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Dr. Christopher Tzermias

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Hair Loss in Women

For most women, their hair is much more than hair. They constiture a means of expression of their style, temperament and personality. Self-esteem is inextricably linked to hair, something that has been proven scientifically.

A “bad hair day”may be enough to cause bad mood and “ruin” our day. Imagine how bad a woman may feel if she starts loosing her hair… Despite the fact that hair thining usually takes a while to become apparent, having to pick up a bunch of hair everyday is sufficient to cause a depressed mood.

Hair thinning and hair loss is not a male “privilege”, as many women may think. The truth is that 40% of people that experience hair loss are women. In some of these women hair get thinner, losing their volume in all their head, while in other women hair thinning occurs only on the top of their head (the so-called wreath). In contrast to men, the female head loses its hair seldomly usually around the forehead (anterior frontotemporal hairline).

Hair loss may affect only the head or the whole body. Early diagnosis and the appropriate treatment of its causes, as well as advice on ways to prevent hair loss, its progression may be stopped and never lead to alopecia (i.e permanent and visible hair thinning).

In women, the progress of hair loss is divided into different stages, as specified by the Ludwig scale, shown below:

κλιμακα ludwig

The Ludwig scale

Types of Hair Loss

Normal hair loss

In a scalp there are around 100,000 hairs approximately. Due to natural processes on average 50-100 hairs are shed every day, which have gone through all three phases of their life cycle (anagen, catagen and telogen phases). This is normal hair loss and hairs that fall out are immediately replaced by new ones. The degree of hair loss does not lead to significant differences in terms of hair density.

Seasonal hair loss

Seasonal hair loss usually lasts for two months and it is a reversible condition. It usually appears in spring and in autumn, and, in general, women are more affected than men.

Pathological hair loss

In certain cases diffuse hair loss may act as a precursor to some type of alopecia (ie permanent apparent hair thinning). Hairs are lost, regrow and shed more quickly. Or they may be lost and regrow but hairs are different in terms of colour, quality and quantity. Or they may be lost and never regrow, because hair follicles shrink and become idle. In this case, hair loss is characterised as a pathologic condition, which can lead to alopecia.

  • Hereditary predisposition (male pattern hair loss)

Hereditary predisposition is the most common cause of hair loss, the scientific term of which is “androgenetic alopecia”. Genes cause sensitivity of hair follicles to the body’s male hormones (androgens), independently of the hormonal levels.

Hair follicles start producing hair that are gradually more thin and weak, leading finally to the production of vellus hair. Usually, the hair of women is not affected at the frontal scalp but hair thinning is evident on the top of their head (the so-called wreath).

  • Patcy hair loss (Alopecia areata)

This is an autoimmune disorder, in which the immune system attacks its own hair follicles and causes intense hair loss. If it progresses, it creates patches without hair (hairless areas) of round or oval shape on the scalp or on the whole body. Typically, hair loss is not permanent. In most patients hair regrow within a year.

It has been estimated that patcy hair loss (alopecia areata) affects approximately 1-2% of the population. Many times it coexists together with other autoimmune disorders, such as vitiligo, Hashimoto’s thyroiditis, etc.

  • Diffuse hair loss

In this type of hair loss, a large number of hairs enter the resting (telogen) phase too soon, a phase that also leads to hair thining and hair shedding. Usually it does not affect more than 50% of the hair in the scalp. Hair loss may appear up to three months after the initial cause. Among the casues the following are included:

  • Mental or physical stress, such as a recent surgery, an illness, or high fever, sudden or excessive weight loss, a divorce or losing a family member.
  • Endocrine system disorders, such as hyperthyroidism, hyporthyroidism and uncontrolled diabetes mellitus.
  • Poor nutrition, such as lack of protein, iron, zinc, magnesium, vitamisn D and B12, folic acid and fatty acids.
  • Side effects of medicines, such as anticoagulants, antithyroid drugs, chemotherapeutics, antipsychotics, cholesterol-lowering drugs, thallium, and boric acid. Typically, the hair loss stops and the hair is restored after discontinuing the medication.
  • Hormonal fluctuations during pregnancy. Many women see their hair becoming thicker during pregnancy. The increased levels of estrogen keep hair in the catagen phase for longer, thus delaying hair shedding. However, after childbirth hormonal levels return to normal and the “protected” by hormones hair may start shedding more quickly. It may take up to two years for the hair to return to its normal condition.
  • Hormonal changes due to the administration of contranceptives. Hair loss is a possible side effect of contraceptive pills’ usage. Hormones that suppress ovulation can cause hair thinning and hair loss in some women, something that usually occurs after treatment discontinuation.
  • Hormonal disorders during menopause. Decreased production of estrogen in combination with an increased activity of androgens affect adversely the function of hair follicles, leading to the progressive production of weaker hari as times goes by.
  • Hormonal imbalances due to the polycystic ovary syndrome (POS). This is a common disorder of the endocrine system and it is usually observed in women of childbearing potential. The organism produces higher levels of androgens, which reduce the percentage of hair in the anagen phase and activate the conversion of hair into vellus hair.


  • Traumatic hair loss

There are two types of hair loss, which are not related to a defect in hair’s life cycle.

    • Trichotillomania

Trichotillomania is a compulsive behaviour in which a person pulls his/her hair out of the scalp, eyelashes, or eyebrows. There is usually mounting tension before pulling the hair and a feeling of relief afterward. Hair loss is observed in certain areas and the shape is irregular.

  • Traction alopecia

Traction alopecia may be caused by your method of hairstyling and it involves hair loss around the edge of the hairline. It is especially noticeable around the face.

  • Pathogenic hair loss

This is a type of hair loss which is caused by a medical condition.

    • Developmental disorder and hereditary conditions: skin aplasia, epidermal nevi, porokeratosis of Mibelli, ichthyosis, Darier disease, etc.
    • Defects due to natural causes: mechanical traumas, burns, x-ray dermatitis.

Microbial infections: tinea/ringworm infections, bacterial infections (lupus vulgaris, leprosy, tertiary syphilis, furuncle, carbuncle, folliculitis, acne necrotising), leishmaniasis, viral infections (herpes zoster, chickenpox, smallpox).

Neoplasia: basal cell carcinoma, cicatricial (scarring) basal cell carcinoma, metastatic carcinomas.

Various other dermatoses/skin diseases of unknown aetiology: lichen planus, lupus erythematosus, scleroderma, etc.



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