Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 4/28/2021
Hair loss doesn’t just happen to men. If your part has become wider, or you’ve been noticing big clumps of hair in your shower drain, you are not alone. Around 80 percent of women will have noticeable hair loss by age sixty.
There are many potential causes of severe hair loss in women, including medical conditions, medications and physical or emotional stress. In this article, we’ll take a look at what constitutes severe hair loss, what causes it, the symptoms of severe hair loss and hair loss treatment options to help you recover your luscious locks.
As women, we’re expected to all have thick, healthy, long, flowing locks. Not only is that totally sexist, but it’s also unrealistic. Hair loss isn’t a male-only problem. In fact, about one-third of women experience hair loss at some time in their lives.
Hair shedding is a normal and common occurrence. Hair shedding can happen during the warmer months of the year or after a stressful event such as going through a divorce or losing a job. It's normal to shed between 50 and 100 hairs per day.
Severe hair loss, however, is different from hair shedding. Hair loss occurs when something stops the hair from growing. The medical term for this condition is female pattern hair loss. If you are experiencing hair loss, your hair will not grow back until the cause of hair loss stops.
A healthcare provider can distinguish between hair loss and hair shedding. If you are concerned by the amount of hair falling out, speak with your healthcare provider. The healthcare provider can help you identify the cause of your hair loss and suggest treatment options. With hair loss, the sooner the treatment begins, the better the outcome.
As we previously mentioned, shedding between 50 and 100 hairs per day is normal. If you go several days between washing your hair and notice a couple hundred hairs in your brush or shower drain, that is also normal.
Hair loss is different from hair shedding. If you're noticing a wider part line, diffuse thinning across top of the scalp, or seeing noticeable patches of thinner or missing hair, you may be experiencing hair loss.
In order to determine if you are experiencing severe hair loss, a healthcare provider will conduct an examination of your scalp. They may also do lab work to check for vitamin and mineral levels and/or hormone levels. Your healthcare provider may ask you about your habits including what kind of hairstyles you wear, what types of foods you eat, if anyone in your immediate family has experienced hair loss or if there is anything stressful going on in your life right now.
From tight hairstyles to autoimmune diseases, there are several things that may cause severe hair loss in women. Let's explore these different causes.
Traction alopecia is the term used to describe hair loss caused by tight hairstyles such as braids or buns. This type of hair loss occurs over time and causes trauma to the hair follicles by pulling them too tight.
Traction alopecia is common in Black and African-American women who wear various forms of tight hairstyles for extended periods of time.
The prevalence of traction alopecia in women of African descent is also due to the characteristics of the curved hair follicle and cultural hairdressing practices. Additionally, traction alopecia is much more common in women than in men.
Check out this blog post to read more about traction alopecia.
Hair loss is a symptom of several autoimmune disorders, including hypothyroidism and lupus.
Hypothyroidism is when the thyroid gland doesn’t make enough thyroid hormones to meet the body’s needs. Thyroid hormones control the way the body uses energy. Without enough thyroid hormones, many of your body’s functions slow down—and that includes hair growth.
Treatment for hair loss caused by hypothyroidism is typically oral thyroid replacement medication. Once your thyroid levels are back to a normal level, your hair should begin to grow back.
A lupus diagnosis may also cause hair loss. Whether or not hair grows back on the scalp depends on whether there is scarring, as well as how much scarring there might be. When the hair loss is widespread, but there is no scarring, the hair will often grow back.
If hair loss is caused by lupus medication, you may have to wait until your lupus is under control to treat the hair loss. Fortunately, this type of hair loss is mostly reversible.
The main type of hair loss is the same for both men and women, and it’s called androgenic alopecia.
This type of hair loss is caused by your body’s reaction to hormones known as androgens. In women, the typical female pattern hair loss begins with thinning of the part line, followed by diffuse hair loss throughout the top of the head.
Healthcare providers use the Ludwig Classification to classify the severity of female pattern hair loss.
Type I begins with minimal thinning at the part line that can be hidden with various hairstyles and techniques.
Type II is defined by a more noticeable decrease in hair volume and a wider part line.
