Hair Loss in Women

When a woman says her hair has thinned, she is usually right: more hair on the brush and pillow, a wider part, a thinner ponytail. But the same complaint can come from very different conditions. Some settle once the cause is gone; others progress slowly and, left untreated, take density away year after year.

This page covers the essentials of hair loss in women: telogen shedding after illness, stress or childbirth, the role of hormones and the thyroid, female pattern hair loss and age-related change. It draws on the research and publications of the doctors in the Trichology Institute's clinical trichology department.

We do not diagnose from a photo or at a glance. The cause is established through a detailed history, examination, trichoscopy and, where needed, lab tests. Often there is more than one cause at once, and treatment works when all of them are found.

When to see a trichologist

Every day some hairs naturally reach the end of their cycle and fall out, while new ones start growing from the same follicles. Book a consultation if:

shedding is clearly heavier than usual and has not eased for several weeks;
your part is widening, the scalp shows through on the crown, or your ponytail has become thinner;
bald patches or broken hairs have appeared;
the scalp itches, burns, hurts, turns red or flakes;
along with your hair, your menstrual cycle has changed, or you notice acne, excess hair on the face or body, or nipple discharge;
hair has become dull and brittle, the outer part of the eyebrows has thinned, the skin is dry;
the shedding began after starting or stopping hormonal medication or other drugs.

Do not wait for your hair to "settle down on its own" if thinning has gone on for months. Female pattern hair loss progresses gradually, and the earlier it is recognised, the more follicles can be preserved.

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Causes of hair loss in women

More than 80% of hair loss cases are non-scarring: androgenetic, diffuse and patchy (areata) alopecia and trichotillomania. In women, these are the causes we most often have to sort out.

Telogen shedding after illness, stress or childbirth

This is the most common type of hair loss. A high fever, serious illness, surgery, rapid weight loss or a severe shock pushes many hairs into the resting phase (telogen) at the same time. That phase lasts about 12 weeks, so the hair starts to fall out with a delay, when the event itself is already over.

In the second half of pregnancy the share of hair in the growth phase rises from 85 to 95%. After delivery these follicles move quickly into the resting phase, and postpartum shedding begins 1 to 4 months later. A similar picture can appear from 2 weeks to 3 or 4 months after stopping oral contraceptives. Telogen shedding after sunburn of the scalp has also been described.

Hormones and the thyroid

The hormones with the greatest effect on hair growth are androgens, oestrogens, thyroid hormones, prolactin and corticosteroids. Hypothyroidism is about ten times more common in women than in men: hair becomes dull, coarse and brittle, and diffuse thinning develops gradually. In hyperthyroidism diffuse shedding is seen in 20 to 40% of cases. Excess prolactin can cause both telogen shedding and androgenetic alopecia.

Excess androgens, for example with polycystic ovaries or adrenal disorders, show up as hirsutism and thinning on the scalp. In genetically predisposed women, contraceptives or hormone therapy containing progestins with androgenic activity can also trigger hair loss. More in the publication Hormones and hair.

Female pattern hair loss

Over a lifetime it affects up to half of all women. In genetically predisposed follicles, androgens make each new hair thinner and shorter than the last, down to barely visible vellus hair. It can begin in the teenage years or later, around menopause. The mechanisms and treatment are covered in the publication Androgenetic alopecia.

Menopause and age-related change

As oestrogen falls after menopause, hair becomes drier and the tendency to pattern hair loss increases. In postmenopausal women the share of growing hair, the growth rate and the hair diameter all decrease, most of all at the front of the scalp. After 50, involutional alopecia can also develop: a very slow but steady diffuse thinning that does not depend on androgens. See the publications Involutional hair loss and Biological foundations of hair follicle ageing.

Nutrition, medication and general health

The hair shaft is made almost entirely of protein, so a shortage of protein, energy, vitamins and trace elements, or poor absorption of them, shows in the hair. Some medicines, endocrine and metabolic disorders and psychological distress can also cause shedding. Do not stop medication you have been prescribed on your own: that decision belongs to the doctor who prescribed it.

What it looks like

Outward signs can suggest the type of hair loss, but they are not enough for a diagnosis.

Heavy shedding all over the head a few weeks or months after illness, childbirth or stress: hair on the brush, in your hands, in the drain, with density falling evenly. This is how telogen shedding usually looks.
Gradual thinning on the crown with the front hairline preserved: the part widens, sometimes in a "Christmas tree" shape along the centre of the head. Less often the hair also thins at the temples. Hairs become finer and shorter even without noticeable shedding. These are the typical patterns of androgenetic alopecia in women.
Slow, even thinning after 50: hair is drier, more brittle and grows more slowly. Involutional change often coexists with androgenetic alopecia, and the two can be hard to tell apart.
Dull, coarse, brittle hair with thinning of the outer eyebrows and dry skin: a reason to check the thyroid.

