When a woman loses her crowning glory

How much time do you spend taking care of your hair each day?  Multiply that time by the estimated number of days in your lifetime and you will get some idea of the importance of hair in your life.  Why should hair care absorb literally years of a woman’s life?  For many women, hair is not just a cosmetic appendage.  Hair is part of the essence of who they are.  A woman’s hair defines how she sees herself and how she wishes the world to see her.  When something goes wrong with their hair, many women don’t merely have a bad hair day; they often become alarmed and demoralized.

About one-third of women experience hair loss (alopecia) at some time in their lives; among postmenopausal women, as many as two-thirds suffer hair loss or bald spots.  Hair loss often has a greater impact on women than on men, because it’s less socially acceptable for them.  Alopecia can severely affect a woman’s emotional well-being and quality of life.

Family patterns

Hair loss and gradual thinning are a normal part of aging.  Family genes are a factor in the age at which hair thinning begins, how quickly it progresses, and the patterns of hair loss. But most commonly, permanently, hair loss in women is due to pattern thinning — the medical term is androgenetic alopecia.  This is the same type of hair loss that commonly affects men.

Unlike men, women with androgenetic alopecia usually maintain their frontal hairline and rarely experience complete baldness.  Instead, hair generally thins over the entire head with the most noticeable loss often occurring along the part line and crown.

Almost every woman eventually develops some degree of female pattern hair loss.  It can start any time after the onset of puberty, but women tend to notice it first around menopause, when hair loss typically increases.  The risk rises with age, and it’s higher for women with a history of hair loss on either side of the family.

Causes

Addressing hair loss in women depends on the cause, and that’s best determined by visiting your doctor. Some medical conditions — such as thyroid disease, diabetes or lupus — may cause hair loss.  Sometimes, hair loss can be a side effect of certain drugs, such as those that treat gout, arthritis, depression, heart problems, and cancer.

There’s also interest in the possible role iron stores in the body may play in hair loss.  Some studies suggest iron deficiency may be related to different types of hair loss, including androgenetic alopecia — but other studies find no relationship.  Although the evidence related to iron deficiency and hair loss isn’t clear, some experts believe blood tests to measure red blood cell levels in the blood and iron stores in the body (ferritin) are worth considering in women with hair loss.  If there’s a deficiency, iron replacement through diet and supplements may be considered.

Unless there are signs of excess androgen activity (such as menstrual irregularities, acne, and unwanted hair growth), a hormone evaluation is usually unnecessary.

TREATMENT WITH MEDICATIONS

The non-prescription drug minoxidil (Rogaine) is the only drug approved for use by women to treat androgenetic alopecia.  It is available as a two-percent and a five-percent solution and doesn’t require a prescription.  It’s also available as a five-percent foam.  Minoxidil is rubbed into the dry scalp twice daily to slow hair loss and encourage regrowth.

Results with minoxidil vary.  Typically, it takes at least six months to see results, although some women get no benefit.  With ongoing use, hair thinning is usually reduced and what hair remains is retained.

Minoxidil doesn’t affect existing hair.  Rather, it makes new hair being formed in the root of the hair follicle thicker. Although new hair from minoxidil use may still be thin, for some women it’s enough to compensate for thinning areas and to blend in with existing hair.

But clearly, minoxidil is not a miracle drug.  While it can produce some new growth of fine hair in some — not all — women, it can’t restore the full density of the lost hair. It’s not a quick fix either. You won’t see results until you use the drug for two months. The effect often peaks at around four months, but it could take longer, so plan on a trial of six to 12 months. And if minoxidil works for you, you’ll need to keep using it to maintain those results.  If you stop, you’ll start to lose hair again.

How to use minoxidil: Be sure that your hair and scalp are dry. Using the dropper or spray pump that’s provided with the over-the-counter solution, apply it twice daily to every area where your hair is thinning.  Gently massage it into the scalp with your fingers so it can reach the hair follicles. Then air-dry your hair, wash your hands thoroughly, and wash off any solution that has dripped onto your forehead or face.  Don’t shampoo for at least four hours afterwards.

Minoxidil-related side effects, such as itching, rash, or fast or irregular heartbeat, are uncommon but should be reported to your doctor as soon as possible.

Surgical options

If hair loss is extensive or minoxidil hasn’t been helpful, surgery may be considered. Procedures include:

• Hair transplant.  This involves having a dermatologic surgeon transplant micrografts of skin containing hair follicles — each containing one to several hairs — from one area of your scalp to another.  These micrografts are taken from your scalp where hair is growing well — normally on the back of the head — and then implanted into scalp that’s lacking hair (see illustration). Several transplant sessions may be needed to keep up with the hereditary hair loss over time. 

The transplanted hair generally takes about six to eight months to become cosmetically acceptable.  Although the surgery isn’t without risk, the procedure is generally safe and effective with a normal success rate of over 95 percent.

• Scalp reduction and flap surgery.  These are generally performed only in men, but can be used in women in certain circumstances.  Scalp reduction is surgical removal of scalp skin that lacks hair. Flap surgery involves moving scalp with hair to an adjacent area that’s lacking hair. 

But for some women, however, an alternative to medical treatment may be as simple as changing their hairstyles or using a quality, natural-looking hairpiece or wig!