What is female pattern hair loss?

Female pattern hair loss describes hair loss and hair thinning in females. It is also known as androgenetic alopecia. It is the most common cause of hair loss in females.

Female pattern hair loss can develop at any age, but it is more common after menopause.

Almost half of all females show signs of hair loss by the age of 50.

What symptoms are related to female pattern hair loss?

Female pattern hair loss follows a different pattern to male pattern hair loss. Your hair usually thins across the scalp, starting at the parting. You might notice more hairs falling out. Your part may be wider and the hairline at the front of your head may have less hair. The skin of your scalp will look normal.

Hair loss usually progresses gradually over decades, though it come in bursts. Sometimes you may have a period of noticeable hair loss followed by a return to normal hair loss. The hair loss becomes more noticeable over time.

A receding hairline or a bald patch on the top of the head is rare in females, but this can happen if you have high levels of androgens (male hormones) in your body.

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What causes female pattern hair loss?

Genetics usually play a part in the development of female pattern hair loss. You can inherit genes for female pattern hair loss from one or both of your parents. Not all females who experience hair loss have a family history of baldness.

With female pattern hair loss, your hair follicles are more sensitive to the effects of androgen (male) hormones. The hormones cause your hair follicles start to produce thin, colourless hair instead of thick, coloured hair.

Most of the time, hormone levels are normal. In some cases, there is an underlying illness responsible for high levels of androgens that cause hair loss — for example, if you have polycystic ovarian syndrome. Rarely, hair loss is caused by an androgen-secreting tumour.

How is female pattern hair loss diagnosed?

Your doctor can usually diagnose female pattern hair loss without any tests. They will ask about how quickly you've lost hair and where on your body you've noticed hair loss. Your doctor will examine your hair and scalp.

If you have acne, irregular periods or a lot of body hair, your doctor might recommend a test to check your hormone levels.

If it's not clear what's causing your hair loss, your doctor might also recommend taking a biopsy (sample of skin) from your scalp to test for other hair loss conditions.

They may also refer you to a dermatologist if they suspect other skin conditions.

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When should I see my doctor?

If you think you are losing a lot more hair than usual, or your hair is thinning, your doctor can discuss your options. Remember that it's normal to lose around 100 hairs a day. You may see hairs in your brush or when you wash your hair.

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How can I manage female pattern hair loss?

If female pattern hair loss is bothering you, you might choose to try a treatment. There is no cure.

The main aim of treatment is to slow down or stop hair loss. Treatment might also aim to stimulate hair growth, but this doesn't work for everyone. Discuss your goals for treatment with your doctor to understand realistic expectations and possible risks and benefits.

Taking photographs before, during and after treatment can help to keep track of progress.

Choices of treatment may differ depending on:

• how severe your hair loss is
• your preferences
• the risk of adverse effects
• costs

If hair loss is caused by a medical condition, treating the underlying condition might help.

Medicines for female pattern hair loss

Your doctor might suggest minoxidil for your scalp or prescribe anti-androgen tablets such as spironolactone or cyproterone acetate. These treatments can also be used as a combination therapy.

Minoxidil comes as a foam or lotion and must be applied to your scalp daily. It is available over-the-counter. It stops hair loss, and some people also notice hair regrowth. You will need to continue applying minoxidil for it to be effective. Once you stop treatment, your scalp will return to your previous state of hair loss.

It is normal for hair shedding to increase during the first weeks of minoxidil treatment, after which it will settles down. Other side effects may include a dry, red and itchy scalp. Oral minoxidil is prescribed to treat high blood pressure, so there is also chance it will be absorbed from your scalp into your bloodstream and affect your blood pressure.

Minoxidil should not be used during pregnancy, if you are breastfeeding or if you have heart or blood pressure problems.

Spironolactone and cyproterone acetate are anti-androgen medicines take as daily tablets. They help to stop hair loss and stimulate hair growth.

If you are pregnant or planning to become pregnant, it is important to talk to your doctor and stop treatment with anti-androgen medicines. Make sure that you are using effective contraception methods during treatment.

Side effects may include:

• irregular periods and spotting
• breast tenderness or lumpiness
• tiredness
• depression
• weight gain

It's important to discuss the potential side effects of these treatments with your doctor, and to tell your doctor if you are breastfeeding or may be pregnant.

It can take up to 6 to 12 months to know if treatment is working. The medicines will only help for as long as you keep taking them. If you don't notice any improvement after this time, your doctor may refer you to a dermatologist who can prescribe other anti-androgen medicines or oral minoxidil.

Other treatment options

There are many ways you can camouflage your hair loss:

• Change your hairstyle or parting to make hair loss less noticeable.
• Use synthetic sprays or powders to disguise thinning hair.
• Wear a scarf, hat or wig.
• Get special tattooing (micropigmentation) that can give the illusion of thicker hair.
• Get a hair transplant.

Appropriate hair care can also help to reduce hair loss.

• Use wide-tooth combs and brushes to reduce hair breakage.
• Blot your hair dry with a towel, rather than rubbing.
• Use light, non-drying hairsprays to reduce breakage.

Some hair loss clinics provide other treatments for hair loss that have not yet proven to be effective. There is not enough evidence to show that laser treatments, plasma injections, 'hair tonics' and nutritional supplements are effective. Talk to your doctor before trying these treatments to understand any risks and benefits.

What are the complications of female pattern hair loss?

For some people, hair loss can be distressing and affects their self-esteem, leading to:

• depression
• relationship problems
• work problems
• poor sleep
• avoidance of social activities

It is also important to make sure that you protect your scalp from sun damage. Your scalp is more exposed in areas of hair loss. Wear a hat or a scarf when you are outdoors to help prevent sunburn and damage.

Resources and support

Hair loss can be distressing and affect your mental health. If hair loss is upsetting for you, it might help to talk to your doctor or to see a psychologist for counselling.

Beyond Blue can help if you feel anxious or depressed because of hair loss. Call 1300 22 4636 anytime.