Before I explain Telogen Effluvium, we need to differentiate between the two major causes of hair falling out in women.
- 1) Genetic – Typically a slow gradual progression of hair loss over time in which most patients don’t see a significant amount of shedding. They notice most of the thinning in the frontal area. The back of the hair looks pretty good. This occurs in a variety of different women and a variety of patterns. Mostly, it is the thinning in the front. They usually retain the frontal hair line.
- 2) Shedding Type of Hair Loss – This is a distressing type of hair loss which is called telogen effluvium. This is the type of hair loss that comes out in globs.
There are many different reasons for a shedding type of hair loss.
Update: April 19,2011: Dr. Mejia references Telogen Effluvium and understanding of hair loss treatment options after watching Fox News TV segment on hair loss
First of all, you need to understand some of the stages of hair loss to understand the cycle. Generally speaking, 90% of our hairs are in a growth phase. 10% are in a resting or shedding phase. These hairs that are in the resting phase are called the telogen hairs which shed over a three month period. Typically in that stage, 10% of your hairs constitute between 100-150 hairs that are shed per day. Normally we have about 100,000 hairs on our scalp, so an average type of hair loss is between 100-150 hairs per day.
When women start complaining that their hair is falling out like crazy and thereare tons of strands on the floor and they bring bags of the hair to my office, this is a significant amount of hair loss. What happens is that the hairs that are in the growth phase get shifted into telogen and you get a much higher proportion than normal of hairs in telogen than the anogen, or the growth phase.
The growth phase typically lasts two to five years and usually grows about a centimeter a month. After it grows two to five years, it then enters into this resting phase. Now all of a sudden, if we have an event, and there’s a shift into telogen, you’ll notice a significant amount of hair loss three months after that event.
So what is the event that we are talking about? There are many different causes for these events to cause telogen effluvium or shedding. When patients come in and say to me, “ I woke up today and my hair is shedding like crazy,” I have to ask them what happened three months ago because that is typically the cause of the hair loss today. Some of the responses patients give me are: “I was fasting for weight loss or I was sick and hospitalized.” Many of these events in our body play havoc with our hair loss, but unfortunately with a three month delay cycle.
Stress due to job loss, divorce, infections, fevers, hospitalizations, medications, new drugs or new pills are also factors for hair loss in women and cause a delayed telogen effluvium.
If you have recenlty been put on an iron medication or even blood loss as for heavy menstruation, you may experience some shock hair loss a little bit later. Chronically, this could lead to iron deficiency anemia or low values in ferritin and we typically recommend that the iron level be checked in a CBC blood test.
Additionally, there are a variety of medications that have been known to be associated with hair loss, beta blockers for the heart or some cholesterol lowering medications. So when we think of hair loss in women or especially the shedding type of hair loss which can also occur in men, we usually have to go three months earlier. It’s like doing a little detective work to figure out what factors were involved to cause the hair loss and therefore out bodies start to show the signs of that three months later.
What can we do today? Sometimes the answer is time and patience. That hair will regrow, but it might take a while to grow back because hair grows slowly about a centimeter per month. Sometimes Rogaine can stimulate new hairs. It can stimulate growth in the antigen phase. But once you start Rogaine, it is a continual process to help the hairs especially if you have a genetic or female pattern type of hair loss.
Another probably cause of hair loss in women is hair breakage and in today’s society there are many chemicals and treatments added to the hair which can cause fragility and fracture of the hair. When you comb your hair and see that there is no bulb or root, then it is more likely it is hair breakage. In that case, then it requires more gentle care with your hair.
Hopfully this has helped you to understand the different causes of hair loss in women . In most cases it will get better on its own with some patience to allow those hairs to grow.