It is estimated that at least 50% of all women experience some degree of hair loss at various points in their lives. Hair loss in females can result from many factors, including hormonal changes induced by pregnancy, childbirth or menopause, external triggers like stress and poor diet, and also hereditary baldness. However, most of these can be classified under one of two conditions: Telogen effluvium (stress-induced hair loss) or Female pattern hair loss (androgenetic alopecia).
The natural hair growth cycle
Before looking into the different causes of female hair loss, it is crucial to understand how our hair grows.
The natural growth of our hair is characterised by 3 separate phases:
- Anagen/Growth Phase.
This is the phase when active hair growth occurs. It lasts for 3 to 7 years and is typically longer in females compared to males.
- Catagen/Transitional Phase
This marks the transition between growing hair and resting hair. Hair growth is still present but is greatly slowed as the follicles begin to shrink. Catagen lasts for about 2 to 4 months.
- Telogen/Resting Phase.
At this stage, hair growth stops and the old hair detaches from the roots. Hairs in telogen will eventually shed to give room for new hair to emerge.
Generally, most individuals with healthy hair will have between 5 – 10% of their hair in telogen. This is naturally balanced and replaced by the large numbers of hair in the anagen and catagen phases, allowing us to keep a full head of hair.
However, if there are any disruptions to this cycle, hair loss can occur. This is the case for the most common causes of female hair loss: Telogen effluvium and Pattern hair loss
Telogen effluvium is the result of hairs entering telogen prematurely, leading to increased shedding. For telogen effluvium, however, this is increased to about 30%. The natural shedding of hairs outpaces the natural replacement rate, leading to observable hair loss.
- Causes and triggers
Telogen effluvium is usually caused by external triggers affecting the body. These triggers may include but are not limited to:
- Mental/psychological stress
- Poor diet and nutrition, or sudden weight loss
- Temporary hormonal changes caused by pregnancy, childbirth or menopause
- Side effects of drugs and other medical treatments
There are several ways for doctors use diagnose telogen effluvium, such as:
- The “pull test”. Doctors will grab a small tuft of hair at specific locations on the scalp and gently tug on them. If telogen effluvium is present, 10% or more of the tugged hair will fall out easily.
- Monitoring the amount of hair shed during hair washing
- Doctors may examine the shed hairs under a microscope to determine the stage of growth they are in. If telogen effluvium is the cause, all the shed hairs will be in the telogen phase.
- Identifying possible triggers during the consultation
Genetic Female Pattern hair loss (androgenetic alopecia)
Female pattern hair loss is a hereditary condition that runs in the family. Unlike telogen effluvium, it occurs without any obvious triggers. Hair loss in this case is localised around the natural parting of the hair and the frontal hairline, creating an “bald spot”. Also, the shedding tends to be less noticeable immediately, as compared to telogen effluvium.
In general, female pattern hair loss is due to a shorter than normal anagen phase, together with an increased gap between the natural shedding of old hair and the growth of new hair. The amount of shedding does not increase, but the growth of new hair is reduced.
Female pattern hair loss is usually triggered by the actions of hormones called androgens, which regulate hair growth amongst many other functions. In most cases, this condition is hereditary, but it can also be a result of endocrine disorders leading to excess androgen production.
Female pattern hair loss is characterised by the following:
- Hair loss localised around the natural parting and the frontal hairline
- Lack of obvious triggers, such as stress or disease
- Having a family history of pattern hair loss
Often, doctors will inspect the scalp, shed hairs, and arrange a blood test to rule out other causes of hair loss before diagnosing pattern hair loss. Often, the Ludwig scale is used to determine the extent of hair loss and determine the best course of action.
Treatments for female hair loss
Female hair loss, although common, is a very treatable condition. At The Clifford Clinic, we offer 3 main courses of treatment for female hair loss.
- Regenera Activa hair loss treatment
Regenera Activa hair loss treatment is an effective, minimally invasive approach to address most forms of hair loss, including telogen effluvium and genetic pattern hair loss. It utilises capillary regeneration technology to activate dormant cells under the scalp.
During the treatment, several healthy hair follicles are extracted from the back of the head. These are then mixed with a potent and specialised solution with the Regenera Activa device. This breaks down the grafts into a suspension of viable scalp cells. This suspension is injected into strategic points on the scalp experiencing hair loss. The cell suspension stimulates dormant cells under the scalp, triggering new hair growth
The whole procedure takes about 45 minutes and is performed under local anaesthesia to minimise pain and discomfort.
