PCOS Hair Loss: What Is It & What To Do?
Written by
Morgan German
Medically approved by
Ahmad Chaudhry M.D.

The occurrence of PCOS hair loss is not yet clear, reports, however, point towards 40-70% prevalence, with most cases of women in their early teens. It is one of the most frequently reported symptoms along with hirsutism, acne, and menstrual irregularities.

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What is PCOS?

Polycystic Ovary Syndrome (PCOS), also known as polycystic ovarian syndrome, is caused by a disruption in androgen levels, it is most common in women of breeding age.

What causes PCOS related hair loss?

In polycystic ovary syndrome, a leading cause of pattern hair loss is excess androgen levels surge in the body. Androgens are naturally produced within the ovaries, adrenal gland, and fat cells in women. These androgens play a role in stimulating pubic and underarm excessive hair growth and regulating the loss of blood during menstrual periods.

In PCOS, cysts are formed in the ovaries that lead to a surge in the level of androgens in the body. The increase in the production of cytokines pushes more of the hair in the telogen stage, causing the derma papilla to deteriorate. The affected hair becomes thinner in diameter, shorter in length, and eventually stops growing at all.

Besides this, DHEA and DHT are two other hair loss-inducing hormones.

How does PCOS related hair loss start?

It usually starts at the frontal scalp midline in the shape of a triangle and progresses towards the sides and front of the scalp, resulting in diffuse hair loss. The frontal hairline is not affected, and it is one of the reasons why baldness is a rarity in women with alopecia areata.

Symptoms of PCOS hair loss

Some of the common signs indicating female hair loss are given below:

• Increased hair shedding

• Dry or damaged hair follicles (more prone to breakage)

• Visible scalp at the crown or hairline.

• Itchy/irritated scalp

• Dandruff and build upon the scalp

• Hair fall affects the sidewalls and frontal area of the scalp.

• Thinning hair at the parting area.

 Receding hairline above the temples.

On average, we shed about 100 to 150 strands of hair in a single day. A noticeable difference in hair loss is only observed when you've already lost 20-25% of total scalp hair.

It is essential to observe the excess hair loss during combing, the pattern of thinning hair, and the presence of other symptoms to pinpoint the reason for scalp hair loss in an individual.

How to know if it's excessive hair loss? Read our guide!

Alopecia is not an isolated cause of an increase in androgens hormone due to PCOS so it's beneficial to look out for other signs such as menstrual abnormalities and increased facial hair growth (hirsutism).

 

Is PCOS hair fall treatable?

Yes, hair fall resulting from PCOS can be overturned by treating the underlying condition and managing the imbalance of hormones. As the hair follicle remains alive in PCOS related hair loss, there's a chance of re-stimulating hair growth.

A combination of various drugs can be used by an endocrinologist or gynecologist to regulate the hormone.

Additionally, a person should adopt a healthier lifestyle, incorporate regular workouts, adhere to a diet with lesser carbs, and practice stress management. It is important to remember that an early diagnosis and intervention are critical in avoiding severe female pattern baldness.

How to tackle PCOS hair loss?

The various drugs used for hair loss are beneficial at successfully slowing down the progression of hair loss than reversing it. Managing androgen levels and stabilizing the disease are the primary steps to be taken while treating unwanted hair loss with PCOS.

Minoxidil

The topical application of minoxidil, in combination with drugs or as a stand-alone, has been used to treat various degrees of hair loss in women. In some studies, minoxidil has been shown to shrink the telogen (resting) phase and extend the anagen (growth) phase. The serum can help augment the shrunken follicles and increase the weight and volume of hair.

Although, it has to be used indefinitely to maintain the results achieved through its usage. The application and use of 5% minoxidil yields result in about 4-6 months with 40% of the users exhibiting remarkable improvement.

Spironolactone

This medication has been long used as a diuretic but was found to show some antiandrogenic effects. It works by blocking the androgen hormone receptors and also inhibits the production of androgens by the ovaries.

Spironolactone takes a minimum of 4-7 months to slow down the advancement of hair loss. Patients with hair loss depicting the female pattern along with acne and hirsutism, which is common in PCOS, respond better to spironolactone.

