GENERAL

HAIR LOSS IN WOMEN

თმის ცვენა

Although hair loss isn't a life threatening condition, it has very serious impact on quality of life and on one's psychologic being.

There are approximately 100 000 hair follicles on the scalp and each of them has its own life cycle which includes growth and resting phases.

At a given moment most of the hair follicles are in their growing phase which lasts for 2 to 6 years.

This stage is followed by resting phase when hair doesn't grow anymore. The length of this phase is approximately 100 days and it ends by disconnection the hair from its follicle where the new hair starts to grow.

The normal amount for falling hairs are 50-100 unit a day and this loss is permanently balanced by new hair growth.

In case of man, the reason of hair loss is genetic boldness in 90%. But when the woman has this problem, a lot of different reasons can stand behind it. Some of them can seriously impact the overall health and needs to be treated. So it's reasonable to start diagnostic process by excluding this conditions and here the role of endocrinologist is high, because hair loss is a symptom of many hormonal disorders.

Androgenic alopecia

The most frequent reason of hair loss in women is high level of androgen hormones or increased sensitivity on their action. This condition is called androgen alopecia.

Androgen hormones have serious impact on hair follicle life cycle. Dihydrotestosterone causes shortness of grows phase and jumping faster into the resting phase. Also the hair follicle changes in such way that it becomes small and can't function any more.

The most frequent cause of high androgen levels in woman is polycystic ovarian syndromeThe detection of this disease is important because beside of hair loss it has lot of negative results in the body such as: infertility, insulin resistance and so on.

The second group of cases caused by androgenic alopecia is genetic. In these cases it's not necessary for testosterone level to be high than normal, because genetic predisposition provide the fact that hair follicles have very high sensitivity to testosterone action. So we still have androgenic problems despite the normal androgen level.

Genetic androgenic alopecia is incurable. Different local medications have there effect only when they are used foe a long time and after taking off this effect is lost. Also it's important such a treatment to be started early when hair follicle aren't damaged yet and their function are preserved.

Hair loss is also present in case of hormonal imbalance: testosterone isn't high but estrogen level is low.

Thyroid gland

The cause of hair loss from thyroid diseases can be as Hyperthyroidism, so Hypothyroidism.

If we know that thyroid disorder doesn't have long history and is detected in early stage, it's unlikely to be the reason of hair loss.

But in most cases thyroid disorders aren't diagnosed for years, or after diagnosis it's left untreated for a long time. Exactly this type of disease can be cause of excess hair loss along with other symptoms. Hair loss is diffuse, it isn't located in one particular area and can be reversed.

After compensation of hypo or hyperthyroid states hair's normal volume returns back. But patient must know that recovering process is long lasting, it may take several months and having patience is an important factor for successful treatment.

Also very characteristic symptom for thyroid disease is brow hair loss on its outer third.

Because of hair life cycle sometimes hair loss begins when for example hypothyroidism is diagnosed and treatment starts. In this case patient may decide that thyroxin medication is the reason for hair loss and may even stop the treatment. Of course this is a big mistake and it causes worsen of symptoms after some time.

If autoimmune disease of thyroid is present, beside it can be other autoimmune diseases including alopecia areata. But in this case the autoimmune system is responsible, not the thyroid.

Prolactin level measurement

Prolactin receptors are found in hair follicles. This fact indicates that this hormone has a direct impact on hair cycle.

Also prolactin participates in testosterone metabolism and it stimulates androgen release.

Stress

Different kind of acute or chronic stress causes cortisol release by adrenal glands. Cortisol for itself causes early transition of hair grows phase to resting phase, which is followed by excess hair loss.

Stress also can cause worthening of hair loss from any other causes.

Stressors can be different psychosocial and physical factors such as surgical intervention, trauma and childbirth.

The hair loss due to stress has acute onset, diffuse and temporary.

Rapid weight loss

Significant weight loss during short period acts as stressor for the body and for this reason stress hormones are activated. So it result hair loss, which lasts approximately 6 months and then hair volume is recovered without any treatment.

Very often weight loss is provided by unhealthy diets and because of this the body may become deficient in some important proteins, vitamins and minerals. This affects hair health too. In this case we must work at eating plan.

Nutrient hair loss

  • lack of protein in diet - protein is a building material for hair, so the food must include sufficient amount of protein.
  • iron deficiency - low level of iron and ferritin can impact hair health.
  • vitamin C - vitamin C is crucial for gastrointestinal tract to absorb the iron. Otherwise It doesn't have direct impact on hair follicles.
  • vitamin A - both low and high levels of vitamin A can cause hair loss.
  • vitamin D deficiency is one of the main causes of hair loss.
  • biotin (vitamin B7) - many hair care products contain this product and often is recommended by doctors, but its efficiency isn't confirm by randomized researches.

Taking extra amounts of vitamins can worthen hair loss.

Postpartum hair loss

Approximately 4 months after childbirth most of the women experiences significant hair loss. This is a physiologic process and is caused by rapid drop of estrogen level.

Estrogen level is very high during the pregnancy, for this reason the growing phase of hair is prolonged. In this period hair loss is minimal and follicles become synchronized. Lowering estrogen level after delivery becomes reason that many hair follicles transfer to resting phase at the same time. As we mentioned this phase last 100 days and exactly after 100 days postpartum hair loss begins.

Additional reason for hair loss is also delivery stress.

This condition is temporary and most of the moms notice that hair volume is recovered for babies first birthday.

For minimize discomfort it's recommended to use shampoos with increasing volume effect, or change the hair style and to choose short variants.

If the problem stays after 1 year from childbirth, It can be sigh of other medical disorders and it's reasonable to consult with doctor.

Other frequent causes of hair loss:

  • alopecia areata
  • lupus erythematosus
  • chemotherapy
  • some medications
  • specific hair styles and chemicals in hair care products
  • age related - after 50-60 years

So some kind of hair loss such as postpartum and age related hair loss is normal part of our lives.

Hair loss doesn't need treatment in these cases:

  • postpartum period
  • postsurgical period or after recovery from any serious disease
  • after rapid weight loss
  • after cancer treatment
  • if hair loss is seasonal and is evident in autumn

Diagnostic researches

For affective treatment of hair loss the first step is to detect its cause.

A doctor decides which laboratory tests are needed to be performed in each individual case.

Written by: Elga Giorgadze, MD


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