I have never had a great relationship with my hair. When I was a kid, it was fine and straight and blond and there wasn’t much of it. In puberty, it turned a mousy brown and I subjected it to a spiral perm or two (it was the ’80s, what can I say).
Through all four of my pregnancies, my hair was full and I suffered through the dreaded postpartum shed each time. But after each pregnancy, a halo of new hairs would form at my hairline and I would sigh in relief.
But a couple of years ago, something alarming started happening. I started finding my own long strands on my clothes, on my desk, and in my brush. And then I noticed my ponytail was getting even smaller in diameter than it had ever been before. It was official: I was losing my hair, and it wasn’t growing back like it did when I was postpartum. I started poring over the data. I know a lot of you have worried about hair loss too, so I thought I would share what I have learned.
What causes hair loss?
Hair loss can be caused by a number of different factors. If you have been pregnant, you have likely experienced postpartum hair loss. This happens as a result of dropping estrogen levels postpartum. The precipitous drop causes a large number of hairs to enter the stage in the hair cycle where shedding occurs all at once. Emotional stress, illness, or anesthesia can lead to a similar kind of shedding. Significant weight loss like that seen with medications such as semaglutide (Ozempic/Wegovy) can also cause this type of shedding. In each of these cases, the shedding is temporary and typically resolves on its own.
Some hair loss is autoimmune, like alopecia areata — which looks like punched-out round holes of missing hair — or alopecia totalis — which affects all types of hair, including eyebrows, eyelashes, and body hair.

Vitamin deficiencies can cause hair loss. In particular, low iron levels and low B12 levels are common in women and can lead to diffuse hair loss. Vitamin deficiencies can also exacerbate other types of hair loss, such as the hair loss seen with weight loss. As a result, I always recommend to my patients who are experiencing hair loss that we check these levels. If levels are low, a supplement to return levels back to normal can significantly improve hair.
The type of hair loss most women experience in the perimenopausal years is female pattern hair loss. Nearly 19% of women experience female pattern hair loss, which is a diffuse decrease in hair density that can be more apparent at the crown and temples. The good news is that it rarely progresses to baldness. But in a social environment where it is much more acceptable for men to have thinning hair than for women, it can cause significant distress.
Why do women develop female pattern hair loss?
Also called androgenetic alopecia, female pattern hair loss can occur when there is a shift in the levels of male hormones relative to estrogen. Estrogen falls but testosterone and other similar hormones, collectively referred to as androgens, stay roughly the same. This means testosterone levels are relatively higher. These higher levels of testosterone can act on hair follicles, causing them to become inactive.
Not all scalp hair follicles are susceptible to androgens. This is why some areas of the scalp thin in response to androgens more than others. There is a genetic component to this susceptibility as well. That is why some people, men and women, experience androgenetic alopecia and some do not. A look around at your relatives could give you some insight into what your own experience might be. Remember, you get your genes from mom and dad, and both sides contribute to your risk for hair loss.
Can female pattern hair loss be treated?
There are a couple of things you can try to reduce the effects of female pattern hair loss. For a long time, topical minoxidil (Rogaine) was the mainstay of treatment. A Cochrane review found topical minoxidil to be effective not just at preventing further loss but also in regrowing hair. It also has very few side effects. Occasionally people will have a skin reaction to it, and some women complain that even when they are careful to keep it on their scalp they see an increase in peach fuzz on the face.
Many of my patients are reluctant to use topical minoxidil because you have to apply it daily, which can be cumbersome and affect hair’s appearance. If you are going to use topical minoxidil, Rogaine 5% women’s foam, which has the texture of a mousse, can be easier to apply where you want it (on your scalp) and not where you don’t (on your face), and is less likely to make hair gloppy and weighed-down.
In recent years, oral minoxidil has been shown to be an effective option for treating female pattern hair loss. The benefit of oral minoxidil is that you just need to swallow a pill — no gloppy serums or mousses. It is also generic and cheap.
One issue that limits its usefulness for some women is that you cannot target it just to the scalp. As a result, some women will get a bothersome increase in face and body hair growth. Additionally, minoxidil was originally developed to treat high blood pressure, though usually higher doses than those used for hair loss are needed to reduce blood pressure. But even on low doses, some people will feel lightheaded.
Another promising treatment for female pattern hair loss is platelet-rich plasma (PRP) injections. This is a procedure in which the patient’s own blood is drawn and the component parts of the blood are separated by spinning it in a centrifuge. Then the plasma — the liquid part of the blood, which is rich in growth factors — is injected into the scalp.
There is no standard procedure for PRP treatments. This leads to some variability in the data. But a meta-analysis of four randomized controlled trials including 177 subjects found that PRP injections increased the density of hairs on the scalp and the thickness of the individual hairs compared with a placebo. PRP also seems to be effective when added to other treatments such as minoxidil. There are few side effects as well, the most common being pain during the procedure. You will need a consultation with a dermatologist experienced in the procedure if PRP is a treatment you are interested in pursuing.
Hair loss, while quite common, is often very distressing for women. However, there are effective treatments that can both halt it and lead to improved hair growth. A dermatologist knowledgeable in treating hair loss can help you determine what is causing yours and which treatment options might be most effective for you.
The bottom line
- Female pattern hair loss is common and often affects women in midlife.
- Also called androgenetic alopecia, female pattern hair loss is the result of relative shifts in estrogen and male hormone levels.
- Minoxidil — both topically and orally — has been shown to stop hair loss and result in new hair growth but can cause side effects such as increased face and body hair growth, and dizziness.
- Platelet-rich plasma injections have been shown to increase hair density and thickness.
Log in