Hair loss in women: what to do? Types of hair loss and treatment algorithm

According to statistics, every second woman has experienced intense hair loss in her life. And although a decrease in hair density cannot but upset you, you don’t need to immediately suspect that you have some kind of serious illness. Sometimes hair loss is just a temporary reaction of the body to stress, illness, medication, pregnancy and childbirth, or other unusual mental and physical conditions. There is no need to worry too much about this; hair growth will recover on its own without any additional products or procedures. However, if severe hair loss continues for several months and leads to a noticeable decrease in thickness, this is a reason to become concerned about the condition of the hair follicles and the entire body and take measures so as not to be left completely without hair.

Types of hair thinning in women

Androgenetic (androgenic) alopecia

Androgenetic alopecia (AGA) is the most common cause of hair loss in both men and women: it accounts for over 90% of all alopecia. Androgenetic alopecia does not impair a person’s physical health in any way. This is an exclusively cosmetic problem, but it significantly impairs the quality of life, causing psychological discomfort.

Androgenetic alopecia is found in people whose hair follicles are genetically sensitive to androgens (male hormones). In the presence of such sensitivity, dihydrotestosterone has a negative effect on the hair follicles, as a result of which they decrease in size, thin out and die over time.

Androgenetic alopecia changes the hair growth cycle. The active growth phase (anagen) is shortened, and the resting phase (telogen), when the hair does not grow, lengthens. The ratio of anagen to telogen periods becomes less than 8:1, with the norm being 12:1. With each cycle, the anagen phase becomes shorter and shorter, while the telogen phase remains the same. Changes in the hair growth cycle lead to shortening of the overall hair length. Over time, the size of hair follicles decreases. Normal, healthy, thick hair is replaced by thin (vellus) hair that appears unhealthy and sparse.

Female hair loss pattern

With androgenetic alopecia in women (female pattern of hair loss), the volume of hair in the frontoparietal zone decreases. Thinning on the crown is rare.

There are three stages of hair loss in women (according to the Ludwig scale): Stage 1 is characterized by noticeable thinning of hair in the frontoparietal zone and widening of the parting, while the marginal hairline remains unchanged. Stage 2 is diagnosed when there is severe hair thinning in the frontoparietal area. Stage 3 , in which hair in the frontoparietal zone is completely lost, is extremely rare.

Ludwig scale

Thinning in the central parting area

Thinning in the side parting area

Unlike men with androgenetic alopecia, women with the same diagnosis do not lose hair as intensely and abundantly, so there are practically no completely bald women. In addition, androgenetic alopecia begins to appear in women at a later age than in men and is more treatable.

The influence of hormones (androgens) on hair growth and loss

The effect of androgens on hair loss in men has been thoroughly studied and fully proven. As for women, in some cases there is indeed a relationship between hair loss and increased levels of male hormones in women (hyperandrogenism). In addition to hair loss, hyperandrogenism can also manifest itself with symptoms such as acne, hirsutism (increased facial and body hair), and menstrual irregularities. However, all these manifestations can occur even with normal levels of male hormones. Thus, hair loss that follows a female pattern is not always a consequence of hyperandrogenism. Genetic factors play a leading role in hair thinning in both women and men.

Treatment

Therapy with external and internal means

The most effective treatment for stopping hair loss and restoring hair growth is the following regimen: - Androgen receptor antagonists - cyproterone acetate (used in Europe and Canada) and spironolactone (used in the USA). These substances work to stop hair loss. — Hair growth stimulants – minoxidil, nitrolipins (Regeus).

Preparations containing these substances are applied externally directly to the areas of hair thinning and/or taken orally. The regimen and duration of treatment are determined individually. The earlier therapy is started, the higher its effectiveness. In later stages, when conservative treatment does not help, hair transplantation or the use of concealers is recommended.

