It might begin with more hair than usual in your brush or extra hair in the shower drain. Then the part in your hair seems a bit wider than usual. But it’s not until your hairdresser remarks that your hair seems to be thinning on top that you confront the horrifying reality that you’re gradually losing your hair.

There are multiple reasons for hair loss in women, some hereditary, others related to stress, hormone changes, medication and illness. If you’re suffering from hair loss, it’s important to make an appointment with your physician to determine the cause. In some cases, the loss may be treatable or temporary.

A healthy head of hair has about 100,000 hairs, and it’s normal to shed about 50 to 100 each day. Hair loss problems are caused by a sudden increase in the number of hairs being shed or by a more gradual failure to replace all those being shed over a longer time period. A simple pull test can often clarify whether the loss is the result of hereditary alopecia or excessive hair shedding with a specific cause such as stress, childbirth or reaction to a drug.

The pull test involves grasping a clump of about 60 hairs and pulling them firmly. Normal shedding would yield about 6 hairs or less. If more than six hairs are shed it’s an indication that something is causing active shedding.

When no obvious cause can be found lab tests such as a punch biopsy, in which a small area of scalp is sampled, can be performed.

Female pattern baldness.

Although we generally think of men when we conjure up images of a balding head, women are also affected by this hereditary condition known as androgenetic alopecia. Alopecia is the technical term for hair loss.

Female pattern balding doesn’t look like male pattern balding. Male hair recedes from the front hairline and is gradually lost on top in a horseshoe type pattern. Women’s hair tends to thin out all over; where before there were five hairs there are now only two. Wispy, thinning hair is distressing, however, and causes many women to avoid swimming and other outdoor activities.

Hereditary hair loss is the most common cause in women, eventually affecting about 50 percent of women to some extent. It can begin as early as the 20s but it’s more common in the 40s and 50s.

Many causes of hair loss are reversible so it’s important to get to the “root” of the problem.

Reasons for Hair Loss in Women:

• Excessive shedding (telogen effluvium) points to a disturbance in protein metabolism, something that can take three months to show up. A very stressful event such as a high fever or severe psychological distress could cause such a disturbance.

• Certain medications, including chemotherapy to treat cancer can be to blame.

• Thyroid problems, common in many women approaching menopause, can cause excessive hair shedding and can be remedied with thyroid medication.

• Anemia, often the result of heavy menstrual bleeding and also seen in avid runners or vegetarians, can affect hair growth. Iron supplements can boost iron levels thus improving the hair loss.

• Many women notice extra hair shedding about three months after childbirth when hormone levels drop suddenly. This is a temporary loss and resolves as hormone levels stabilize.

• Medications associated with hair loss include beta blockers, some cholesterol lowering drugs and antidepressants. A physician can usually prescribe an alternate drug to resolve the problem.

• Eating disorders can affect hair growth. Anorexia and bulimia as well as fad diets in which nutrition is compromised can all result in excessive hair loss.

• Hairstyles that pull or exert too much pressure on hair can create traction alopecia. Corn rows, overly tight ponytails and extensions can literally pull hair from its roots. Changing to more natural styles stops further damage.

About two percent of women, men and children suffer from alopecia areata, an autoimmune disorder where the body’s immune system attacks itself, causing hair to fall out in clumps. The result is patchy hair loss that can resolve spontaneously, only to recur at a later date. It is often treated with minoxidil or corticosteroids.

Treatment for hair loss:

Minoxidil

There’s no simple solution to some forms of hair loss. The drug minoxidil (Rogaine), originally marketed for men, is now approved for use in women. In a two percent solution it produced minimal regrowth in 50 percent of women treated and moderate regrowth in 13 percent. It prevented further hair loss in many of those treated. In fact, the drug is more effective in women than in men.

Minoxidil extends the length of time follicles spend in the active growth phase. It stimulates follicles that have entered the resting phase, and it enlarges the follicles themselves. Peach fuzz type hairs are converted to more robust terminal hairs and fewer hairs are shed. Minoxidil doesn’t work for everyone, however. Available over the counter, the drug needs to be used for about eight months to show the full effect.

A Good Haircut

Hairdressers recommend that women with thinning hair disguise the problem with a good cut and hair enhancing techniques such as volumizers and color. Straight, fine hair can be cut short, all one length to give it a fuller look. Curly hair looks fullest worn short and layered.

Transplants

Some women faced with the pain of hereditary hair loss opt for surgical transplants. New micro-graft techniques achieve much more natural looking results than older hair methods that transplanted hair in clumps giving a doll-like effect. The micro-graft technique involves taking one or two hairs at a time and transplanting them into bare areas in a natural-looking pattern. The transplanted hair falls out soon after the transplant but grows in again from the newly-transplanted root in a couple of months. Men tend to be better transplant candidates than women because the transplant hair is harvested from the usually denser hair at the sides and back. Because many women tend to have thinning hair all over, they may not have a rich area from which to harvest. Many women who have had micro-grafts are very happy with the results, however. The process is expensive, costing $5000 and up.

For women, hair loss can create emotional trauma, loss of self esteem and depression. It’s important to have the problem evaluated by a physician to determine if the hair loss is reversible. If not, women should seek out a competent stylist and can investigate other cosmetic options such as hair pieces, wigs and mini-graft hair transplants, an expensive but satisfactory solution for many.