"Hair loss is a very misunderstood condition, both in terms of how people see their own hair loss and how physicians who are not dermatologists approach hair loss," said Dr. McMichael. "It is important for women to be evaluated by a dermatologist, who specializes in hair loss, at the first signs of a problem - whether she notices that her ponytail is smaller than it used to be, she sees more hair in the shower, or if her part is widening. Determining the cause of the hair loss is the first step in treating it and preventing future hair loss."

Female-Pattern Hair Loss

"Studies examining quality of life issues show that women with hair loss are much more bothered by their condition than men," said Dr. McMichael. "With men, it has become socially acceptable to be bald, but the same is not true for women. Many of my patients report not going to church because they don't want people in the pew behind them to see their thinning hair, or they stop exercising because they don't want to mess up their hair that they've spent so much time styling to try to hide their hair loss. It really can affect many aspects of their lives."

The most common form of hair loss in women is female-pattern hair loss, which is a hereditary condition also referred to as androgenetic alopecia. While pattern hair loss affects both men and women, it is very different in women and does not display the classic receding hairline or bald spot on top of the scalp as it does in men. In women, the frontal hairline is usually maintained, but there is
visible thinning over the crown. Dr. McMichael explained that in both male- and female-pattern hair loss, the hair stays on the head for a shorter time due to a short growth phase, resulting in baby fine hairs that do not reach their full length or diameter.

Fortunately, several treatment options are effective for women with hair loss. Minoxidil 2% is the only topical medication approved by the U.S. Food and Drug Administration (FDA) for female-pattern hair loss. Minoxidil 5% is only FDA-approved for male-pattern hair loss, but it has been shown to be very effective in women as well. Both the 2% and 5% solutions are available over-the-counter. While minoxidil does not grow new hair, it works by prolonging the growth phase of hair - providing more time for hair to grow out to its full density.

"Minoxidil is a wonderful option for women with thinning hair, as it only treats the hair you want to keep that is not reaching its maximum growth and is an easy way to fill in hair density," said Dr. McMichael. "Although minoxidil is an over-the-counter treatment, women should consult their dermatologist who is experienced with the product and can explain how it works and off-set any known side effects - such as irritation or fine facial hair that could develop along the cheeks and jaw line."

In some cases, other medications may be used off-label to treat female hair loss, including finasteride (which is FDA-approved for male-pattern hair loss) for women of non-childbearing age only, and the anti-androgens spironolactone and flutamide that work by blocking the male hormone testosterone at the cellular level of the hair follicle. These oral medications also may be an option for women who may not want to spend time applying minoxidil every day. Dr. McMichael also noted that hair transplantation is an extremely effective procedure for women who want to fully restore their lost hair and works best in conjunction with topical or oral medications to prevent further hair loss.

Alopecia Areata

An autoimmune form of hair loss that can affect men and women, alopecia areata, occurs when the body's white blood cells attack the hair follicles and put them to sleep. This results in either a small patch of complete hair loss on the scalp that may be easy to cover or complete hair loss on the scalp (similar to the effects of chemotherapy in cancer patients) and/or other areas of the body.

While not as common as other forms of hair loss, this condition can be very psychologically upsetting for women and its manifestations are unpredictable from person to person. For example, alopecia areata can happen overnight or occur gradually over the course of several years. Dr. McMichael noted that typically, alopecia areata is initially seen in children and young adults.

Although there are no FDA-approved treatments for alopecia areata, Dr. McMichael explained that dermatologists may use combination therapies off-label such as injectable steroids, topical steroids or minoxidil 5% to try to regrow hair in patches of bald spots. However, she cautioned that not all patients will experience hair regrowth even with treatment - which could have a significant negative impact on their quality of life.

Telogen Effluvium

Another common form of hair loss in both men and women, telogen effluvium, refers to an increase in the number of hairs in the telogen, or rest, phase of the hair cycle, which typically lasts three months in the normal growth cycle. However, telogen effluvium occurs as a result of the body's natural physiologic response to some form of stress, causing more hair to enter the rest phase than the normal 10 percent. For example, surgery, childbirth, dramatic weight loss (including gastric bypass surgery), the death of a loved one, starting
or stopping oral contraceptives, iron deficiency, and chronic thyroid diseases can trigger this type of hair loss.

"When I evaluate patients' hair and their recent medical history, I am able to determine if their hair loss is a result of telogen effluvium. I always tell women to be patient and that their hair needs to grow back on its own," said Dr. McMichael. "In these cases, I would only recommend minoxidil to less than 50 percent of women and oral medications would not be effective. Once the trigger is removed, the hair simply needs to return to normal - which could take anywhere from three to nine months. The key is determining the trigger and when it occurred in relation to the hair loss."

Future Research for Female-Pattern Hair Loss

Dr. McMichael is optimistic that research in hair loss will continue to expand in the future. McMichael also suggested that in addition to seeing their dermatologist for proper evaluation and treatment, women who are bothered by their hair loss can find help through the many support groups that are available to patients on the Internet.