adrenal glands in both men and women. It is only a genetically predisposed female who may suffer androgenic alopecia and genetic inheritance determines that only certain follicles will be abnormally sensitive to the circulating androgens in these females.
This type of hair loss can be differentiated from the others by its typical location and progression. In men the onset is recognised by an M-shaped recession at the frontal hairline leading to oval baldness at the crown and, eventually, total balding at the front and crown region of the scalp leaving a small ‘skirt’ of hair from ear to ear. In women the loss is also restricted to the frontal and crown region, however, it appears as more of a thinning without the recession of the frontal hairline. The degree of hair loss in women seldom reaches the extent of loss seen in the male form. The onset is usually later and also less rapid.
Development usually occurs as a diffuse thinning of the hair at the frontal region often commencing alongside hormonal changes that occur during the menopause or, less frequently, after pregnancy. The progression may be gradual or intermittent and the hair may become less manageable. By their 40th year, about 25 % of women have developed some thinning and this percentage increases in the fifth decade.
Evaluation of a hair loss problem in women is very important to ensure that no coexisting hair loss is also present that may need an alternative treatment.
A full history is explored and certain blood tests may be required. This is done primarily by taking a detailed case history during the consultation. Treatment very much depends on the outcome of the consultation and/or blood test results.