Finasteride

It works by reducing the conversion of testosterone to DHT which in turn stops the coaction of these receptors on the hair follicles with DHT, this results in a decrease in the intensity of hair shedding. It is usually recommended in combination with an oral contraceptive.

Several exploratory studies showed that dutasteride, another 5 alpha-reductase inhibitors, may prove beneficial for women who didn't see improvement in thinning hair by using Finasteride.

Note that, Finasteride, since it affects the entire body, might cause unwanted hair growth. Here are some alternatives you can consider.

Flutamide

It is a non-steroidal anti-androgen that inhibits the binding of testosterone to the nucleus of all testosterone-sensitive tissues in the body. It has been shown as an effective remedy for female pattern hair loss in hyperandrogenic women.

One case report showed that a patient who had not displayed an improvement with spironolactone and minoxidil benefited from treatment with flutamide. It has an early onset of about 3 months but should be used only in the most severe cases of pattern hair loss, as it can cause various side effects including but not limited to rarely fatal liver toxicity.

Multiple drug therapy

Spironolactone and 5 alpha-reductase inhibitors in combination with oral contraceptives have been used by many endocrinologists to increase the efficacy of these drugs against female and male hair loss. It helps treat complicated cases.

Metformin

PCOS results in insulin resistance and metformin has proven successful against dealing with metabolic effects of it. It has also shown some anti-androgenic activity. It could take about 6 months to a year to see results with this treatment.

Presently, there are not a lot of scientific studies supporting the use of these medications in female and male pattern hair loss.

Low-level light therapy

This treatment emits photons into the scalp tissues which are absorbed by the weak cells and encourage growth. Patients have observed an improvement in the weave and consistency of their hair, even when no regrowth was noted.

PRP

Platelet-rich plasma is a process in which plasma is collected from your blood by a hair transplant surgeon or dermatologist and then injected into the scalp. It contains several different growth factors that cause the proliferation of stem cells and stimulate new hair regrowth.

Microneedling

It is a non-abrasive procedure where thin sterilized needles prick the skin to increase collagen production in the concerned area of the scalp. Micro-needling is usually coupled with other hair growth-promoting topical treatments for enhanced drug delivery.

Hair transplant

This hair loss treatment includes the relocation of hair from the occipital to the affected areas on the scalp. Ideal candidates for this procedure are people with female pattern hair loss. They usually have dense hair in the donor site and suffer from hair thinning from the frontal scalp.

Hair supplements

Amino acids, zinc, iron, vitamin D, biotin and other micronutrients remains controversial in the treatment of androgenic alopecia. Other organic ingredients such as pumpkin seed oil have shown some anti-androgenic properties but its efficacy as a mono-therapy still needs more investigation.

Scandinavian Biolabs Hair Growth Routine

This product, developed with natural ingredients, strengthen the hair follicle cells and improve the natural balance of the scalp.

One of the key ingredients, Curcuma longa, has early evidence of being therapeutically beneficial for male pattern baldness and female hair loss.

It can cause the duration of the anagen phase to extend while simultaneously shortening the telogen phase of the hair. Another important component in these products is caffeine. In an in-vitro study, caffeine encourages hair follicles to grow hair.

This Hair Growth Routine also contains various moisturizing and protecting ingredients that play a vital role in maintaining scalp health.

When to see a specialist?

If you suspect that your hair loss is due to undiagnosed PCOS (see PCOS symptoms here) and it is affecting your mental health and negatively intervening in your daily life then contacting a gynecologist or endocrinologist is a good idea.

In one study, depression was observed in 55% of women suffering from hair loss but after treatment, 89% of women displayed an improvement in the symptoms of depression.

A specialist can help you identify the reason for your hair loss and suggest possible treatments to manage the condition.

Conclusion

Hair loss due to polycystic ovary syndrome can be a harrowing condition for most women, affecting both their mental and physical well-being. It is important to remember that an early diagnosis and an appropriate treatment plan targeting the hormonal imbalance can prove beneficial against androgenic alopecia and possibly reverse it.

Although many medications and remedies are available in curtailing and controlling hair loss, they have not earned approval by FDA for use in women's hair loss. Hopefully, more studies in the future will lead to advancement in the treatment options available to women suffering from this condition.

Always consult your doctor if you suffer from a severe hair loss condition. The underlying cause could be anything. The doctor can recommend medication according to it.

Citations

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