Injections

The treatment method for androgenetic alopecia is based on the natural activation of regenerative processes. The essence of the method is to use your own cells, namely platelet-rich plasma. The drug is administered intradermally or subcutaneously, the course lasts at least 3 months. The treatment regimen is selected individually. Injection of platelet-rich plasma leads to the activation of key growth factors such as platelet-derived growth factor (PDGF), transforming growth factor (TGF), vascular endothelial growth factor (VEGF) and epidermal growth factor (EGF). This cascade of reactions leads to regeneration and repair and ultimately to the restoration of the physiological cycle of hair follicles.

Diffuse alopecia

Other names: telogen effluvium, symptomatic alopecia, telogen effluvium hair loss. Telogen effluvium hair loss is characterized by the loss of more than 100 hairs per day, with hair falling out evenly over the entire surface of the scalp. Of the hair shed, most of it is in telogen rather than anagen.

Causes

Acute telogen effluvium occurs in childhood after infections, as well as in women from 30 to 50 years old and can last 3-6 months. In women of any age (including the elderly), acute telogen effluvium can occur against the background of androgenetic alopecia and aggravate its course. In such cases, the patient is given two diagnoses at once: androgenetic alopecia and diffuse alopecia, although this is quite rare.

“In my practice, there was such a case, and the patient was convinced that the doctors simply could not understand what was wrong with her, that the diagnoses differed and this aggravated her psychological state (and this could aggravate hair loss). Please trust your doctors, ask questions, study scientific articles if you don't believe anyone. The effectiveness of treatment depends on this. Fortunately, such types of diagnostics as trichoscopy and trichogram help in making both diagnoses.”
Elizaveta Dubinskaya Dermatologist, trichologist

Provoking factors for diffuse hair loss: surgical interventions, hospitalization, taking certain medications (neuroleptics, anticoagulants, interferons). If diffuse hair loss continues for more than 6 months with exacerbations, then a diagnosis of chronic telogen effluvium is made. There are two forms of such alopecia: - primary idiopathic, predominant in women before menopause; - secondary, occurring against the background of systemic chronic diseases (especially against the background of hypothyroidism), as well as against the background of conditions such as nutritional deficiency, stress, depression, malignant neoplasms. Young patients with seborrheic dermatitis also experience increased hair loss in the telogen phase, but this issue still requires clarification of the cause-and-effect relationship.

Diagnosis and treatment

The differences between diffuse and androgenetic alopecia are not always obvious; moreover, cases of transition from diffuse to androgenetic alopecia have been recorded (Sinclair et al., 2004). Non-invasive diagnostic methods: hair traction test, hair washing test, dermatoscopy and trichogram are sufficient to establish most diagnoses. Histological examination may help but is rarely required. To treat telogen effluvium, it is important to quickly identify and, if possible, eliminate the triggering factors. No special acute treatment is required, and most patients recover spontaneously within six months. The prognosis for chronic telogen effluvium is uncertain; spontaneous improvement may occur after several years.

Alopecia areata

Alopecia areata is a chronic disease of the hair follicles, manifesting itself in the form of round, non-scarring foci of hair loss on the head, and less often on the body.

Causes

Many authors consider the autoimmune nature of the disease, when cells of the immune system attack hair in the growth phase. The interaction of aggressive lymphocytes with hair follicle cells, abnormal expression of certain tissue antigens, and the initiation of apoptosis (programmed cell self-destruction) contribute to the development of autoimmune inflammation.

Among the factors contributing to the development of the disease: genetic predisposition, microcirculatory and immune disorders, endocrine and metabolic disorders, adverse environmental influences. In addition, nervous system disorders at various levels play an important role. The literature has now accumulated a lot of data indicating various emotional disorders, the presence of hypothalamic pathology and autonomic disorders in patients with alopecia areata.

How does alopecia areata manifest?

