Hair loss in women: causes, treatment and when to see a GP

Treatment depends on the cause. The NHS says most hair loss does not need treatment because it is either temporary and will grow back, or a normal part of getting older. Hair loss caused by a medical condition usually stops or grows back once you have recovered.

For female pattern hair loss, BAD says there is no cure but it tends to progress very slowly, over several years to decades. Applying 2% or 5% minoxidil solution to the scalp every day may help slow the progression and partially restore hair in some women. Only the 2% strength is licensed for women, and neither is available on the NHS. It should be used for at least 6 months before any benefit is noticed, any benefit lasts only while it is used, and it may cause an initial hair fall in the first 4 to 6 weeks. Minoxidil should be avoided if you are planning pregnancy or breastfeeding.

BAD adds that low-dose oral minoxidil may be at least as effective as topical in some situations, and that spironolactone, cyproterone acetate, flutamide and bicalutamide can block the action of androgens on the scalp. These are not licensed for female pattern hair loss and are specialist options. Spironolactone and cyproterone acetate should be avoided in pregnancy, and flutamide carries a risk of liver damage.

The NHS lists other options for various types of hair loss, including steroid injections and creams for bald patches, immunotherapy, light treatment, micropigmentation (a tattoo that looks like short hair), hair transplant and wigs. Some wigs are available on the NHS but you may have to pay unless you qualify for financial help.

BAD says platelet rich plasma (PRP) and hair transplantation are not offered on the NHS and can be sought privately, and that research on PRP is too limited to understand when and how it might work.

The NHS says some types of hair loss are permanent, such as male and female pattern baldness, which usually runs in the family. Others are temporary and can follow an illness, stress, cancer treatment, weight loss or iron deficiency. Occasionally hair loss can be a sign of a medical condition, which is why a GP check is worthwhile.

BAD says female pattern hair loss is caused by a combination of genetic and hormonal factors, may be inherited from either or both parents, and can accompany conditions with raised androgen levels such as polycystic ovary syndrome, whose signs include acne, increased facial hair, irregular periods and infertility.

BAD says in women the onset is later than male pattern hair loss, usually in the 50s or 60s, occasionally in the 30s or 40s. There is diffuse thinning mainly over the top of the scalp, the mid-parting becomes more visible and widened, and the front hairline often remains normal. Hairs in the affected areas become thinner and shorter before they are lost. It is not usually associated with scalp symptoms, though some women report itch.

Diagnosis is usually based on the history of gradual thinning or increased shedding on the top of the head, the pattern, and any family history. The scalp skin looks normal, and a skin biopsy may occasionally be requested.

BAD points out that hair loss can have a significant psychological impact, with decreased self-esteem and body image concerns, and that it is important to discuss your emotional wellbeing with a healthcare professional. It also advises covering bald areas with sun block, a hat or a wig, because hair helps protect the scalp from sunlight.

BAD explains that hair grows in cycles: about 85% of scalp follicles are growing and about 15% are resting before they shed. In telogen effluvium the shedding proportion rises to 30% or more, often suddenly and around 3 months after a trigger. Most people notice more hair on the brush, in the shower drain or on the pillow, and hair thickness decreases all over rather than in patches.

It affects all ages and both sexes equally and does not run in families. BAD says it usually gets completely better without treatment: the shedding phase lasts 3 to 6 months, after which new hair starts to grow, though it may take many months to return to normal volume. It is considered chronic if it lasts more than 6 months, and can recur if a cause such as iron deficiency is not treated. Medication does not speed regrowth.

A diagnosis is usually made from the scalp appearance and history, sometimes with a gentle hair pull test. A blood test may be done to exclude thyroid conditions and iron deficiency. BAD suggests avoiding harsh brushing, heated tools, bleaching and tight hairstyles, not smoking, and eating a balanced diet with iron and protein.

BAD describes alopecia areata as a common condition of non-scarring hair loss that can occur at any age. It usually causes small, coin-sized, round patches on the scalp, although eyebrows, eyelashes and body hair can be affected, and occasionally the whole scalp (alopecia totalis) or the whole body (alopecia universalis). There may be itching, burning or tingling before or after the hair loss.

It is caused by the immune system mistakenly attacking the hair follicle. Hair can regrow on its own over months, and rarely years, but this cannot be guaranteed and new patches may occur. BAD says the chances are better if less hair is lost initially, the hair sometimes regrows white at first, and a UK study found higher rates of depression and anxiety, so emotional support matters.

The NHS says a GP may be able to tell you the cause by looking at your hair, and asks you to say if the hair loss is affecting your wellbeing. BAD says blood tests may be done for thyroid conditions and iron deficiency when shedding is sudden, and that a scalp examination and sometimes a scalp biopsy help in uncertain cases.

Iron deficiency anaemia is diagnosed with a full blood count, according to the NHS, which lists hair loss among less common symptoms, alongside tiredness, breathlessness and pale skin. It says heavy periods and pregnancy are very common causes.

The NHS says to see a GP if you are worried about your hair loss. A GP appointment is also the place to raise how it affects your wellbeing and ask what treatments are available, and the NHS says that your GP may be able to help you get counselling if the hair loss is causing distress.

BAD advises seeing a doctor if hair shedding does not get better, to rule out other causes. Get a check promptly if hair loss is patchy, sudden and widespread, comes with a painful or scarred scalp, or is accompanied by tiredness, weight change or irregular periods.

On the NHS a GP assesses hair loss, arranges blood tests and can refer to a dermatologist. The NHS says not all treatments are available on it, so you may have to pay, and that no treatment is 100% effective. It also says to see a GP before going to a commercial hair clinic.

Private dermatology and trichology assessments, PRP and hair transplantation are available privately, as BAD notes for PRP and transplantation. Because pattern hair loss progresses slowly and treatments only work while used, ask any provider about the evidence, the cost over time and what happens if you stop.