Female pattern baldness

Alternative Names

Alopecia in women; Baldness - female; Hair loss in women; Androgenetic alopecia in women

Definition

Female pattern baldness is the most common type of hair loss in women.

Causes

Each strand of hair sits in a tiny hole (cavity) in the skin called a follicle. In general, baldness occurs when the hair follicle shrinks over time, resulting in shorter and finer hair. Eventually, the follicle does not grow new hair. The follicles remain alive, which suggests that it is still possible to grow new hair.

The reason for female pattern baldness is not well understood, but may be related to:

Aging
Changes in the levels of androgens (male hormones). For example, after reaching menopause, many women find that the hair on their head is thinner, while the hair on their face is coarser.
Family history of male or female pattern baldness.

Symptoms

Hair thinning is different from that of male pattern baldness. In female pattern baldness:

Hair thins mainly on the top and crown of the scalp. It usually starts with a widening through the center hair part.
The front hairline remains unaffected except for normal recession, which happens to everyone as time passes.
The hair loss rarely progresses to total or near total baldness, as it may in men.

Itching or skin sores on the scalp are generally not seen.

Exams and Tests

Female pattern baldness is usually diagnosed based on:

Ruling out other causes of hair loss.
The appearance and pattern of hair loss.
Your medical history.

The doctor will examine you for other signs of too much male hormone (androgen), such as:

Abnormal new hair growth, such as on the face or between the belly button and pubic area
Changes in menstrual periods and enlargement of the clitoris
New acne

A skin biopsy or other procedures or blood tests may be used to diagnose skin disorders that cause hair loss.

Looking at the hair under a microsope may be done to check for problems with the structure of the hair shaft itself.

Treatment

Hair loss in female pattern baldness is permanent, if not treated. In most cases, hair loss is mild to moderate. You do not need treatment if you are comfortable with your appearance.

MEDICATION

The only medication approved by the United States Food and Drug Administration (FDA) to treat female pattern baldness is minoxidil:

It is applied to the scalp.
For women, the 2% concentration is recommended.
Minoxidil may help hair grow in about 1 in 4 or 5 of women. In most women, it may slow or stop hair loss.
You must continue to use this medicine for a long time. Hair loss starts again when you stop using it.

If minoxidil does not work, your doctor may recommend other medicines, such as spironolactone, cimetidine, birth control pills, ketoconazole, among others. Your doctor can tell you more about these if needed.

HAIR TRANSPLANT

During hair transplant, tiny plugs of hair are removed from areas where hair is thicker, and placed (transplanted) in areas that are balding. Minor scarring may occur where hair is removed. There is a slight risk of skin infection. You will likely need many transplants, which can be expensive. However, the results are often excellent and permanent.

Outlook (Prognosis)

Female pattern baldness is usually not a sign of an underlying medical disorder.

Hair loss may affect self-esteem and cause anxiety.

Hair loss is usually permanent.

When to Contact a Medical Professional

Call your doctor or nurse if you have hair loss and it continues, especially if you also have itching, skin irritation, or other symptoms. There might be a treatable medical cause for the hair loss.

Prevention

There is no known prevention for female pattern baldness.

References

Bunagan MJK, Banka N, Shapiro J. Hair transplantation update: procedural techniques, innovations, and applications. Dermatol Clin. 2013;31:141-153.

Mesinkovska NA, Bergfeld WF. Hair: what is new in diagnosis and management? Female pattern hair loss update: diagnosis and treatment. Dermatol Clin. 2013;31:119-127.

Sperling LC, Sinclair RD, El Shabrawi-Caelen L. Alopecias. In: Bolognia JL, Jorizzo JL, Schaffer JV, eds. Dermatology. 3rd ed. Philadelphia, Pa: Elsevier Saunders; 2012:chap 69.