Clinical picture: - presence of alopecia foci on the skin with clear boundaries; - the presence of stumps of hair in the lesion in the form of an exclamation mark and a “loose hair zone” at the border of the lesion (active stage); - detection during microscopic examination of hair epilated from the lesion of dystrophic proximal ends in the form of a “broken rope”; - the presence of light vellus hair in the growth area (in the regression stage); - sometimes along one edge of the lesion there are fragments of hair in the form of an exclamation mark, and on the opposite - the growth of thin hair; - detection during examination of nails of signs of onychodystrophy: thimble-shaped indentations, longitudinal striations, changes in the free edge in the form of wavy patterns.

If the disease is less than 1 month old, the following subjective symptoms may occur: hyperemia, burning, itching in the area of hair loss.

Treatment

Considering the autoimmune mechanism for the development of baldness, the main therapeutic direction is immunosuppression.

In very severe forms, drugs from the group of glucocorticosteroids are prescribed orally. For milder forms, external treatment with drugs of the same group is used. Intradermal injections of diprospan are used simultaneously with the main line of therapy.

The course of the disease is often unpredictable; pathogenetic therapy does not always promote hair restoration and does not guarantee that there will be no relapses. To maintain hair growth, treatment must be continued until complete remission occurs.

Separately, it is worth mentioning the effectiveness of cryotherapy for the treatment of alopecia areata.

The effectiveness of cryotherapy for alopecia areata

Cryotherapy, a treatment with liquid nitrogen for the treatment of alopecia areata, is not widely used, although cryotherapy machines are available in dermatology offices.

The possibility of using cryotherapy in the treatment of alopecia areata was described back in 1986. The therapeutic effectiveness of surface cryotherapy has been proven in various studies. For example, studies have been conducted to evaluate the effectiveness of treatment of alopecia areata with cryotherapy (1 treatment every 2 weeks for 12 weeks) and 0.05% clobetasol propionate lotion. It was shown that despite the lack of complete hair restoration (>95%), the response to treatment was 80% and 91.5%, respectively. This indicator is considered very worthy, taking into account the almost complete absence of side effects with cryotherapy, in contrast to clobetasol propionate. In a large study conducted on more than 350 patients, it was shown that 61% of respondents experienced restoration of normal guard hair growth, and at the initial stage of the disease and short intervals between procedures (no more than 2 weeks), the proportion of positive results was higher.

A large retrospective study published in 2006 found that 68.6% of 153 patients with alopecia areata achieved significant hair improvement, including terminal hair growth within 12 weeks of treatment. In 2021, a prospective study was conducted to compare the effectiveness of superficial cryotherapy and topical steroids as a therapeutic option. It was shown that 73% of patients experienced hair growth after cryotherapy (including 13% who experienced complete restoration of the lesion). Along with the general clinical improvement, the number of terminal (guard) hairs on the treated part of the head significantly increased by 1.6 times, in contrast to the control part, on which no significant changes were observed. Of course, one should remember the possibility of spontaneous remission, which occurs in 34% ~ 50% of patients during the first year of the disease. However, it cannot be ignored that the positive treatment results obtained in the various studies described can be interpreted as a significant therapeutic effectiveness of cryotherapy in the treatment of alopecia areata.

Thus, due to the minimally painful nature of the damage during the procedure and minimally invasive effects, superficial cryotherapy has been found safe and effective in the treatment of alopecia areata.

Traction alopecia

Traction alopecia is hair loss due to external traumatic action on the hair follicle. The main reasons for the development of the disease: frequent tugging, improper combing and addiction to tight hairstyles, including tight ponytails, frequent twisting of hair into buns, tight curlers, backcombing, dreadlocks. As a rule, the most affected hair is along the forehead, on the back of the head and temples, in the parting area, between the braids.

At the initial stage, traction alopecia may manifest itself as soreness of the scalp. At this stage, the disease is easily treatable: it is enough to eliminate the traumatic factor, change the hairstyle, and hair growth is restored on its own. However, if the problem is neglected, irreversible processes may begin; the disease will progress to the stage of cicatricial alopecia, when the hair follicles cease to exist. Unfortunately, with cicatricial alopecia, no remedies will help restore hair growth.

What hairstyles are most likely to cause traction alopecia?

