Alopecia Alopecia in Women Alopecia in Women: Definitive Guide

Alopecia in Women: Definitive Guide


About a third experience alopecia in women at some point in their lives. Among postmenopausal women, up to two-thirds suffer from thinning hair or baldness. Hair loss in women often has a greater impact than hair loss in men, because it is less socially acceptable to them. Alopecia can seriously affect a woman's emotional well-being and quality of life.

Female Pattern Alopecia
Female pattern alopecia may affect post-menopause the most

Generalities in alopecia in women

The main type of hair loss in women is the same as in men. Is named androgenetic alopecia, or female (or male) pattern hair loss. In men, hair loss generally begins above the temples, and the receding hairline eventually forms a characteristic "M" shape; The hair on the top of the head is also thinned, often progressing to baldness. In women, androgenetic alopecia begins with gradual thinning of the part line, followed by increasing diffuse hair loss that radiates from the top of the head. A woman's hairline rarely goes back, and women rarely go bald.

There are many potential causes of hair loss in women, including medical conditions, medications, and physical or emotional stress. If you notice unusual hair loss of any kind, it is important to consult your primary care provider or a dermatologist to determine the cause and proper treatment. You can also ask your doctor for a referral to a therapist or support group to address emotional difficulties. Alopecia in women can be frustrating, but in recent years there has been an increase in resources to deal with the problem.

Statistics on alopecia in women

Baldness in women affects a significant percentage of the population. The frequency of this problem depends a lot on the person's age. After the menopause between 29-38% of women have some degree of baldness. After the 70 years. affects a 55% Women's. Before 50 years of age it is less frequent, appearing between 6-12% Women's.

Female alopecia patterns.

Ludwig scale

Doctors use the Ludwig Classification to describe female pattern alopecia. Type I is minimal slimming that can be camouflaged with styling techniques. Type II is characterized by a decrease in volume and a marked increase in the middle part of the line. Type III describes diffuse thinning, with a transparent appearance at the top of the scalp.

What is androgenetic alopecia?

Almost all women eventually develop 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 generally increases. The risk increases with age, and is higher for women with a history of hair loss on both sides of the family.

As its name suggests, androgenetic alopecia involves the action of hormones called androgens, which are essential for normal male sexual development and have other important functions in both sexes, including sexual desire and regulation of hair growth. The condition can be inherited and involve several different genes. It may also be the result of an underlying endocrine condition, such as androgen overproduction or an androgen-secreting tumor in the ovary, pituitary, or adrenal gland. In any case, alopecia is probably related to increased androgen activity. But unlike androgenetic alopecia in men, the precise role of androgens is more difficult to determine in women. In the possibility that an androgen-secreting tumor is involved, it is important to measure androgen levels in women with clear female pattern hair loss.

Is it the same in both sexes?

In both sexes, hair loss from androgenetic alopecia occurs due to a genetically determined shortening of anagen, a phase of hair growth, and a lengthening of the time between hair shedding and the start of a new phase of anagen. That means it takes longer for the hair to grow back after it falls out over the course of the normal growth cycle. The hair follicle itself also changes, contracts, and produces a shorter, thinner hair shaft, a process called "follicular miniaturization." As a result, thicker, pigmented, and longer-lasting "terminal" hairs are replaced by shorter, thinner, unpigmented hairs called "vellums."

Life cycle of a hair

Each hair develops from a follicle, a narrow skin pocket, and goes through three stages of growth. Anagena (A), the active growth phase, lasts from two to seven years. Catagena (B), the transition phase, lasts approximately two weeks. During this phase, the hair shaft moves up toward the skin's surface, and the dermal papilla (the structure that nourishes the cells that give rise to the hair) begins to separate from the follicle. Telogena (C), the resting phase, lasts about three months and culminates in the detachment of the hair shaft.

How do I know if I have a baldness problem?

Baldness is characterized by excessive hair loss, progressive thinning and loss of hair density. In the case of women, the first sign of baldness is thinning progressive hair over a period of several years. Later there is a loss of capillary density. The most affected area is the part front and middle of the head. Although sometimes it also affects the temporal region and the crown. When it affects the front part, a pattern of "Christmas tree".

"Christmas Tree" pattern
A "Christmas Tree" pattern can be seen

Emotional Condition of Female Alopecia

Generally, women are more affected than men by social and psychological level. This is because for a woman, her hair plays a central role in her femininity and beauty. In addition to alopecia in women, it is not considered as "something normal" as it could be in the case of men.

Diagnosis of alopecia in women

The diagnosis of female pattern alopecia is clinico. Through a physical exam and a clinical storyonly detailed. Blood tests are recommended to rule out hormonal problems. Especially in patients who have symptoms associated with excess androgensAs menstrual abnormalities, hirsutism (male pattern hair growth) or uncontrolled acne.

