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What is female pattern-baldness?

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Female-pattern baldness is a common cause of hair loss in women. According to Alopecia UK it affects 50% of women over the age of 65*. Also known as androgenetic alopecia, female-pattern baldness is a type of female hair loss caused by genetic factors.

Female-pattern baldness is more commonly seen in post-menopausal women, which suggests a connection to the sex hormones (during the menopause, levels of oestrogen drop). Female-pattern baldness is also associated with women who have polycystic ovary syndrome, which causes excess levels of male hormones and disrupts the menstrual cycle.

Female-pattern baldness is more common in older women, particularly those who have gone through menopause, but it can also affect women in their 20s and 30s.

Though we know this type of hair loss is genetic in nature, its causes are not fully understood. In men, male-pattern baldness is caused by sensitivity to the male hormone dihydrotestosterone, which causes the hair follicles to shrink and die.

Symptoms of female-pattern baldness

Female-pattern hair loss is usually fairly easy to distinguish from other types of hair loss. This is because it is characterised by the gradual thinning of the hair on the top (crown) of the head. Female-pattern baldness does not usually lead to complete hair loss but it can cause widespread thinning across the head.

You may first notice that your hair is thinning at your parting; later, you may notice that you can see your scalp through the hair on the top of your head.

Other types of hair loss are distinctive from female-pattern baldness as they tend to cause patchy hair loss, bald spots or total hair loss across the head or body. However, widespread thinning of the hair on the head (that resembles female-pattern baldness) is also the characteristic symptom of telogen effluvium. This type of hair loss is usually temporary, and can be caused by pregnancy, hormonal changes, stress, illness, certain medications and even changes to your diet.

In other words, if your hair is thinning, it may not necessarily be female-pattern baldness, and the loss could be temporary.

What causes female-pattern baldness?

The causes of female-pattern baldness are not wholly understood, but the condition is thought to be genetic in nature and related to levels of male and female sex hormones.

Other causes of baldness in women

If you are experiencing patchy hair loss i.e. your hair is falling out in chunks or leaving bald spots, then it is very unlikely that you are experiencing female-pattern baldness.

Patchy hair loss is the key characteristic of alopecia areata, a type of hair loss caused by the immune system attacking the hair follicles. It is usually temporary, which means hair should grow back within one year. In some cases alopecia areata can develop into a more serious form of hair loss that causes total baldness across the head, and sometimes across the body as well. These types of hair loss are known respectively as alopecia totalis and alopecia universalis.

Despite the name, it is uncommon for female-pattern baldness to lead to total baldness, which makes it easy to distinguish from these two severe forms of alopecia areata.

Some other causes of baldness in women include:

  • Autoimmune conditions such as hyperthyroidism, diabetes and Down’s syndrome
  • Skin conditions such as scleroderma and lichen planus
  • Polycystic ovary syndrome
  • Frontal fibrosing alopecia, which specifically affects post-menopausal women
  • Medical treatments such as chemotherapy and radiation
  • Traction alopecia which is caused by tight hairstyles that put strain on the hair follicles (women who wear weaves, tight braids, or extensions are particularly vulnerable to this kind of hair loss)

What does female-pattern baldness look like?

The characteristic symptom of female-pattern baldness is gradual thinning on the top of the head. Usually you will notice that your parting has widened; as the hair loss progresses, the thinning will become more widespread across the head.

Female-pattern baldness doesn’t usually cause a receding hairline, and does not cause total baldness on the head.

How is female-pattern baldness treated?

Minoxidil is an effective treatment for female-pattern baldness which is available without a prescription in high street pharmacies. It comes as a foam or lotion, and must be applied directly to the scalp, once or twice a day.

You should use minoxidil every day as instructed. Within three or four months you should see an improvement. Most women who use minoxidil find that their hair loss stops; some will also experience regrowth.

If you stop using minoxidil your hair loss will resume within a few months.

Treating female-pattern baldness

Currently, the only treatment available for female-pattern baldness is minoxidil. Female-pattern baldness cannot be treated with finasteride tablets (Propecia); this hair loss treatment is only available to men.

Minoxidil is a foam or lotion that is rubbed into areas of the scalp where the hair is thinning. Minoxidil does not require a prescription, and is not available on the NHS. It can be purchased over the counter from high street pharmacies.

Minoxidil must be used every day; depending on the type, it must be applied to the scalp once or twice a day. If you apply minoxidil every day as instructed you should start to see results within three or four months. In one study, 88% of women saw results from applying minoxidil at a strength of 2% to their scalp twice a day. These women all experienced a halting of hair loss, and some also experienced hair regrowth.

If you’re experiencing female-pattern baldness and you’re interested in using minoxidil, just be aware that it is an ongoing treatment that requires everyday use. If you stop using minoxidil your hair loss will resume within a few months.

Hair loss surgery

Some women experiencing female-pattern baldness may consider getting a hair transplant. These can be effective when done well by a specialist surgeon, but they tend to be very expensive and often require multiple sessions.

Before you get a hair transplant it’s recommended that you try other non-invasive treatments such as minoxidil.