Should I see a doctor: Hair loss in women

Pulling more hair out of your brush than usual or noticing your shower drain clogging faster?

Some daily hair loss is normal, but when it reaches a point where you can’t ignore it, it’s best to explore why. It could just be your time for a cycle of shedding, or maybe it’s something more.

We’re breaking down what you need to know about female hair loss.

What’s ‘normal’

Most women naturally shed about 100 strands of hair each day. You’ll notice those strands in your brush, as you wash your hair, stuck on a hair tie or maybe even around the house when you sweep.

If you notice you’re gradually shedding more hair than what has been normal over the past few years, the answer may be as simple as a shift between your anagen and telogen phases.

The anagen phase is your natural growth period, where your hair is likely to be its thickest, strongest and able to grow its longest. The anagen phase length varies person to person, but can last anywhere between two to eight years.

The telogen phase is a resting period for the hair follicle. During this period, your hair reaches its maximum growth and eventually goes through a shedding period. The telogen phase will likely last a month or two.

As the telogen phase ends, you’ll notice the regrowth is often finer at first until it returns to your typical hair type. Regrowth typically takes a year to a year and a half.

Age may also play a role in your hair thickness and shedding rate. Many older women may notice changes in the length of their anagen/telogen phases, thinning around the hairline above the forehead or widening of the part.

About 50 percent of women will experience this slow, progressive type of hair loss caused by genetics as opposed to hormones or external triggers.

What’s ‘not normal’

When things suddenly and drastically change or excessive shedding persists for months, it could be a sign of telogen effluvium — a common and reversible type of hair loss that typically occurs after a trigger.

A telogen effluvium trigger could be many things, including:

• Surgery
• Infection
• Pregnancy
• Hormone changes
• Stress
• Major emotional events
• Thyroid conditions
• An autoimmune disease
• Weight loss (rapid loss of more than 15 percent of body weight)
• Some medications
• Some dietary choices

It often takes at least three months for the trigger to show its impact on the hair follicle. By then you may be recovered from the event, making it hard to pinpoint the cause. Talking with your primary care provider will be the best first step in nailing it down and exploring possible solutions.

If your hair loss is combined with any of the following symptoms, schedule an appointment with your primary care provider as soon as possible:

• New or worsening acne
• Changes in body hair, including thighs, stomach or back
• Redness around the hair follicle, which could be a sign of inflammation and lead to scarring
• Eyebrow and eyelash loss
• Patches of hair loss
• Scalp burning, itching or pain
• Irregular periods
• Fluid leaking from the nipple
• Receding hairline or widening center part

How to care for your condition

Preventing telogen effluvium starts with understanding your triggers and caring for your hair from the inside out, starting with the scalp and follicle.

Sometimes there’s little you can do about emotional triggers or physical events and conditions, such as a needed surgery. But you can control things like your nutrition, stress or deficiencies.

Your doctor or other health care provider will likely start with an initial evaluation of the scalp and a gentle hair-pull test to see how easily strands come out. A blood panel may then be collected to look at things like vitamin D and iron levels. You’ll also review lifestyle factors, including mental health, diet and physical activity.

You may be asked to track how many strands you’re losing in a day. To get a good gauge, install a mesh cover over your shower drain to collect hair, let it dry and then count the strands.

Some of the best ways to care for your hair from the inside out include:

• Regular annual exams and blood panels to identify any underlying conditions or deficiencies
• Reducing stress and caring for your overall mental health
• Avoiding strict diets, which may limit intake of needed nutrients that support hair health and growth
• Avoiding excess hair damage through bleach-coloring or tight/pulled-back styling

It’s important to remember that hair growth takes time. There isn’t a quick fix to restore your hair once shedding is done — despite what over-the-counter supplements may promise.

Feeling alarmed is normal when shedding picks up. But give it time, talk with your provider if you’re concerned and focus on caring for your whole self.

Medical review provided by Terese Quale, ARNP, OB/GYN at MultiCare Rockwood Clinic – OB/GYN and Midwifery Clinic.