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Many people think that age-related hair loss only affects men. However, it is common for women to also experience hair thinning with age. This is known as female pattern hair loss (FPHL), or androgenetic alopecia in women.

The pattern of hair loss is different in women compared to men (women tend not to have a receding hairline), and complete baldness is rare in women.

Not all women who experience female pattern hair loss seek treatment. However, for those who do, there are several choices available. In addition to cosmetic treatments for hair loss, there are treatments that help prevent further hair loss and stimulate hair regrowth.

Symptoms of female pattern hair loss

Female pattern hair loss is extremely common, affecting about 40 per cent of women to some degree by the time they have reached 50 years of age. Hair loss can start at any age, but is most often noticed after menopause (when a woman stops having periods, which usually happens between the ages of 45 and 55 years).

When age-related hair loss affects women, the pattern of hair loss is different from that seen in male pattern hair loss.

In women:

• the hair tends to thin all over the scalp;
• the hair on the top of the head thins and the hair part line (parting) becomes wider; and
• the hairline at the front of the head becomes more sparse.

With FPHL, women tend to notice that they shed more hair than usual from time to time. Many women report excessive hair loss for a period of 3-6 months, and then a return to normal amounts of hair loss for periods of 6-18 months. The hair loss tends to slowly become more pronounced over many years.

What causes female pattern hair loss?

Most women with female pattern hair loss are thought to have inherited the condition from one or both of their parents. However, some women with FPHL do not have a family history of this condition.

Male pattern hair loss is caused by an inherited sensitivity to male sex hormones (androgens), which affects the scalp hair follicles and results in thinning hair with ageing. FPHL may also be related to sensitivity to these hormones, although the exact role that androgens play in women is uncertain.

FPHL is more common after menopause, suggesting that changes in the levels of female hormones (oestrogens) may also be involved.

A small number of women with female pattern hair loss have a higher than normal concentration of male hormones in their bodies. These women may lose hair in a similar pattern to men with male pattern hair loss and often have additional symptoms related to this excess of androgens, such as:

• hirsuitism (too much hair on the face or body);
• severe acne; or
• irregular periods.

If you have hair loss plus these additional features, your doctor may want to rule out the possibility that a condition such as polycystic ovary syndrome (PCOS) may be causing (or contributing to) your hair loss. Rarely, this combination of symptoms may indicate a tumour that is secreting male hormones.

Tests and diagnosis

Your doctor will ask about your hair loss, including how quickly you have been losing hair and where you have noticed the hair loss. They will also want to check whether you have been experiencing any other symptoms to rule out other causes of hair loss.

As well as examining your scalp, your doctor will perform a general physical examination.

Tests are usually not needed to diagnose female pattern hair loss – diagnosis is usually based on the pattern of hair loss. However, if you have symptoms or signs that you may have an unusually high level of androgens (male hormones) in your body, your doctor may recommend a blood test to check for this. The level of female hormones (such as oestrogen) may also be tested.

Your doctor may also recommend tests or consider referring you to a skin specialist (dermatologist) if there is a possibility that your hair loss could be related to another condition.

Treatment for female pattern hair loss

Treatment for female pattern hair loss is not necessary for all women, but women who are bothered by the effect that their hair loss has on their appearance may wish to treat it.

Available treatments may:

• slow or stop the loss of hair;
• stimulate regrowth of hair; or
• cosmetically treat the hair loss.

Hair loss treatments are more effective for some women than others. Your doctor will be able to discuss with you the risks and benefits of different treatment choices and which treatment option would be most appropriate for you.

Medicines for female pattern hair loss

Medicines include minoxidil solution that you apply to the scalp or tablets to block the effects of androgens (male hormones). Women with significant hair loss may use a combination of both treatments.

Minoxidil

Minoxidil is a medicated solution you apply to the scalp to help stop hair loss. It may also stimulate hair regrowth in some women. Brand names available in Australia include Regaine for Women and Hair A-Gain. Minoxidil for hair loss is available over-the-counter from pharmacies – you don’t need a prescription.

It takes about 4 months of using minoxidil to see any obvious effect. You might have some hair loss for the first couple of weeks as hair follicles in the resting phase are stimulated to move to the growth phase.

You need to keep using minoxidil to maintain its effect – once you stop treatment the scalp will return to its previous state of hair loss within 3 to 4 months. Also, be aware that minoxidil is not effective for all women, and the amount of hair regrowth will vary among women. Some women experience hair regrowth while in others hair loss is just slowed down. If there is no noticeable effect after 6 months, it’s recommended that treatment is stopped.

