Hair loss affects 1 in 10 women before the menopause - here's how to treat it (2024)

Think of hair loss and you might imagine a balding man. But women can also start losing their hair, and because it is more unexpected, it can be extremely distressing.

The condition is not rare – more than one in ten women have some evidence of hair loss before they reach the menopause – according to Nice, the government medical guidance body. But it is rarely talked about and that can bring its own problems.

“It’s not spoken about enough that this is a condition that can be found in women,” says Dr Leila Asfour of the British Association of Dermatologists. “This is a vulnerable group of patients and they can feel really isolated.”

In desperation, some women cycle through an expensive array of unproven remedies like supplements, shampoos and lotions. While most such products do nothing to help, there are a growing number of medical therapies that can slow hair shedding and can even cause partial hair regrowth. So, what causes female hair loss and what are the best science-based ways to treat it?

There are several causes of hair loss, or alopecia, in women. One of the most common conditions is just called female pattern hair loss, to differentiate from the more common male pattern hair loss which tends to start as the characteristic receding hairline, especially at the temples.

In female pattern hair loss, hair tends to just become gradually thinner all over. It gets more common with age and affects nearly all women if they live long enough. But for some women hair loss can start as early as their twenties.

Hair in the shower

Some women first notice more hairs than usual falling out in the shower or on a hair brush. Hairs grow from follicles within the skin, which have a distinct life cycle: they produce hair for several years, then have a resting phase for a few months, when the hair shaft detaches and falls out. It is normal to lose about 100 hairs from our heads a day.

Physical or mental stress can trigger a temporary condition called telogen effluvium, when more hairs move into the resting phase, causing up to three times the usual amount of hairs to be shed per day. This generally stops happening after a few months.

Female pattern hair loss, however, tends to continue. Here, the hair’s growing phase shortens and the resting phase lengthens, so it takes longer for hair to start growing back after it has been shed, leading to thinning.

The hair follicles themselves also start to shrink, causing the hair shaft to be thinner. Over time they switch to producing much shorter and thinner hairs, the type that is found on our skin and is barely visible.

Unfortunately, many of the shampoos and supplements aimed at hair loss don’t work, and there’s not even any theoretical way that they could work. “Shampoos can help to maintain a clean scalp but they’re not going to stimulate the hair follicle,” says Dr Anastasia Therianou, a dermatology lecturer at Imperial College London.

Similarly, widely used supplements of collagen, a structural protein in hair, are not going to help, because proteins are digested into their building blocks of amino acids in our stomach – there is no way that eating collagen can deliver it to your hair follicles. “People pay all this money for these supplements that have no evidence, and the science shows that they wouldn’t be able to work,” says Dr Asfour.

Mineral deficiency

The exception is that a lack of iron or zinc in the diet can contribute to hair thinning, so supplements could be of use there, says Professor Andrew Messenger, a dermatology researcher at the University of Sheffield. But it’s debatable how often this is a cause of hair loss, he says.

In fact, the most common effective treatment for female pattern hair loss is a medicine called minoxidil, which can be bought from chemists as a lotion or a foam, or can be prescribed in tablet form, although not on the NHS.

Minoxidil seems to work by prolonging the growth phase and shortening the resting phase of the hair life cycle, perhaps by increasing blood flow to scalp follicles. It works for about six in ten women who try it, increasing hair density by 10 to 15 per cent.

But the main benefit may be more that it stops or slows the progression of hair loss, says Professor Messenger. “It tends to get worse if you don’t treat it.”

Another prescription drug, called spironolactone, works by blocking testosterone, which may contribute to female pattern hair loss in women who have higher testosterone, such as those with polycystic ovary syndrome (PCOS) or who are post-menopausal.

Once drug treatments have been tried, a more radical option is low-level laser therapy, which involves irradiating the scalp with red laser light for several minutes a day. This can be done by buying a hat-like device or even a laser-emitting brush.

While this may sound gimmicky, laser therapy is thought to stimulate mitochondria, the cell’s energy-producers, and is being investigated in several other medical uses, such as wound healing.

There is some evidence from randomised trials that it slightly increases hair density, by about as much as minoxidil. It is still unclear exactly how it works, says Dr Therianou, but the same is true for many other medical interventions. “In hair loss, not everyone responds to every treatment, so the fact we have another option is important.”

There are other less common causes of female hair loss, including alopecia areata, which is caused by the immune system attacking hair follicles. This year a tablet called Litfulo, used for the severe form of this condition was approved for the NHS, while for milder forms, a cream containing a drug called STS-01 has just produced promising results.

There is also traction alopecia, caused by hairstyles such as tight ponytails, extensions or braids pulling at the same place on the scalp for a long period of time. The treatment here is to stop putting this stress on the hair follicles before it causes permanent damage.

With several possible causes, it is important that women experiencing hair loss ask their GP to see a specialist for advice, says Dr Asfour. “By the time they get to my NHS hair clinic, they will be in despair. But there are treatments. The more severe it’s become, the harder it is to bring those hairs back, but if you catch it early, you can try and salvage quite a few of the hairs.”

Embracing hair loss

Lesley Walsh, a digital marketing consultant, will never forget the evening, ten years ago, when she realised she was losing her hair. Watching TV, she absent-mindedly touched the back of her head, and discovered a round area of smooth skin. In a mirror, she found the patch was completely bald. “I felt sick to the pit of my stomach,” she says.

Lesley was eventually diagnosed with alopecia areata, a condition where the immune system attacks hair follicles. Her dermatologist offered treatment with steroid cream, but admitted it would probably do no good, and said there was little else to offer. (Since then a drug treatment has become available.)

Lesley tried some remedies but nothing worked conclusively, although she feels a good diet is helpful. Alopecia areata can fluctuate with hair growth coming and going for reasons that are unclear. “Sometimes people get hair growth, but it just goes away again at another point anyway – it’s an emotional rollercoaster,” she says. Eventually, exasperated by her half bald head, Lesley shaved off all her hair. “It’s like taking control, being in charge of it,” she says. “You’re no longer looking to see if people can see bald bits. For me, mentally it’s better if I don’t have any hair.”