Expert Q and A: Fighting Hair Loss in Women

An interview with Mary Gail Mercurio, MD.

From the WebMD Archives

Many women with hair loss suffer in silence, altering their hairstyle to hide thinning or patches. But the sooner you seek care, the better the chances of successfully treating it, says Mary Gail Mercurio, MD, associate professor of dermatology at the University of Rochester in Rochester, N.Y.

It's not as uncommon as you may think: As many as 5% of women under 30 and 60% of those older than 70 are affected, she says. At the recent meeting of the American Academy of Dermatology in Miami Beach, Fla., Mercurio discussed common forms of hair loss in women and treatment options.

What's the most common form of female hair loss?

Female-pattern hair loss, which usually has a strong genetic component that can be inherited from either the mother or father. Also referred to as androgenetic alopecia, this type of hair loss can start as early as the late teens -- and the earlier it starts, the more severe the hair loss tends to be.

Most women with pattern hair loss don't get a receding hairline or bald spot on top of the scalp as is common in men. Instead, there is visible thinning over the crown. In men and women, hairs are miniaturized because of a shortened growth cycle where the hair stays on the head for a shorter period of time. These wispy hairs, which resemble forearm hairs, do not achieve their usual length.

The first sign of hair loss that most women notice is often widening of their part or that their ponytail is smaller.

How is female hair loss treated?

Minoxidil (Rogaine) 5% is the only topical medication approved by the FDA for female-pattern hair loss. The once daily use foam treatment regrows hair in 81% of the women who try it. 

Liquid options of 2% and 5% solutions are available over the counter. Minoxidil works by prolonging the growth phase of hair -- providing more time for hair to grow out to its full density.

You have to be patient, as noticeable results usually take three to four months and the product must be used once a day. It tends to work better if started early.

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I put some on my forearm and got a big thick patch of hair. When I stopped, it went away.

Doctors may also test for levels of ferritin (a protein that indicates the amount of total body iron stores). New research suggests levels may be low in women with hair loss. Iron supplements may help.

Also new is the HairMax Laser Comb. It's a red light therapy hairbrush-like device that increases circulation and the biological march that makes hair. It's only approved in men (though some women are using it) and in my experience, is not as good as minoxidil. But in one study, 45% of users reported improvement after eight weeks, and 90% saw improvement after 16 weeks.

In some cases, a hormonal abnormality, such as excess male hormones known as androgens, may be responsible for hair loss in women. One clue that hormones are involved is if the hair loss pattern resembles that of a man’s hair loss. This can be treated with prescription medications such as spironolactone or oral contraceptives.

In men, finasteride (originally marketed as Proscar) is approved for hair loss associated with androgens. In one study, 62% of women also taking oral contraceptives containing the synthetic progestin drospirenone reported improvement. So it may be effective for female hair loss in the setting of increased androgen. But studies are limited and it is harmful to the male fetus so should not be used by women thinking about becoming pregnant or who are pregnant.

Another treatment option is hair transplantation, in which tiny hair follicles taken from one area of the scalp are transplanted into the affected areas. It can be very effective and produce permanent results that are natural looking.

Should I change my hair care regimen?

No. Since there is no structural problem with the hair with female-pattern hair loss, women should continue their regular hair styling regimen. Sometimes women think they should stop washing, coloring, or perming their hair, but these things won’t impact the course of hair loss or speed up the process.

Wash with an anti-dandruff shampoo that contains ketoconazole (an antifungal) or zinc pyrthione (an antifungal and antibacterial).

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Can hair loss be a sign of a more serious problem?

Yes. Hyperandrogenism, a medical condition characterized by excessive production of male hormones called androgens, can cause hair loss in affected women. The most common cause of hyperandrogenism in women is functional ovarian hyperandrogenism, also known as polycystic ovary syndrome. In addition to hair loss, other signs include obesity, acne, and irregular menstruation, and it is one of the most common causes of infertility.

Many of these women have metabolic syndrome -- a combination of five medical conditions including belly fat and high blood pressure that increase the risk of diabetes, heart attack, and stroke.

Although hair loss stemming from hyperandrogenism can be treated with minoxidil, you need to seek care for the other conditions.

WebMD Feature Reviewed by Laura J. Martin, MD on March 11, 2010

Sources

SOURCES:

68th Annual Meeting of the American Academy of Dermatology, Miami Beach, Fla. March 5-9, 2010.

Mary Gail Mercurio, MD, associate professor of dermatology, University of Rochester, Rochester, N.Y.

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