What is female pattern hair loss?
Female pattern hair loss is diffuse thinning over the crown. It resembles the female counterpart of androgenetic alopecia in men and is very common around and after the menopause. About half of menopausal women are affected to some degree. Hair loss can cause considerable emotional distress and sometimes depressive feelings.
What does it look like?
Hair density decreases across a broad area of the crown rather than forming a sharply defined bald patch. The frontal hairline usually remains largely intact and complete baldness is very unusual, even in advanced disease. Truly bare patches suggest that another form of hair loss should also be considered.
Cause and course
The role of hormones is less clear than in male-pattern loss. Most affected women have normal blood androgen levels, although the strong association with menopause suggests that reduced oestrogen or altered follicle sensitivity may contribute. Some women develop symptoms earlier. Progress is difficult to predict: shedding may intensify in episodes and then remain stable for long periods.
Assessment and treatment
Depending on the presentation, a doctor may check thyroid function, haemoglobin and iron. Androgens are usually investigated only when signs such as acne or increased body hair suggest an excess; hormonal abnormalities are rare. Treatment is challenging and major regrowth is uncommon. Topical minoxidil can improve density in some people, with 5% generally more effective than 2%. Benefit is maintained only with long-term use. Hormone-modifying medicines require specialist consideration and are not routinely suitable for every woman. A wig or hairpiece can offer a practical cosmetic option when thinning is extensive.
When to see a doctor
Seek assessment for new or distressing thinning, rapid worsening, a receding frontal hairline or distinct bald patches. Review is also appropriate when hair loss accompanies fatigue, acne or increased body hair. A clinician can look for other causes, discuss realistic treatment expectations and address the emotional effect of the condition.