Dreadlocks

Once you have dreadlocks, a person can wear them for several years. To achieve this hairstyle, hair - natural and synthetic - is twisted together to lengthen and add volume. Because of this, the weight of the hair and the load on the hair follicle increases. In addition, the hair is constantly tense: stretched and fixed in one direction - this leads to its excessive fragility and breakage. If you decide to get dreadlocks, there is a risk that you will remove them along with all your hair. This is perhaps the most dangerous hairstyle.

Braids

Tight weaving of hair, joining in different directions, fixing in rows and lines when creating complex patterns severely injures the hair and provokes hair loss. Beautiful, complex weaves can be done sometimes, but for a daily hairstyle it is better to choose something else.

Bouffant

Backcombing also injures and damages strands, overloads the roots and can lead to hair loss. Hairstyles that require backcombing are also best done on special occasions and not overused. Otherwise, in an effort to have a voluminous hairstyle, you can lose this volume irrevocably.

Postpartum hair loss

Hair loss in women due to pregnancy, childbirth, and lactation is a normal physiological process caused by hormonal changes in the body. Treatment during this period is ineffective. Normally, hair growth should recover on its own within a year after giving birth. If after a year the hair is still falling out intensively and losing volume, this is an alarming symptom: it is necessary to start treatment as soon as possible.

Other types of hair loss in women

Unfortunately, hair loss is still a poorly studied area by science. In our article we have listed the main ones, but there are still many other types of hair loss that are extremely rare.

Why does hair fall out during chemotherapy?

The action of chemotherapeutic (cytotoxic) drugs is aimed at all rapidly dividing cells. These are both malignant and healthy cells, including hair follicle cells, they divide every 23-72 hours. If chemotherapy is prescribed for cancer, hair may begin to fall out within a few weeks of starting treatment. It can occur gradually or suddenly, just on the head or all over the body, including the face, arms, legs, armpits and pubic area.

Total alopecia (complete permanent hair loss) caused by chemotherapy is possible, but is extremely rare - after many years of high-dose chemotherapy.

General recommendations for hair loss in women

What women experiencing hair loss need to remember is that the universal trigger for hair loss is stress. Sometimes the problem of hair loss can be eliminated by seeking help from a psychotherapist and reducing the level and intensity of negative experiences, depression, and irritation. In addition, it must be remembered that often in women, hair loss is not an independent disease, but a symptom of more serious disorders in the body. In this regard, in case of hair loss, you should consult a gynecologist, endocrinologist, gastroenterologist, therapist, dermatologist, and undergo a comprehensive health check to exclude the presence of pathologies that provoke hair loss. If a pathology is detected, it is necessary to treat the underlying disease and use external hair restoration products until the cause of hair loss is eliminated.

“To make a correct diagnosis, it is very important to carefully collect anamnesis and conduct an external examination of the entire scalp. Case study: a 33-year-old female patient has been experiencing hair loss for 3 years. History of polycystic ovary syndrome, autoimmune thyroiditis. After collecting complaints and anamnesis, she suggested a diagnosis: androgenetic alopecia. Trichoscopy in the parietal area did not reveal a typical picture. She examined the entire head and found that the patient had alopecia areata. On the scalp there are multiple small round and oval-shaped foci of baldness with a diameter of 0.3-0.5 cm. It turned out that there was a single foci of baldness in childhood, which resolved spontaneously. She ordered a blood test for syphilis, the result was negative. Having confirmed the diagnosis of alopecia areata, I chose the appropriate treatment tactics, although initially, it would seem, there were all the signs of androgenetic alopecia.”
Olga Fedina Doctor of the highest category, dermatologist, trichologist.

Methods for treating hair loss

To treat alopecia, you need to use an integrated approach: massage, medications and vitamin complexes, the use of specialized shampoos and salon procedures. It is important to note that giving up bad habits, a balanced diet and restoring sleep and wakefulness also play a big role in the treatment of hair loss.

