Stress and Hair Loss in Women: Understanding the Connection and Finding Solutions

Hair loss is often associated with men, but it is a common concern for women as well. It can happen at any age. Up to 40% of women experience noticeable hair loss by age 50. Unlike men, who typically experience a receding hairline or bald patches, women often notice a wider part or a thinner ponytail. This article explores the connection between stress and hair loss in women, delving into the causes, types, treatments, and preventative measures.

The Hair Growth Cycle

Understanding the hair growth cycle is essential to grasp the concept of hair loss. Hair grows in cycles, with new strands constantly growing to replace those that fall out. The hair growth cycle consists of three phases:

• Anagen Phase (Growth): This is the active growth phase, where cells in the hair follicle rapidly divide, pushing the hair out and elongating the hair shaft. Approximately 80% to 90% of hair follicles are in this phase at any given time, lasting between 2 and 8 years. At any time, about 90% percent of the hair on your head is in this growth phase.
• Catagen Phase (Transition): This is a short transitional phase lasting 2 to 3 weeks. The hair follicle shrinks, and hair growth stops. Around 5% of all hairs are in the catagen stage at any given time. This is the transition phase, which lasts 2 to 3 weeks.
• Telogen Phase (Resting/Shedding): This is the resting phase, lasting 2 to 4 months. The hair follicle is inactive, and the hair remains in the follicle until it sheds. Around 5% of all hairs are in the telogen stage at any given time. At the end of it, those strands fall out.

It's normal to lose between 50 and 100 strands of hair each day. However, a sudden increase in hair shedding or visible thinning may indicate a problem.

Causes of Hair Loss in Women

Hair loss in women can be attributed to various factors, including:

• Medications: Specific medications, such as those used during chemotherapy, can cause sudden and dramatic hair loss.
• Telogen Effluvium: This condition occurs when a significant stressor or trauma to the body causes hair in the anagen (growth) phase to prematurely enter the telogen (resting) phase. This results in fewer new strands growing and increased hair shedding (up to 300 strands per day). Common causes of telogen effluvium include:
  • Childbirth
  • Severe infection or high fever
  • Crash diets that are too low in calories and protein
  • Iron deficiency
  • Vitamin D deficiency
  • Psychological stress, depression, or anxiety
  • Thyroid disease
• Female Pattern Hair Loss (FPHL): Also known as androgenetic alopecia, FPHL is the most common type of hair loss in women. It is an inherited condition that tends to become more common after menopause, suggesting a hormonal component. A drop in estrogen levels around menopause may contribute to hair follicle shrinkage. Hormonal shifts may also explain why women with polycystic ovarian syndrome (PCOS) often experience FPHL at younger ages due to an overproduction of androgens (male hormones).
• Medical Conditions and Nutrient Deficiencies: Sudden hair loss in women can sometimes result from underlying medical conditions or nutrient deficiencies.

The Role of Stress in Hair Loss

Physical and emotional stress can cause temporary hair loss in women and men. Excessive hair shedding in response to a sudden trigger, such as physical or emotional stress, is called telogen effluvium. Although scientists don't fully understand why, stress can alter the natural growth pattern, causing telogen hairs to fall out at a faster rate and shortening the anagen period.

Read also: Understanding Male Hair Loss

Chronic stress can increase the body’s cortisol levels, affecting various aspects of regular activity in the hair follicles and resulting in hair loss. One of the effects is an increase in the number of hair follicle stem cells entering a dormant stage, which can lead to a large amount of hair shedding all at once. Many different stressors can cause this shift in the body, including hormonal changes such as postpartum shifts or menopause, as well as emotional stress.

A team led by Dr. Ya-Chieh Hsu of Harvard University studied the underlying mechanisms that link stress and hair loss. The researchers found that corticosterone, a key stress hormone, prevented the dermal papilla from secreting GAS6, a molecule that activates hair follicle stem cells. These results reveal a key pathway involved in hair loss from chronic stress.

Types of Stress-Related Hair Loss

Stress-related hair loss can manifest in various ways:

• Telogen Effluvium: As mentioned earlier, telogen effluvium is a common type of stress-related hair loss characterized by diffuse hair shedding due to hair follicles undergoing an extended resting phase. The average person with healthy hair follicles will shed between 100-200 hairs daily, but the increase in hair shedding during telogen effluvium can result in more than 50% of hairs shed on the head.
• Alopecia Areata: This autoimmune disease is often triggered by stress and leads to unpredictable hair loss in circular, non-scarring patches along the scalp.
• Trichotillomania: This is a hair-pulling disorder characterized by a strong urge to pull out one’s hair, leading to noticeable hair loss. Patients may experience relief from emotional stress following an episode of hair-pulling and have difficulty ceasing the behavior.

