Female Hair Loss

Female pattern hair loss is the most common type of hair loss.

Early treatment will help you to prevent further hair loss and regain your hair.

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How Common Is Female Hair Loss?

Female hair loss is more common than we imagine. As many as 50% of women will experience some degree of hair loss in their life time. Female hair loss is more widely encountered with advancing age, and this rate increases significantly after menopause. The importance of a woman’s hair cannot be underestimated. Quality of life studies have shown that women with hair loss have reported lower self-esteem, negative body image and impaired functioning at school, work and relationships.  Nowadays, many younger women are seeking earlier treatments to combat female hair loss.

Common Types of Female Hair Loss

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Female Patter Hair Loss

Female Pattern Hair Loss

Female pattern hair loss is also known an female androgenetic alopecia, and is the most common cause of hair loss in females. In contrast to male androgenetic alopecia, the role of androgens (male hormones) in female pattern hair loss does not appear to play a role. Many women may complain of seeing more scalp when they part their hair or notice the volume of hair being half of what is used to be when they tie it up. 

Female pattern hair loss is characterised by a reduced density of hair at the central portion and temporal portions of the scalp. The hair gets thinner due to the presence of more immature (vellus) hairs due to hair follicle miniaturization. 

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Telogen Effluvium

Telogen Effluvium

In telogium effluvium, there is early shedding of the hair as the growth (anagen) phase of the hair is shortened. It does not cause complete baldness or hair thinning. In this condition, women may notice an increase in hair shedding after a shock to the system, such as childbirth, illness, accidents or even weight loss. However, there is no specific trigger in the majority of cases. Telogen effluvium can be acute or chronic in nature. The condition may lasts for several months to years, but will self-correct in the majority of cases.

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Alopecia Areata

Alopecia Areata

Alopecia areata is quite unlike the above 2 conditions. A single or multiple patches of hair loss may appear at rather sudden onset. It is believed to be autoimmune in origin, and may be associated with thyroid disease, vitiligo and stressful events. Most cases of alopecia areata are able to recover without any treatments. However, medical treatments are available for more stubborn cases. 

Diagnosis of Female Hair Loss

During the initial consultation, the doctor will ask you questions in relation to how long you have noticed your hair loss, whether you are on any medications, and whether there is a history of hair loss in the family. An examination of the scalp to look for the pattern and distribution of the hair loss will allow us to determine the diagnosis in most cases.

A blood tests to check for underlying factors that may cause the loss of hair may be carried out. We normally tests for thyroid status, iron levels, Vitamin B12, Vitamin D and folate levels. A biopsy may be done in rarer cases of hair loss to help establish the diagnosis.

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Hair loss can affect females from the reproductive years onwards

Female Pattern Hair Loss Treatment:

This section discusses about female pattern hair loss treatments as it is the most common cause of hair loss. To date, only topical minoxidil is an approved treatment, while the others are considered off-label treatments. 

Topical treatment

  • Minoxidil: Minoxidil is the only FDA approved medication for female pattern hair loss. Although the exact mechanisms are unknown, it stimulates hair regrowth by increasing the anagen phase of the growth cycle and increases blood flow around the follicle. It comes in the spray, lotion or foam formulations, with differing concentrations (2 or 5%).  It is common for Minoxidil to cause an initial increase of hair shedding during the first few weeks of treatment. Common side effects include scalp itchiness, dandruff and facial hair growth (mostly at the forehead). You are advised not to use minoxidil if you are pregnant or breastfeeding.
  • Ketoconazole shampoo: Ketoconazole works by reducing inflammation and is anti-androgenic. It is especially useful if you have dandruff or seborrhoeic dermatitis at the same time. 
  • Protaglandin analogues: Latanoprost and bimatropost were developed for glaucoma, an eye condition. They work by prolonging the anagen phase of the hair cycle. Solid evidence for their use is lacking.

Oral treatment

  • Spironolactone: This is the most common off-label oral treatment for female pattern hair loss. Spironolactone exerts an anti-androgen effect. Common side effects include giddiness, breast pain and menstrual irregularities. It cannot be taken if you are pregnant or breastfeeding. 
  • Cyproterone acetate: Cyproterone acetate works by blocking the androgen receptors. However, there is insufficient evidence for widespread use for female pattern hair loss.
  • Finasteride & Dutasteride: Both are not FDA-approved for female pattern hair loss treatment. It cannot be used when pregnant, as it feminises the male foetus. It should not be used in females with a history of breast cancer because it may increase oestrogen levels.
  • Minoxidil: While topical minoxidil is approved for female pattern hair loss, the oral form is not commonly used due to its side effects.  These include postural hypotension, fluid rentention and excessive hair growth on other parts of the body.

Nutritional supplements:

  • Biotin, Zinc and amino acids: Although widely available, the benefits for female pattern hair loss is controversial.
  • Iron and Vitamin D: Individuals with iron and Vitamin D deficiency should have these micronutrients replaced to facilitate hair growth.
  • Viviscal Professional is a 100% drug free hair growth supplement that nourishes thinning hair and promotes hair growth. The Viviscal Professional formula consists of the proprietary AminoMar C marine complex plus a combination of essential nutrients. It may have anti-inflammatory and anti-androgenic properties.

Procedural Treatments:

  • Laser & light therapy: There are several devices on the market that uses low level laser light energy as a treatment for female pattern hair loss. They may take the shape of a helmet, hair-band or even a comb. They are generally safe, and can complement existing medical treatments.
  • Microneedling: Fine needles are used to puncture the skin. Topical therapies such as minoxidil and finasteride may be introduced via these micro-channels to promote hair growth. While initial results are promising, more robust studies are needed.
  • Hair transplantation: Hair transplantation involves the transfer of hair from the back of the scalp to the bald areas. The success of treatment depends on the donor site and the pattern of hair loss. Ideal selection of patients is important to achieve a good result.

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  • Cash TF. The psychosocial consequences of androgenetic alopecia: a review of the research literature. Br J Dermatol. 1999;141:398-405.
  • Levy LL, Emer JJ. Female pattern alopecia: current perspectives. Int J Women’s Health. 2013;5:541-556.