Hair loss treatment methods:

Surgical - Scarring alopecia can be treated with hair follicle transplantation. Many patients cannot afford surgical operations, and for some, operations are not an acceptable solution due to the presence of contraindications.
Physiotherapy. Medicinal products are applied to the skin and heated using special devices. This is where laser therapy comes into play. The laser stimulates all metabolic processes in the body and hair treatment occurs more actively.
The injection method improves hair growth, awakens “dormant” hair follicles, eliminates dandruff and fights scalp diseases by injecting a special cocktail into the scalp. The complex of preparations for the procedure contains all the necessary vitamins, microelements, nutrients, beneficial amino acids, etc.
Therapeutic method is the use of ointments, masks, shampoos, conditioners, and folk remedies.

Women often resort to home care. But folk remedies cannot cope with the problem of baldness better than professional salon procedures.

Additional materials

Home test for hair loss

Run your fingers through your hair, pinch the hair between your fingers, pull out the strands, sliding along them. Don't pull out your hair! There should be no pain during traction. Count how many hairs you pulled out.

If you have less than 6 hairs in your hand, congratulations! There's nothing wrong with your hair.
If there are more than 6 hairs, hair falls out beyond normal.

Hair roots require attention and care. Before the test, it is advisable not to wash your hair for 5 days. The test can be repeated on different parts of the head to determine which areas are experiencing intense hair loss. If hair loss in the frontal-parietal zone is above normal, and in the back - within normal limits, then with a high degree of probability, androgenetic alopecia can be diagnosed.

List of primary diagnostic procedures for hair loss in women

Blood test: general, hormones (DHEA sulfate, testosterone, androstenedione, prolactin, follicle-stimulating hormone, luteinizing hormone, antibodies to TPO, T4, TSH), iron, ferritin, TSH.
Test for syphilis.
Computer diagnostics of the scalp and hair (trichogram or phototrichogram). Computer diagnostics will allow you to determine the type of hair loss: under high magnification, the doctor looks at the condition of the follicles, the ratio of normal, vellus and thinning hair, and checks whether there is inflammation of the skin. The phototrichogram shows the growth rate, density, percentage of hair growing and falling out. In the Regeus laboratory you can get a trichogram for free:
Additionally, in case of pathology of the hair shaft, it is necessary to conduct a spectral analysis of the hair for microelements.

Authors: Elizaveta Dubinskaya, Olga Fedina, Melanya Aidinyan

How to tell if your hair is falling out due to stress

How do you know if your hair is falling out more than it should? If you have recently experienced stress, you should consult a trichologist in any case. Under the influence of stress, the whole body may malfunction, and hair loss may begin later, so you may no longer remember the traumatic situation or associate a hair problem with it.

If there is no doubt about hair loss after unpleasant events in life, the help of a doctor will be even more necessary. Only an integrated approach will allow you to preserve your hair with its natural volume. Assessing the degree of hair loss will allow the doctor to determine the extent of the problem and prescribe the best therapy for hair suffering from hair loss.

Is your hair falling out excessively? Pull a section of hair with your hand. There should be no more than ten hairs left on the palm. This is a very rough test that will only allow you to roughly estimate the consequences of hair loss from stress. Hair may fall out unevenly, and misjudging the situation will cause your hair to lose its volume.

How to effectively care for your hair to stop hair loss?

To get a good result, you and I, dear friends, will need a set of tools.

Shampoos for hair loss, such as “With traditional oriental herbs” from Mielle. Apply it 1-2 times a week in the usual way.
Anti-hair loss conditioner Apply it after shampoo, leave for 2-3 minutes and rinse off.
Anti-hair loss mask or oil against hair loss and to stimulate hair growth. How to use: Apply once a week to a clean head, wrap with film, and rinse after 10–15 minutes.
Hair growth activators or hair serum are concentrated products with beneficial elements against hair loss.
Use shampoos without silicones, sulfates and parabens.

Co-washing for hair loss, 300 ml, Nano Organic

500 ₽

Dietary supplement NOT A MEDICINE