FEMALE PATTERN HAIR LOSS (FPHL)
Hair loss often has a greater impact on women than on men, because it's less socially acceptable for them. Alopecia can severely affect a woman's emotional well-being and quality of life.
Female pattern hair loss (FPHL) is also otherwise known as androgenetic alopecia. As many as around 40% of women by age 50 show signs of hair loss and less than 45% of women actually reach the age of 80 with a full head of hair. As many as two-thirds among postmenopausal women suffer hair thinning or bald spots.
FPHL is quite different from the male pattern baldness, which usually begins with a receding frontal hairline that progress to a bald patch on top of the head.
In women, androgenetic alopecia begins with gradual thinning at the part line, followed by increasing diffuse hair loss radiating from the top of the head. A woman's hairline rarely recedes, and women rarely become bald unless there is excessive production of androgens in the body. However, some women may develop some hair thinning at the frontal hairline with normal aging.
The Ludwig (Savin) Scale Of Female Pattern Baldness
The first image (labeled I-1) is a woman with no hair loss in the central parting of a woman. The images 2 to 4 (labeled I-2, I-3, I-4) the width of the parting gets progressively wider indicating thinner hair along the center of the scalp. The images labeled II-1 and II-2 show diffuse thinning of the hair over the top of the scalp. The image labeled III represents a woman with extensive diffuse hair loss on top of the scalp, but some hair does survive. The image labeled “advanced” represents a woman with extensive hair loss and little to no surviving hair in the alopecia affected area. Very few women ever reach this stage and if they do it is usually because they have a condition that causes significant, abnormally excessive androgen hormone production. The last image in the Savin scale is somewhat different, it shows a woman with a pattern of hair loss that is described as “frontally accentuated”. That means there is more hair loss at the front and center of the hair parting instead of just in the top middle of the scalp.
FPHL is closely related to genes although the mode of inheritance is not determined. There are many genes that contribute to this condition, and these genes could be inherited from either parent, or both.
Currently, it is unclear if androgens (male sex hormones) play a role in FPHL, although androgens have a clear role in male pattern baldness. Many women with FPHL have normal levels of androgens in their bloodstream. Due to this uncertain relationship, the term FPHL is preferred to ‘female androgenetic alopecia’.
FPHL is more common after the menopause suggesting oestrogens may be stimulatory for hair growth. But laboratory experiments have also suggested oestrogens may suppress hair growth.
In either sex, hair loss from androgenetic alopecia occurs because of a genetically related shortening of anagen, a hair's growing phase, and a lengthening of the time between the shedding of a hair and the start of a new growth phase. (See "hair growth cycle") That means it takes longer for hair to start growing back after it is shed in the course of the normal growth cycle. The hair follicle itself also shrinks and produces a shorter, thinner hair shaft resulting in thicker, pigmented, longer-lived "terminal" hairs being replaced by shorter, thinner, non-pigmented hairs called "vellus."
Progress of FPHL
FPHL can affect women in any age group but it happens more commonly after menopause. The hair loss process is not constant and usually occurs in fits and bursts. It is common to have accelerated phases of hair loss for 3 to 6 months, followed by periods of stability lasting 6 to 18 months. Without medication, it tends to progress in severity over the next few decades of life.
Should I Seek Medical Help?
Majority of women affected by FPHL do not have underlying hormonal abnormalities. However a few women with FPHL are found to have excessive levels of androgens. These women tend also to suffer from acne, irregular menses and excessive facial and body hair. These symptoms are characteristic of polycystic ovarian syndrome (PCOS) although the majority of women with PCOS do not experience hair loss. Less often, congenital adrenal hyperplasia may be responsible.
A clinician diagnoses female pattern hair loss by taking a medical history and examining the scalp. She or he will observe the pattern of hair loss, check for signs of inflammation or infection, and possibly order blood tests to investigate other possible causes of hair loss, including hyperthyroidism, hypothyroidism, and iron deficiency. Unless there are signs of excess androgen activity (such as menstrual irregularities, acne, and unwanted hair growth), a hormonal evaluation is usually unnecessary.