- Follicular Unit Extraction (FUE) hair transplant
FUE hair transplant is perhaps the most effective long-term solution female pattern hair loss. As the name suggests, healthy hair follicular units are extracted from regions of the scalp least susceptible to hair loss, usually from the side or back of the head. These follicular units (called “grafts”) are carefully examined and sorted based on the number of follicles in each graft. Skilled Hair Technicians will then plant the grafts into the scalp at suitable locations and angles to provide natural looking results.
After FUE hair transplant, the transplanted hair follicles will grow new, healthy hair in their new homes. Even though the new hairs are expected to shed within the first few months, most patients can expect to see best results after a year. The results may not be immediate, but they can be permanent as long as patients take good care of the transplanted hairs.
FUE hair transplant is performed under local anaesthesia and can take between 4 to 8 hours depending on the number of grafts.
- Fraxel Laser treatment for hair growth
Laser treatment is one of the more recent treatments on the scene. At The Clifford Clinic, we offer the 1927nm Thullium Fraxel Laser to treat hair loss.
Fraxel Laser works by stimulating cell rejuvenation and removing aged/dead cells in the skin and hair follicles. The removal of dead cells induces the hair follicles to enter anagen, the active growth phase. This directly triggers the growth of new hair in the treated areas. Hence, the Fraxel Laser is effective in managing both telogen effluvium and female pattern hair loss, as it directly affects the hair growth cycle, increasing the rate of hair growth.
Imported directly from South Korea, Bellasonic is one of the latest technologies to be used in The Clifford Clinic. It is an Ultrasound therapy device used primarily for boosting cell rejuvenation in the skin, which includes cells associated with hair growth. Bellasonic emits high-frequency ultrasound into the skin at 1-10MHz into the skin. The ultrasound stimulates the activity of important molecules like Glycosaminoglycans (GAGs) and Heat Shock Proteins (HSPs), which are associated with regenerative processes. The vibration from the ultrasound also improves blood flow and oxygenation to the treated areas. When applied to the scalp, these regenerative effects are applied to the hair follicles, effectively boosting the rate of hair growth and alleviating hair loss.
Hair loss in females can also be treated with prescribed medication as well. Some of these include:
- Minoxidil as either an oral or topical medication.
- Spironolactone (Aldactone)
You should always seek professional medical advice before taking any medication, as different medication targets different types of hair loss and are effective in different situations.
It is important to note that all hair loss treatments, including Regenera Activa and FUE hair transplant, work best in the early stages of hair loss. At later stages, the effects of these treatments, especially Regenera Activa, become very limited. Hence, patients suffering from hair loss should not delay treatment and should seek professional help as early as possible.
At The Clifford Clinic, our doctors have over 10 years of experience in managing hair loss and hair transplant cases. They will examine your conditions and customise the most suitable course of treatment for you.
How do I know if I have telogen effluvium or genetic pattern hair loss?
For diagnosis on the cause of your hair loss, you should always consult a hair specialist. However, you may look at the following for the most obvious differences between the 2 conditions as a rough guide.
|Telogen effluvium||Genetic female pattern hair loss|
|Location of hair loss||All around the head with no specific pattern||Localised balding around the natural parting of the hair and the frontal hair line|
|Shedding of hair||Hair shedding is active, and hairs can be easily pulled out from the scalp||Usually has no observable increased shedding.|
|Texture of hair||Hair texture is the same as usual||Hair feels finer than usual|
|Family history||Has no hereditary connections||Family members and close relatives are likely to have the same condition.|
Are the treatments painful?
Both Regenera Activa and FUE hair transplant are performed under local anaesthesia so there will be minimal pain and discomfort. In both cases, you may feel some soreness after the anaesthesia has worn off. Our doctors will prescribe medication to help ease this discomfort.
Fraxel Laser may cause some minor pain, but is usually tolerable for most patients.
Bellasonic is completely painless without any discomfort at all.
Which treatment is the most suitable for me?
Medication, Fraxel Laser treatment, Bellasonic and Regenera Activa are suitable for managing both telogen effluvium and pattern baldness.
FUE hair transplant is usually not required nor recommended for telogen effluvium.
However, as each patient’s condition differs slightly, it is always best to consult our doctors before commencing any treatment. They will use their professional experience to recommend the most suitable course of treatment for you.