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Hair loss in women

By DR. GRACE CAROLE BELTRAN, The Philippine STAR Published May 11, 2021 5:00 am

Samantha is my beautiful Spanish patient who lived in Great Britain for 10 years. She had problems with her menstrual cycle for years. It started in college when she wouldnt have her period for two months, have a normal cycle for one month, and bleed heavily for weeks.

When she consulted her doctors, they told her the same thing: Take birth control pills to regulate the cycle. Samantha would take the pills for a while, but was hesitant to stay on them for periods longer than six months.

After going off the pill, she would have normal cycles for about four months before things went wacky again. Over the years, she would gain and lose weight, then gained it back again. She was sick of taking pills to stop her symptomatic bleeding.

At one point, she stopped taking pills and ended up bleeding heavily for over three months straight. She ended up in the hospital with 1/4 less the amount of blood she should normally have. Samantha then had to get a blood transfusion.

She also noted that her hair started falling out in clumps, clogging their bathroom drain every time she showered and even more so every time she brushed her hair. 

Thinning hair due to the effects of male hormones (androgens) is called androgenic alopecia. It is a major source of psychological distress to women.

Finally, Samantha was told she had polycystic ovary syndrome (PCOS), and that she had to be on birth control pills for the rest of her childbearing years to keep her cycle regulated.

Thinning hair due to the effects of male hormones (androgens) is called androgenic alopecia. It is a major source of psychological distress to women. This male-pattern hair loss is often seen in women with PCOS, congenital adrenal hyperplasia, and other disorders of excess male hormone.

Additional causes may be hormonal changes secondary to a reduction of estrogen levels, which are physiological at menopause, as well as in thyroid disorders.

Certain drugs for anemia, nutritional deficiencies and severe illnesses and infections may be a trigger for diffuse hair loss.

Associated with hormonal changes, alopecia is caused by genetic and environmental factors. In many, the alopecia pattern may start as a triangular thinning of the hair, which I have labeled as the triangle sign, with gradual progression of hair loss from the midline frontal scalp line towards the vertex and sides of the scalp. In most women with androgenic alopecia, the frontal hairline remains intact despite diffuse hair loss.

Limit stress. Undefined stresses and hormonal medications (androgenic-like oral contraceptives, as well as a number of other medications) may be associated with hair loss.

The average number of hair strands lost in a day is about 100 to 150. It should be noted that it might take at least 20 to 25 percent of total loss of scalp hair before it may be visibly recognized. Thus, awareness of excessive hair loss when combing or after shampooing are the first signs of the onset of alopecia.

Why does PCOS cause hair loss?

The female body produces male hormones, also called androgens. This includes testosterone. Androgens play a role in triggering puberty and stimulating hair growth in the underarms and pubic areas. They have other important functions as well.

The incidence of androgenic alopecia in PCOS is not clearly defined, but several reports vary from a prevalence of 40 to 70 percent, with a number of young women who may demonstrate this sign in their teens.

PCOS causes extra androgen production resulting in virilization. This refers to the development of more masculine features, including excess hair in places where it doesnt usually grow, such as the face, neck, chest, and abdomen.

These extra androgens can also cause the hair on your head to start thinning, especially near the front of your scalp.

Will it grow back?

Any hair that you lose due to PCOS wont grow back on its own. But, with treatment, you may be able to stimulate the growth of new hair.

What medical treatments can help?

PCOS hair loss is caused by a hormonal imbalance, so hormone regulation is an important part of treatment. Best results are with a combination of medication plus treatment procedures to help stimulation of hair regrowth.

Medical treatments include oral contraceptives (OCP) in combination with anti-androgens. Birth control pills can lower androgen levels, which may help reduce excess hair growth and slow down hair loss. It also helps with other PCOS symptoms such as irregular periods and acne.

An anti-androgen drug is often prescribed in combination with oral contraceptives for PCOS-related hair loss. These include Diane-35 (containing cyproterone acetate and ethinyl estradiol), OCP in combination with a 5-alpha reductase inhibitor, OCP with flutamide, multiple-drug therapy, and Minoxidil.

Unlike acne and hirsutism (excessive hair growth), medical management of hair loss is much more difficult. The listed drugs and options are more successful in slowing the progression of androgenic alopecia than actually reversing it. In PCOS, controlling the androgen overproduction of male hormones and stabilizing the disease is an essential first step prior to the use of these drugs.

Regenera Activa. It helps a lot in halting hair fall and stimulates whatever remaining hair follicles you have within the scalp. Combining it with hair transplant procedures delivers magical results. In younger individuals, Regenera alone works wonders.

Coherent laser light. It is the latest and most powerful, high-tech solution to hair loss, stimulating stem cells at the base of the hair follicles and restoring hair at a cellular level. A natural solution to hair loss with no harmful side effects, its been proven to regrow hair through multiple clinical trials.

Sustained-release peptide energy. This is the first hair filler in the world. It promotes blood circulation in the scalp, revitalizes hair follicles and induces hair growth by increasing the size of the hair follicles and thus stopping hair loss.

Restricted diet and weight reduction.

Let me also share with you some hair-care tips and procedures for caring for your scalp and hair. Some of these tips have been modified from the book by Philip Kingsley.

  • Hair should be shampooed daily, and rinsed fully. Conditioning the hair removes tangles, particularly at the ends of the hair.
  • Avoid insufficient rinsing, and minimize any tangling with a wide-toothed comb.
  • Use of a brush with sharp bristles should be avoided. Smooth combs are preferable.
  • Limit stress. Undefined stresses and hormonal medications (androgenic-like oral contraceptives, as well as a number of other medications) may be associated with hair loss.
  • Blow-drying should be done with the hair dryer about six inches away. As the hair starts to dry, reduce the heat gradually. Avoid blow-drying hair from damp to dry to minimize hair damage, brittleness and split ends.
  • Rollers have to be used carefully, and not tightly. Similarly, pins and clip use should be minimal and never while sleeping. If elastic bands and barrettes are used at all, they must not be tight. They have been noted to cause traction alopecia. Similarly, pulling the hair too tightly from the forehead may also lead to severe hair breakage and ponytail alopecia.
  • Avoid compulsively touching and pulling hair (trichotillomania).