What causes increased hair loss in women?

Common Causes of Increased Hair Loss in Women

The most common causes of increased hair loss in women include androgenetic alopecia, telogen effluvium, alopecia areata, nutritional deficiencies, hormonal imbalances, and certain medical conditions. 1, 2

Primary Types of Hair Loss

Androgenetic Alopecia (Female Pattern Hair Loss)

• Most prevalent form of hair loss in women, affecting over 50% of postmenopausal women and up to 40% of women of reproductive age 2
• Characterized by diffuse thinning of the parietal or frontovertical areas with an intact frontal hairline 3
• Related to sensitivity to dihydrotestosterone (DHT) 1
• May be classified as early- or late-onset, with or without excess androgens 3

Telogen Effluvium

• Stress-induced shedding that causes diffuse hair loss 1
• Usually self-limited and depends on addressing the underlying cause 4
• Common triggers include:
  • Physical stress (surgery, illness, rapid weight loss) 4
  • Psychological stress 1
  • Postpartum hormonal changes 4
  • Medication side effects 4

Alopecia Areata

• Autoimmune condition mediated by T lymphocytes targeting hair follicles 5, 1
• Characterized by patchy, non-scarring hair loss 5
• About 20% of people with alopecia areata have a family history 5
• Associated with other autoimmune diseases 5

Other Important Causes

Nutritional Factors

• Iron deficiency - though studies on its role in alopecia areata specifically show conflicting results 5, 2
• Vitamin D deficiency - multiple studies have found lower serum vitamin D levels in women with hair loss 5
• Zinc deficiency - serum zinc levels tend to be lower in patients with alopecia areata 5
• Folate deficiency - may contribute to hair loss 5, 6

Hormonal Causes

• Hyperandrogenism from conditions like:
  • Polycystic ovary syndrome 3
  • Adrenal hyperandrogenism 3
  • Ovarian hyperandrogenism 3
• Thyroid disorders (both hypo- and hyperthyroidism) 4
• Postmenopausal hormonal changes 3

Medical Conditions

• Systemic lupus erythematosus 5, 1
• Fungal infections (tinea capitis) 5, 1
• Scarring alopecias (lichen planopilaris, central centrifugal cicatricial alopecia) 2

Mechanical/Physical Causes

• Trichotillomania (compulsive hair pulling) 5, 1
• Traction alopecia from tight hairstyles 4

Medication-Induced Hair Loss

• Anagen effluvium (drug-induced) 5, 1
• Common culprits include chemotherapy agents, anticoagulants, retinoids, and certain antidepressants 4

Diagnostic Approach

• Clinical examination to determine pattern and type of hair loss 5, 3
• Dermoscopy can aid diagnosis - look for yellow dots, exclamation mark hairs, and cadaverized hairs in alopecia areata 5
• Laboratory testing when indicated:
  • Serum ferritin, vitamin D, zinc, and folate levels if nutritional deficiency is suspected 5, 6
  • Thyroid function tests 4
  • Androgen levels in cases of suspected hyperandrogenism 3
  • Fungal culture if tinea capitis is suspected 5
  • Skin biopsy in unclear cases 5

Important Considerations

• Hair loss can have significant psychological impact on women, often causing anxiety, depression, and reduced quality of life 7, 4
• Early diagnosis and treatment is important as most treatments are more effective at arresting progression than stimulating regrowth 7
• Multiple factors may contribute simultaneously to hair loss in women 6
• Treatment response often takes 12-24 months, requiring patience and consistent therapy 7