Type III is the most severe, and is defined by a diffuse thinning throughout the entire scalp, with a see-through appearance on the top of the head.
Physical and emotional stress can also lead to a type of hair loss called telogen effluvium. If you've recently experienced divorce, the death of a loved one, major surgery or a serious illness, your body may shut down certain processes like hair production.
Typically, there's around a three-month delay between when a stressful event occurs and when you may see hair loss. If you experienced a stressful event and are now seeing thinner hair, stress may be the culprit.
It is important to note, however, that stress does not cause permanent hair loss. Once the stressful event has been resolved, your hair should continue to grow back normally.
Conditions, such as Type 2 diabetes, can cause hair loss in women.
Type 2 diabetes is a chronic decrease in the oxygen and nutrient supply, which can cause follicular damage due to vascular impairment. This results in hair alterations like hair thinning, hair fragility, sparseness of hair or decreased hair growth speed.
Early diagnosis and treatment are key to getting your diabetes under control. This will also aid in preventing further hair loss from the disease.
Iron deficiency is the world’s most common nutritional deficiency and is a well-known cause of hair loss. Due to menstruation, women are more likely to be iron deficient than men. The degree of iron deficiency that may contribute to hair loss, however, remains unclear.
Zinc deficiency may be either inherited or acquired and may affect multiple systems in the body—including hair growth. A study of 312 patients with androgenic alopecia showed that they had lower zinc concentrations as compared to 30 healthy controls.
Deficiencies in other minerals and essential vitamins, including niacin, fatty acids, selenium, vitamins D, A and E, folic acid, biotin, amino acids, proteins and antioxidants may cause hair loss as well.
Treatment for hair loss caused by nutritional deficiencies requires correcting the deficiencies. In iron deficiency and anemia, supplementation is required, but women with iron deficiency in the absence of anemia must be approached on a case-by-case basis. It is believed that raising levels of storage iron may improve hair loss, although the research is not conclusive. Most importantly, if you are receiving iron supplementation, your healthcare provider must monitor you due to toxicity risk.
For other nutrient deficiencies, such as zinc, supplementation has resulted in hair growth, although, again, your healthcare provider should monitor your intake to mitigate your toxicity risk.
Cancer does not typically cause hair loss. However, some types of cancer treatment, including chemotherapy, can cause the hair on your head and other parts of your body to fall out. Radiation therapy can also cause hair loss on the part of the body that is being treated.
Once chemotherapy and radiation therapy have stopped, your hair will likely begin to grow back. Hair often grows back in two to three months after chemotherapy treatment has ended.
After radiation therapy, hair likely grows back in three to six months. If you rceived a very high dose of radiation, your hair may grow back thinner or not at all on the part of your body that received radiation.
Fortunately, if you’re looking for a hair loss treatment, there are several great treatment options for women who are experiencing severe hair loss. Keep in mind, however, that the results you experience from these treatments will not happen overnight. You may need to use multiple treatments for months or years to see results.
Topical minoxidil is an FDA-approved medication for androgenic alopecia in women. Though it’s unknown exactly how minoxidil works, most researchers believe it does so by signaling the blood vessels in the affected area to open. This allows more nutrients and oxygen to flow to the hair follicles and cells where the minoxidil is applied.
Minoxidil also works to elongate the growth phase of the hair, so more follicles are produced to replace lost hairs. It is available as a 2% topical solution or 5% foam to treat female pattern baldness.
Spironolactone is a medication that is typically prescribed to treat cystic acne. However, this medication is also used as an off-label treatment of hair loss in women.
Spironolactone works by preventing the conversion of testosterone to DHT. Further, spironolactone may also be useful in preventing the production of androgens. In fact, it has been proven to improve or stabilize hair loss in women. Pregnant women, however, should not take spironolactone.
We’ve covered more on spironolactone in our guide to Spironolactone and Hair Loss.
Hair loss doesn’t just happen to men. Many women experience severe hair loss for a variety of reasons, such as medical conditions, stress, nutritional deficiencies and more. If you are experiencing severe hair loss, talk to your healthcare provider about treatment options that may be right for you.
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