Conditions can overlap. Androgenetic alopecia itself comes with increased shedding of resting hairs, and telogen shedding drags on if its cause is still active. That is why shedding that has not stopped after a few months should be seen by a doctor.

Diagnosis at the Trichology Institute

A first consultation with a trichologist at the Institute includes digital trichoscopy on FotoFinder equipment. The doctor asks when the changes began and what came before them: illness, surgery, childbirth, diets, new medication, starting or stopping contraceptives. Your menstrual cycle, chronic conditions and hair loss in relatives matter too.

Trichoscopy shows the hair shafts, the follicle openings and the skin between them. Each type of hair loss has its own signs, described in our doctors' publication Trichoscopic differential diagnostic algorithms for non-scarring alopecias:

in telogen shedding there are empty follicles, a predominance of single-hair follicular units and regrowing hairs, with the changes spread evenly over the whole scalp;
in androgenetic alopecia hairs vary in thickness (over 20% of hairs in androgen-dependent areas), and the front and top of the scalp have more vellus hairs and single-hair units than the back of the head;
involutional alopecia looks similar to androgenetic alopecia on trichoscopy, so age and the course of the condition matter for the diagnosis.

The TrichoScale phototrichogram on FotoFinder equipment and TrichoLab quantitative trichoscopy measure hair density and thickness in a defined area. These figures become the baseline: at follow-up visits they are compared in the same area.

Lab tests are ordered after the examination, based on your symptoms: they may include blood counts, iron status, thyroid hormones, sex hormones and prolactin. Samples can be taken at the clinic, see laboratory diagnostics. If the picture is atypical, a scalp biopsy with histology is done. Complex cases are reviewed by Professor Yuliya Ovcharenko or by an international clinical and pathology consilium.

Treatment

Treatment starts from the cause. There is no universal remedy "for hair loss", and two women with the same complaint may need completely different plans.

Telogen shedding. The key is to find and remove the trigger: a deficiency, a thyroid disorder, the effect of medication. If the cause lies outside trichology, the doctor brings in other specialists. Scalp mesotherapy and plasma therapy are used as supporting methods (publication Injection options in the therapy of hair pathology).
Androgenetic alopecia. There are treatments with proven effect, both topical and systemic. For women with signs of androgen excess the doctor may consider anti-androgen medicines. Many of these are contraindicated in pregnancy and when planning one, so only a doctor chooses them. Injection methods and laser therapy with the Theradome laser helmet are used as part of combined treatment. Once the condition is stable and the donor area allows, hair transplantation is an option.
Age-related and hormonal change. We take your general health into account: in later life, signs of illness are often wrongly put down to age. Decisions about hormone therapy in menopause are made by a gynaecologist; the trichologist assesses how it may affect your hair.

For scalp and hair care during treatment there are the procedures of the esthetic trichology department. If you need visible density back right now, trichopigmentation and hair replacement systems can help. Prices for diagnostics and procedures are in the clinical trichology price list.

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When it is something else, and what to expect

Some conditions masquerade as ordinary shedding, so they have to be ruled out:

Alopecia areata. Usually round bald patches, but the diffuse form resembles telogen shedding. Trichoscopy shows yellow and black dots and exclamation-mark hairs. For its links with other diseases, see the publication Comorbidity in alopecia areata.
Trichotillomania: hairs broken off at different lengths because of a habit of pulling them out.
Inflammatory scalp conditions: seborrhoeic dermatitis, psoriasis, red scalp syndrome, lupus erythematosus, dermatomyositis. Redness, itching or burning together with hair loss need their own treatment (publication Scalp ageing and associated conditions).
Scarring alopecias, including frontal fibrosing alopecia: the hairline above the forehead recedes and the eyebrows thin. A follicle lost here does not come back, so do not delay.

What to expect from treatment

Hair grows slowly and in its own cycles. Usually shedding decreases first, and density changes later. Telogen shedding often resolves once the cause is removed. Androgenetic alopecia is a chronic condition: treatment slows or stops the thinning but needs long-term maintenance. That is why we judge results not "in the mirror" but by trichoscopy and phototrichogram at follow-up visits.

Doctors

Prices

Consultation of a trichologist using digital trichoscopy	2000/1500 UAH
Consultation of the trichologist, follow up (up to 2 months after the first one)	800 UAH
Online consultation with trichologist	2000 UAH
Quantitative trichoscopy using TrichoLab	1500 UAH

Frequently Asked Questions

How much hair loss a day is normal?

