Alopecia in Women: What It Is, Types, and Causes of Hair Loss

Everyone loses hair — it is part of the normal cycle. But when noticeable bald patches appear on the head and the part widens, this is no longer a cosmetic nuisance but a condition called alopecia. Without promising miracles, let us explain what is known about the causes and how doctors look for an explanation.

What alopecia is and how it differs from ordinary hair loss

Alopecia is pathological hair loss leading to partial or complete disappearance of hair in certain areas of the head or body. Losing up to 100 hairs from the scalp per day is normal, and in most people they grow back. Alopecia begins where hair stops regrowing in its former volume.

Some types of hair loss are temporary: after illness, stress, weight loss, iron deficiency, or cancer treatment, hair usually returns. Other types are permanent — for example, male- and female-pattern baldness, which is often passed down in families.

Types of alopecia in women: androgenetic, patchy, diffuse

The most common types include androgenetic (androgenic), diffuse, and patchy (areata) alopecia; scarring alopecia, in which hair does not grow on scarred skin, is classified separately. In androgenetic alopecia in women, hair thins in the central part area and spreads to the sides, and severity is assessed using the Ludwig scale. Data on its frequency in women vary — from 20 to 90 percent of all cases of hair loss, because the manifestations are less noticeable and harder to diagnose.

In patchy alopecia, patches of complete hair absence occur. The diffuse, or symptomatic, form is thinning and reduced density over the whole head, including telogen and anagen hair loss.

How baldness manifests: thinning, bald patches, and baldness on the head

Alopecia on the head looks different. In the androgenetic form, hair remains but becomes thin, short, and colorless — vellus hair — and no longer covers the skin: this is how a bald spot forms. Ten to twelve years after alopecia appears, the follicular openings become overgrown with connective tissue and stop producing even vellus hair.

• Widening of the central part and thinning over the whole head
• Clearly defined hairless patches in the patchy form
• Thinning of strands over the entire scalp surface in the diffuse form
• Absence of hair growth on scarred areas

Why alopecia occurs: hormones, heredity, diseases

Male-pattern baldness is linked to androgens — hormones produced by bodies of both sexes. Their action goes through the cells of the dermal papilla, and the development of baldness is ultimately determined by intracellular metabolism of androgens and estrogens. Follicles at the back of the head contain more aromatase, which restrains this process, than at the top of the head: 1.8 times more in women. Estradiol prolongs the hair growth phase — most noticeably in pregnant women, and after childbirth estrogen levels fall and hair falls out more synchronously.

Other causes include family history, stress, protein deficiency and poor nutrition, iron deficiency, weight loss, certain diseases (thyroid problems, diabetes, lupus), taking certain medications, and chemotherapy. Alopecia can accompany syphilis, ringworm, and trichotillomania.

How the cause of baldness is diagnosed

A doctor may suspect the cause by examining the hair. The severity of androgenetic alopecia in women is assessed using the Ludwig scale.

When to see a dermatologist

You should see a doctor if hair loss is bothersome, visible bald patches or hairless areas have appeared, or thinning is progressing. The specialist will explain what is happening and discuss available options. Commercial hair restoration clinics are logically visited after a doctor has established the cause.

Alopecia by itself is not a reason to call an ambulance. Numbers 103 and 112 are for when, alongside hair loss, there are signs of a life-threatening condition: for example, acute breathing difficulty, loss of consciousness, or a sharp deterioration in well-being.

This material is for reference: it helps you understand what to ask your doctor, but does not replace a consultation and examination by a specialist.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer