Common causes of hair loss in women

by Tony Pearce RN.
Specialist Trichologist, National Trichology Services

Hair loss from some form of hormonal disturbance has arguably become one of the most frequently seen complaints in pre and postmenopausal women. Diffuse (“all over”) hair fall anecdotally seems equally as common, with this category subdivided as ‘temporary, self-correcting’ and ‘continuing until corrected’.

For the reader specifically seeking information on the subject, androgenetic alopecia from hormonal origin has been detailed within other articles at this website. This item will instead concentrate on the causes and treatment of diffuse hair loss.

Diffuse hair loss is excessive hair loss from all over the entire scalp. Because the growing hair is very sensitive to nutritional, metabolic or environmental disturbances, hair is often one of the first areas of the body to reflect disturbances in physiological functioning. The continuously dividing cells of the hair follicle are one of the most metabolically active in the body, and often express changes by alterations in phases of the hair cycle, leading to decreased hair growth, excessive hair fall, or a diminishing of hair shaft integrity.

High fevers, food poisoning, surgical/dental procedures, sudden weight loss/dietary changes, commencing/ceasing certain medication, acute psychological shock, or following childbirth are some of the events that may cause a percentage of hair in the growing (anagen) phase to prematurely pass into the falling (telogen) phase. Two–three months after any of these experiences, the hair will begin to shed abruptly and be lost in excessive amounts for about 2-3 months before settling. This type of diffuse hair loss is termed “temporary, self-correcting”.

Although the above initiators are essentially self-correcting forms of undue hair shedding, a woman’s iron and nutritional status should always be reviewed to limit the problem’s continuance.

When hair loss is subtle, slowly thinning out over many months or even years, the underlying cause is apt to be a nutritional or metabolic disturbance. It is important to remember here that your hair is essentially a reflection of what’s happening within your body.

A nutritional disorder may occur from many causes such as vitamin, mineral, or amino acid deficiency or excess. A nutritional deficiency causing excessive hair fall is usually the result of poor dietary habits over a prolonged period. Iron deficiency in females is commonly caused from blood loss during menstruation and insufficient consumption of iron-rich foods.

Besides iron, other frequently seen mineral disturbances are zinc, chromium, and copper (in excess). Vitamin D (calcitriol) deficiency has been increasingly reported among the elderly population – particularly those confined to nursing homes/hostels etc. Vitamin D is essential for the absorption and utilisation of calcium and phosphorus from the gut. Loss of muscle tone and softening of the skeletal bones (osteomalacia) will eventually result from defective calcium utilisation.

Glands, Hormones & Hair Loss:

Endocrine glands secrete hormones into our body’s bloodstream, where, through complex negative feedback systems, they regulate body metabolism, the internal environment, and energy balance. The endocrine system consists of endocrine glands and several organs that contain endocrine tissue.

A metabolic disturbance might equally be defined as hormonal, for an under or overproduction of tropins (hormones that influence other endocrine glands) – or the hormones secreted by the glands themselves, is the primary cause of disruption to hair cycle phasing – resulting in a ‘continuing until corrected’ form of hair loss.

It is beyond the scope or intention of this article to detail all the conditions associated with endocrine dysfunction. Suffice to say that diffuse hair loss is a common sign, whilst good history-taking and medical referral for specific blood testing/management should confirm the diagnosis.

An astute trichology practitioner can assist by holistically reviewing the patient’s diet, lifestyle, and stress levels to determine whether or not these issues are impacting on their hair.

There are many different reasons why an individual may experience severe or prolonged physiological or emotional stress. It may be the illness/death of a loved one, an abusive relationship or relationship failure, impending/threatened financial penury, chronic pain conditions, addictions etc. These types of severe stressors may activate a diffuse, androgenetic, or autoimmune hair loss situation in a pre-disposed person.

Whilst our body’s ‘normal’ stress response is a protective adaptation against harmful situations; the well-coined ‘fight or flight’ syndrome – excessive or protracted stress can pathologically influence our physiology to advance acute or chronic illness.

Reaction to stress is a complex cascade of hormones from one endocrine gland to another, with equally complex negative feedback mechanisms. This endocrine response occurs in conjunction with direct neural stimulation from the sympathetic nervous system.

Many important hormones are influenced by our response to stress including growth hormone (somatotropin), thyroxine, adrenaline and cortisol from the adrenal glands, and glucagon from the pancreas. All of these hormones have the capacity to raise blood sugar levels, whilst elevated blood cortisol can deplete a number of important steroid hormones.

Finally, it’s well documented that stress directly influences many illnesses including ulcerative colitis, rheumatoid arthritis, asthma, migraine headaches, and depression. However stress as a cause for hair loss is often prematurely diagnosed by some practitioners, who are either unsure of what to look for or what to ask. The person experiencing the problem should be the best judge of whether or not they are or have been under sufficient stress to initiate their presenting complaint. It reflects poorly on a practitioner who, without proper investigation, dismisses their patient as “stressed”, vain, or neurotic. Remember: “if it’s a problem to the person it’s happening to … then it’s a problem.”


About the Author: Tony Pearce is a Specialist Trichologist & Registered Nurse. He is a founding member of the Society for Progressive Trichology & the official lecturer for Analytical Reference Laboratory (ARL) for hair loss & hormone imbalance. In Australia he can be contacted on +61 2 9542 2700, or through his website at www.hairlossclinic.com.au. Copyright Anthony Pearce

Copyright Anthony Pearce 2005. *References for this article available on request