A doctor diagnoses female pattern hair loss by taking a medical history and examining the scalp. She or he will look at the pattern of hair loss, check for signs of inflammation or infection, and possibly request blood tests to investigate other possible causes of hair loss, such as hyperthyroidism, hypothyroidism, and iron deficiency. Unless there are signs of excess androgenic activity (such as menstrual irregularities, acne, and unwanted hair growth), a hormonal evaluation is usually not necessary.

Treatment for alopecia in women

Medications are the most common treatment for alopecia in women. They include the following:


This medication was initially introduced as a treatment for high blood pressure, but people who took it noticed that hair was growing in places where they had lost it. Research studies confirmed that minoxidil applied directly to the scalp could stimulate hair growth. As a result of the studies, the FDA originally approved 2% over-the-counter minoxidil to treat alopecia in women. Since then, a 5% solution has also been available when a stronger solution is needed for a woman's hair loss.

Clearly, minoxidil is not a miracle drug. While it may re-grow fine hair in some, but not all, women, it cannot restore the full density of lost hair. It is not a quick solution, nor for alopecia in women. You will not see results until you use the medicine for at least two months. The effect often peaks around four months, but it could take longer, so plan a six to 12 month test. If minoxidil works for you, you will need to continue using it to maintain those results. If you stop, you will start losing hair again.

How to use minoxidil:

Make sure your hair and scalp are dry. Using the dropper or spray pump provided with the over-the-counter solution, apply twice a day to each area where your hair is thinning. Gently massage into the scalp with your fingers so that it can reach the hair follicles. Then air dry your hair, wash your hands well, and wash any solution that has dripped onto your forehead or face. Do not shampoo for at least four hours afterward.

Some women find that the minoxidil solution leaves a deposit that dries and irritates the scalp. This irritation, called contact dermatitis, is probably not caused by minoxidil itself, but by the alcohol that is included to facilitate drying.

Side effects and concerns:

Minoxidil is safe, but it can have unpleasant side effects even apart from alcohol-related skin irritation. Sometimes new hair differs in color and texture from the surrounding hair. Another risk is hypertrichosis: excessive hair growth in the wrong places, such as the cheeks or forehead. (This problem is more likely with the stronger 5% solution.)

Because Rogaine's patent (the brand-name version of minoxidil) has expired, there are many generic products available. They all contain the same amount of minoxidil, but some include additional ingredients, such as herbal extracts, that can trigger allergic reactions.


Androgens include testosterone and other "male" hormones, which can accelerate alopecia in women. Some women who do not respond to minoxidil may benefit from the addition of spironolactone (Aldactone), an antiandrogen medication, for the treatment of androgenic alopecia. This is especially true for women with polycystic ovary syndrome (PCOS) because they tend to produce excess androgens. Doctors generally prescribe spironolactone along with an oral contraceptive for women of reproductive age. (A woman taking one of these medications should not become pregnant because it can cause genital abnormalities in a male fetus.) Possible side effects include weight gain, loss of libido, depression, and fatigue.

Can be treated with antiandrogens

Iron supplements.

Iron deficiency could be a cause of alopecia in some women. Your doctor can assess your blood iron level, especially if you are a vegetarian, have a history of anemia or heavy menstrual bleeding. If you are iron deficient, you will need to take a supplement and can stop hair loss. However, if your iron level is normal, taking extra iron will only cause side effects, such as an upset stomach and constipation.

Platelet Rich Plasma

El platelet rich plasma It is useful for baldness problems in women, especially in the early stages of the problem.

Hair transplant

El hair graft, a procedure used in the United States since the 1950s to treat androgenic alopecia, involves removing a strip of scalp from the back of the head and using it to fill in a bald spot. Today, 90% of hair transplant surgeons use a technique called follicular unit transplantation, which was introduced in the mid-1990s.

During this procedure, surgeons remove a narrow strip of scalp and divide it into hundreds of small grafts, each of which contains only a few hairs. Each graft is planted in a cleft in the scalp created by a knife or needle in the area of ​​the lost hair. Hair grows naturally this way, in small groups of one to four follicles, called follicular units. As a result, the graft looks better than the larger plugs associated with hair transplants of yesteryear.

Video of Alopecia in Women

Video Alopecia In Women

More information

  1. Harvard Health:

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Dr. Enrique Orozco
Dr. Enrique Orozco
General Director, Specialist in Trichology and Hair Transplantation Certified by ABHRS. Only ABHRS Certified with residence in Mexico.


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Dr. Enrique Orozco
General Director, Specialist in Trichology and Hair Transplantation Certified by ABHRS. Only ABHRS Certified with residence in Mexico.




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