Symptoms of Stress-Related Hair Loss

Telogen effluvium is typically characterized by sudden hair loss in women. Those who develop this condition begin to notice hair falling out in clumps or even handfuls. Larger amounts of hair may fall out while shampooing, combing, or brushing. The shed hairs usually have a club-shaped root at the bottom. Symptoms usually begin around two to three months after the physical or emotional stress begins.

Patients often observe diffuse hair loss caused by telogen effluvium as “en-mass” hair shedding, appearing as overall hair thinning or hair loss rather than a widening part or gradual thinning in specific areas. Oftentimes, patients will notice a substantially thinner ponytail or an increase in the amount of hair shed while combing or shampooing as an indicator of telogen effluvium.

Read also: Lasting Hair Graft Results

Alopecia areata typically is indicated through patchy hair loss, with bald patches that are typically about the size of a quarter. Trichotillomania often develops in adolescents and can continue until adulthood, affecting around 1-2% of the population.

Diagnosis and Treatment of Hair Loss in Women

If you're concerned about hair loss, consulting a healthcare provider, preferably a dermatologist, is essential. They can diagnose the cause of your hair loss and recommend appropriate treatment options.

Diagnosis

An experienced medical professional, such as a board-certified dermatologist, can physically assess the scalp and hair to help diagnose the type of hair loss and best treat it. Diagnosis may involve:

• Medical History: Discussing your medical history, including any recent illnesses, medications, or stressful events.
• Physical Examination: Examining your scalp and hair to assess the pattern and extent of hair loss.
• Blood Tests: To identify any underlying medical conditions or nutrient deficiencies.
• Scalp Biopsy: In some cases, a scalp biopsy may be necessary to rule out other conditions.

Treatment Options

Treatment for hair loss depends on the cause and may include:

• Stress Management: Reducing stress through techniques like talking with a mental health professional, exercise, yoga, or meditation.
• Lifestyle Modifications: Avoiding hair products (like chemical treatments) that damage your hair and changing your hairstyling routine to avoid damaging your hair follicles.
• Nutritional Support: Taking vitamins or supplements for a vitamin deficiency.
• Topical Minoxidil: This over-the-counter drug is approved by the FDA for both male and female pattern baldness. It is available in 2% and 5% strengths and is meant to be applied to the scalp daily.
• Low-Light Lasers: Laser combs and caps use low-energy light to stimulate hair follicles. While several types are on the market, only a few have earned FDA approval.
• Prescription Oral Medications: Finasteride and spironolactone are both FDA-approved medications, but neither is approved specifically for female pattern hair loss. Some dermatologists use them off-label to treat hair loss.
• Platelet-Rich Plasma (PRP): This treatment involves taking plasma from your blood and injecting it into your scalp. While it is FDA-approved for orthopedic uses, it’s not specifically approved for hair regrowth.
• Microneedling: This treatment is often used along with topical minoxidil. The doctor uses fine needles to make tiny holes in the scalp, then applies the topical treatment.
• Intralesional Corticosteroid Injections: Corticosteroids are anti-inflammatory medications that prevent the immune system from attacking hair follicles. During treatment, the corticosteroids are injected directly into the individual bald patches.

Specific Treatments for Stress-Related Hair Loss

• Platelet-Rich Plasma (PRP) Injections: PRP is an innovative, in-office treatment that relies on your body’s growth factors and nutrients to stimulate healthy hair follicles and produce new hair growth.
• Topical and Oral Medications: Topical treatments for hair loss can be essential in preventing new loss and stimulating hair regrowth. Minoxidil is the only FDA-approved topical treatment for combating hair loss and can help regenerate new hair. Dr. Green may recommend taking an oral medication to cease hair shedding and promote new hair growth.
• Other medications: Spironolactone and other anti-androgens, Finasteride and other alpha-reductase enzyme inhibitors, Estrogens, Prostaglandin analogs, Steroids.

It’s important to talk to your healthcare provider before starting any form of treatment for hair loss. Some types of treatment aren’t safe to use if you’re pregnant, planning on becoming pregnant, or going through menopause.

Read also: Customizing Your Hair Oil Blend

Duration and Outlook for Stress-Related Hair Loss

Stress-related hair loss typically begins two to three months after a significant stressor or stressful event. Once feelings of stress are under control, hair shedding may continue for up to six months or, in some cases, continue for years. Stress-related hair loss is usually not permanent for everyone who experiences it; however, practicing stress management techniques and consulting with a board-certified dermatologist can help stop hair loss.

For most patients, hair will regrow after the stress is removed. Patients often find that their hair can be restored to its former glory, although it can take many months for the hair loss to cease and hair growth to begin.

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