Always carefully follow the directions for use, making sure you use minoxidil only when your scalp and hair are completely dry. Take care when applying minoxidil near the forehead and temples to avoid unwanted excessive hair growth. Wash your hands after use.

Side effects associated with minoxidil

The most common side effects of minoxidil include a dry, red and itchy scalp. Higher-strength solutions are more likely to cause scalp irritation.

Bear in mind that minoxidil is also used in tablet form as a prescription medicine to treat high blood pressure, and there is a small chance that minoxidil solution could possibly affect your blood pressure and heart function. For this reason, minoxidil is generally only recommended for people who do not have heart or blood pressure problems.

Minoxidil should not be used if you are pregnant or breast feeding.

Anti-androgen medicines

Spironolactone and cyproterone acetate (brand names include Androcur, Cyprone and Cyprostat) are anti-androgen medicines that may be prescribed to treat female pattern hair loss.

These medicines help stop hair loss and may also stimulate hair regrowth. Spironolactone has been shown to stop the loss of hair in 90 per cent women with androgenetic alopecia. In addition, partial hair regrowth occurs in almost half of treated women.

The effects of treatment generally only last while you continue to take the medicine – stopping the medicine will mean that your hair loss will return.

Spironolactone and cyproterone acetate should not be taken during pregnancy. Effective contraception must be used while you are being treated with these medicines, as it can affect a developing baby. These medicines should also not be taken if you are breast feeding.

Side effects of anti-androgen medicines

Side effects of spironolactone can include:

• irregular periods and spotting;
• breast tenderness or lumpiness; and
• tiredness.

Side effects of cyproterone acetate can include:

• spotting and irregular periods;
• tiredness;
• weight gain;
• reduced libido; and
• depressed mood.

Hair transplant surgery for women

Your doctor can refer you to a dermatologist or hair transplant surgeon to assess whether hair transplant surgery may be a suitable option for you.

Hair transplant surgery involves follicular unit transplantation, where tiny clusters of hair-producing tissue (each containing up to 4 hairs) are taken from areas of the scalp where hair is growing well and surgically attached (grafted) onto thinning areas. However, if your hair is very thin all over your scalp, you may not have enough healthy hair to transplant.

Hair transplant surgery can be expensive and painful, and multiple procedures are sometimes needed. Side effects may include infection and scarring.

Talk to your doctor about the risks and benefits of this treatment.

Cosmetic treatments for hair loss

The following cosmetic treatments for hair loss are available for women with FPHL.

• Hair bulking fibre powder, such as natural keratin fibre, is an inexpensive treatment that involves applying tiny, microfibre ‘hairs’ that bond to existing hair through static electricity to give the appearance of thicker hair.
• Colouring the scalp with a camouflage dye, or coloured hair spray.
• A special type of tattooing called scalp micropigmentation or dermatography may be recommended in some cases where the hair is thinning to give the appearance of thicker hair.
• Synthetic and real hair wigs are available for those with severe hair loss.

Unproven treatments

Hair loss remedies that have not yet been shown or proven to be effective include:

• laser treatment;
• nutritional supplements;
• platelet-rich plasma injections (also referred to as PRP rejuvenation);
• scalp massage; and
• acupuncture.

Some hair loss clinics and alternative medicine practitioners offer unproven treatments for hair loss. Make sure you understand exactly what is involved with any hair loss treatment and whether there is any proven scientific evidence for its effectiveness.

Discuss with your doctor the risks and benefits of any treatments that you are interested in before trying them. This will help you avoid spending money on a treatment that is unlikely to help and may involve side effects.

Your GP can refer you to a specialist dermatologist for an expert opinion on current treatments that have been shown to be safe and effective.

Sun protection for your scalp

Having thinner hair may mean that your scalp is vulnerable to the harmful effects of the sun. Protect your scalp from UV radiation when you are outdoors, especially during the warmer months by wearing:

• sunscreen (spray-on forms of sunscreen can be used for protection if applied correctly and according to instructions); and
• a hat or scarf.

Support for women with hair loss

Many women find that hair loss can impact on their confidence and self-esteem. Some women may even develop depression. Counselling can help, as can joining a support group where you can share experiences with other people experiencing hair loss. Talk to your doctor if your hair loss is causing you distress.

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