Female pattern hair loss common during menopause, reversible if promptly treated

Key takeaways:

• Female pattern hair loss is common during menopause.
• Options are available to reverse hair loss, but prompt diagnosis and treatment are key to successful regrowth.

CHICAGO — Female pattern hair loss is a common condition for menopausal women, but options to reverse and regrow hair are available if patients are diagnosed and treated, according to a speaker at the Annual Meeting of The Menopause Society.

When diagnosing hair loss, the most important diagnostic tool is the patients’ history as well as patients’ experience with hair loss, the duration, recent stressors, new medications or health changes and body hair changes, according to Omar Ibrahim, MD, MBA, co-director of Chicago Cosmetic and Dermatologic Research, clinical instructor in the department of dermatology at Rush University Medical Center and adjunct faculty at Cleveland Clinic.

“A lot of practitioners tell their patients that postpartum hair loss, medication-induced hair loss, shedding with menopausal hormonal changes — ‘It all comes back; don't worry about it.’ But that's not true,” Ibrahim said during the presentation. “A shed in your teens and a shed in your menopausal years are very different. It's almost like breaking a bone in your 50s and 60s vs. breaking the bone in your teens. The recovery is very different.”

Diagnosing hair loss

Female pattern hair loss is a gradual condition, most common during menopause. It is caused by a combination of shedding, hair follicle miniaturization and genetics; the hormonal component is not well understood, Ibrahim said. Diffuse alopecia areata, frontal fibrosing alopecia, central cicatricial centrifugal alopecia, traction alopecia and temporal triangular alopecia are all differential diagnoses for female pattern hair loss.

According to Ibrahim, some clues to a diffuse alopecia areata diagnosis are severe parietal and temporal loss and distinct, circular patching. Central centrifugal cicatricial alopecia, which is a scarring progressive alopecia almost exclusively found in women of African descent, results in complete obliteration of the hair follicle. Once the follicle is gone, no hairs can be regrown through the scar, so it is important to refer patients with this condition to a dermatologist for diagnosis and treatment. Traction alopecia is similarly common among women of African descent but results in broken hairs from constant tugging and pulling that result in permanent hair loss. Temporal triangular alopecia can occur during adolescence with triangular hair loss patches that develop temporally.

During menopause, many women can also develop frontal hairline recession, or frontal fibrosing alopecia, which results in shrinking hair follicles that leads to extreme hair thinning and loss, according to Ibrahim. Frontal fibrosing alopecia is a genetic, scarring and progressive alopecia commonly found among white women around age 50 years.

The incidence of frontal fibrosing alopecia is increasing worldwide and can result in hair loss for a few years before it is noticed, though its exact cause remains unknown, according to Ibrahim. Frontal fibrosing alopecia may be caused by several factors, Ibrahim said, such as hormones, allergens and, controversially, chemical sunscreens. The condition is also associated with higher risk for thyroid disease, contact allergies to fragrances, lupus and rheumatoid arthritis.

Importantly, Ibrahim said, if frontal fibrosing alopecia is observed in young patients, a full workup and biopsy should be conducted to diagnose this condition and other possible associated comorbidities.

Hair loss treatments

If a patient is diagnosed early before the hair follicles are gone and scarred, then there are treatment options available to revert and regrow the follicles.

Ibrahim highlighted several common treatments for female pattern hair loss:

• topical or oral minoxidil;
• spironolcactone;
• dutasteride;
• finasteride;
• low-level laser therapy;
• platelet-rich plasma injections; and
• exosomes.

For frontal fibrosing alopecia, promising treatment options include:

• topical corticosteroids/calcineurin inhibitors;
• intralesional corticosteroid injections;
• oral tetracyclines;
• hydroxychloroquine;
• dutasteride/finasteride;
• ciclosporin;
• pioglitazone; and
• JAK inhibitors.

According to Ibrahim, early diagnosis of female pattern hair loss and prompt intervention is key to successful regrowth and future prevention.

“Patient empowerment is vital because there are a lot of stigmas,” Ibrahim said. “We educate patients that if [hair loss] bothers them, they should treat it, but we should use evidence-based and empathetic care to manage and dedicate the impact of hair loss on our patients’ wellbeing.”