Hair renews itself all the time: some hairs finish their cycle and fall out, and new ones start growing from the same follicles. So a few dozen hairs on the brush or after washing is normal, and after a few days without washing there will be noticeably more. There is no need to count hairs every day. What should worry you is something else: shedding that goes on for weeks, a visible loss of volume, a wider part, a thinner ponytail. Then it is better to come for trichoscopy than to wait.

Can telogen shedding make me go completely bald?

Telogen shedding affects only part of the hair while the follicles themselves remain, so it does not usually cause complete baldness, and the hair grows back once the cause is removed. It can, however, last a long time if the trigger is still active: a deficiency, a thyroid disorder, medication, chronic stress. Heavy shedding can also reveal hidden thinning from androgenetic alopecia, which will not go away on its own. Trichoscopy helps tell these conditions apart.

My hair is coming out in handfuls after childbirth. When will it recover?

Late in pregnancy more hairs stay in the growth phase, and after delivery they move into the resting phase almost at once. That is why heavy shedding starts a few months later. It usually subsides on its own, and the hair recovers gradually. If the shedding has not eased after six months, or you notice patches, thinning on the crown or signs of a thyroid problem, come for a consultation. During breastfeeding the doctor chooses treatment separately, taking into account what is safe for the baby.

Can hair loss be treated during pregnancy?

Yes, but the choice of methods is limited. Some treatments used for androgenetic alopecia, including anti-androgen medicines, are contraindicated in pregnancy and for women planning one because of the risk to the baby. So tell the doctor about pregnancy plans at the very first visit. Trichoscopy is non-invasive and suitable for diagnosis. Scalp laser therapy can be used in pregnancy: the light does not penetrate deep enough to affect the baby. The final decision on treatment is the doctor's.

Do hormonal contraceptives affect hair?

Yes, in different ways. A few weeks or months after stopping oral contraceptives, many women notice increased shedding similar to postpartum shedding. Pills with progestins that have androgenic activity can trigger pattern thinning in genetically predisposed women. At the same time, doctors use combined contraceptives with anti-androgen action in treating androgenetic alopecia in women. So if you have hair problems, discuss your contraception with a gynaecologist and a trichologist rather than changing it on your own.

My hair started thinning at menopause. Is it permanent?

Not necessarily. As oestrogen falls, hair becomes drier and finer, but thinning at this age has different causes: androgenetic alopecia that first appears at menopause, involutional change, thyroid disease, deficiencies, side effects of medication. These are often put down to age and left untreated. Trichoscopy and, if needed, lab tests show what exactly we are dealing with. That determines whether the process can be slowed, whether some density can be regained and which methods are suitable.

Should I have hormone tests done before my first visit?

There is no need to test everything in advance: the doctor puts together the list of tests after the examination and trichoscopy. For example, with signs of androgen excess sex hormones matter, with dry skin and dull hair thyroid hormones, with cycle irregularities prolactin. Some hormones are tested on specific days of the menstrual cycle, and the doctor will tell you when. If you already have recent results, bring them with you. Tests can also be done at the clinic.

Can hair loss be the first sign of a thyroid problem?

Yes. Thyroid hormones regulate hair growth, and too little or too much of them is often noticed in the hair first. Hair changes on their own are non-specific, so the doctor looks for accompanying signs: dry skin, feeling cold or, on the contrary, sweating and palpitations, weight change, thinning eyebrows. Hypothyroidism is much more common in women than in men, especially between 40 and 60. Medicines that affect thyroid hormone metabolism can also cause shedding, so do not change their dose on your own.

Will vitamins or an anti-hair-loss shampoo help?

Vitamins and supplements help when there is a deficiency; without one they rarely change the picture. A shortage of protein, energy, vitamins and trace elements does show in the hair, so the doctor reviews your diet and orders tests if needed. Shampoos and lotions can improve the condition of the scalp, but they do not address hormonal causes or androgenetic alopecia. The most common mistake is spending months trying products at random and losing time while the condition progresses.

Can I have a consultation online?

Yes, the clinic offers online consultations with a trichologist: the doctor will ask about the course of the problem, review your photos, test results and reports, and advise which examinations you need. But an accurate diagnosis of hair loss often requires trichoscopy, which can only be done in person. So for the first visit it is best to come to the Institute in Kharkiv, 17 Danylevskoho St. Consultation prices are in the consultations price list.

Is hair transplantation an option for women?

Sometimes. In a transplant your own follicles are moved from the donor area to thinning areas, and the transplanted hair keeps the properties of the donor area. In women the donor area is often more limited than in men, and advanced androgenetic alopecia can thin the hair diffusely. So an accurate diagnosis and a stable condition come first, and only then an assessment of the donor supply. Involutional change is not a contraindication if expectations are realistic. More on the hair transplantation page.