Do you find a lot of hair strands stuck to your brush in the morning? End up with a handful in your hand after shampooing? Despite all the hair care and beauty supplements you use, do you still lose hair the same?
What if this significant hair loss was due to Polycystic Ovary Syndrome ?
Alopecia is a very common symptom amongst women affected by PCOS.
In this article, I’ll explain in detail what it is, its link with PCOS, and most importantly, how to stay on top of this hair loss!
How Does Hair Grow?
To understand why we lose hair, it is important to understand how they grow!
Some basic data, first:
- Our hair contains between 100,000 and 150,000 hair strands;
- Our scalp is covered with 50,000 to 65,000 hair follicles from which groups of 1 to 4 hair strands grow;
- We naturally lose between 60 and 100 hair strands every day;
- Hair grows in cycles;
- Our hair follicles are programmed to go through 25 to 30 hair cycles of 3 to 5 years on average.
We should, therefore, have enough hair until the end of our lives. But if you are affected by PCOS, you already know it’s not that simple.
I’ll explain later how hormonal imbalance can impact this natural cycle.
The Hair Cycle
As you may have guessed, our hair grows in cycles. The follicle “makes” about 2 mm of hair per week during its growth phase. This phase is called the anagen phase and lasts an average of three years. Its duration will determine the maximum length hair strands can reach. At any given time, in a healthy subject, 90% of hair strands are in the anagen phase. This is why our scalp is covered with hair all the time.
The catagen phase follows suit. It is a resting phase where hair growth stops. It lasts between 2 and 3 weeks. Gradually, the cells of the follicle disappear. The hair follicle becomes twice as small, pushing the hair bulb to the surface of the scalp.
The last stage is the telogen phase, where the “dead” hair remains attached to the scalp for about three months until it falls out. As the cell destruction of the hair follicle continues, the bulb moves to the surface until the hair naturally falls out.
Once the hair falls out, the cycle restarts and a new follicle forms to begin a new cycle.
What is Alopecia?
Alopecia is defined as hair loss on the body. In some cases, it is the hair from the head that is most affected, often leading to aesthetic complexes in the affected individuals. There are different types of alopecia with varying causes. Here they are:
Androgenetic Alopecia
About 20% of women in general have this type of alopecia and, according to an INSERM study (1), 70% of them are women with PCOS. Androgenetic alopecia accounts for 80% of the causes of lasting hair loss. It is due to the action of androgen hormones and/or a genetic predisposition. While these hormones are present in smaller quantities than in men, they are often higher in cases of PCOS.
In women, this is observed as widespread hair loss over the top of the scalp and temples. Unlike male androgenetic alopecia (commonly called baldness), all the hair does not disappear from one area; it is generally thinning.
Causes of Androgenetic Alopecia
The main cause of androgenetic alopecia is an increased sensitivity of the scalp’s hair follicles. This area is indeed very sensitive to the action of androgen hormones. The culprit is a substance derived from testosterone, called DHT (dihydrotestosterone). This hormone reduces the size of scalp follicles and accelerates the rate of hair cycles. DHT impregnates the scalp and promotes this type of alopecia.
Over the years, due to the pace imposed by this hormone, hair becomes thinner, lighter, and falls out more easily.
We normally have between 20 to 25 hair growth cycles to last us a lifetime; with this hormonal imbalance, these cycles get exhausted in a few years.
It is worth noting that various contraceptive pills, hormone treatments, stress, and excess “bad” cholesterol may also promote female alopecia. (2)
It is the main cause of hair loss in cases of PCOS.
Telogen Effluvium
These are temporary diffuse hair losses, where up to 30% of the hair dies prematurely. They are not localized and are often linked to a specific event triggering the death of the hair. It usually takes three months from the beginning of follicle degradation to hair loss. The fall occurs three months past the triggering event. Common events include:
- Significant psychological shocks;
- Childbirth;
- Miscarriages and abortions;
- Major surgical operations with general anaesthesia;
- Stopping hormonal contraception;
- Nutritional deficiencies (particularly iron).
Durable Diffuse Hair Loss
Other factors can cause hair loss with random regrowth.
Here are some examples:
- Thyroid dysfunction;
- Nutritional deficiencies (iron, zinc, magnesium, B vitamins, or calcium);
- Extreme eating behaviour disorders (e.g., anorexia);
- Excess stress;
- Uncontrolled diabetes;
- Severe depression;
- Various medications;
- Chemotherapy or radiotherapy.
Traumatic Alopecia
There are two types: trichotillomania and cosmetic alopecia.
Trichotillomania is a behavioural disorder where the person pulls out their hair. While it is quite common in children, it can also occur at any age, more commonly in women. It is a psychological disorder that requires psychiatric care for best support.
Cosmetic alopecia is mostly due to poor hair care habits. Extensions, blow-drying, repeated straightening, but also dyeing, bleaching, and tight daily hair buns weaken the hair down to the root.
Alopecia Areata
This autoimmune disease affects 2% of the population. It manifests as sudden and significant hair or hair loss in patches. The most likely hypothesis is an autoimmune reaction that mistakenly attacks hair follicles.
What is the Link with PCOS?
When you have PCOS, you are often affected by a high level of androgen hormones. These “male” hormones, testosterone, Delta 4-androstenedione, or DHEA, are produced in excess. This is called hyperandrogenism. It can manifest as androgenetic alopecia, excessive body hair, and acne.
But what are the solutions to limit hair loss? Can this hair grow back? How to strengthen it? We’ll tell you everything!
A Difficult Symptom to Live With: Self-Image
One of our missions at Sova is to be there for you and listen to you, to help you feel less lonely while facing PCOS. The testimonials we receive every day show that alopecia is one of the most challenging symptoms for us. And for a good reason. This visible hair loss affects our identity and self-image. Many of us report a drop in self-esteem related to this hair loss.
Be sure to know that you are not alone and that solutions exist! <3
Which Healthcare Professionals For The Diagnosis of My Type of Alopecia?
If the cause of your alopecia has been left undiagnosed, it is important to go check with a healthcare professional.
An endocrinologist will carry out the necessary tests to understand if the cause is hormonal, such as related to PCOS, but also if it is thyroid-related or due to nutritional deficiencies, etc. Blood work for hormone levels is generally necessary.
A dermatologist will help you understand if it is related to a skin disease.
A psychologist will help if you suffer from trichotillomania. But this professional can also help you find peace of mind if alopecia is a source of stress or anxiety. The important thing is not to stay alone!
The following tips are mainly dedicated to androgenetic alopecia, the most common cause of hair loss with PCOS.
What Allopathic Treatments for Alopecia
Today’s allopathic medicine offers several treatments for women’s androgenetic alopecia. We have compiled the most common ones here so you can have a better idea.
This list is for information purposes only. Furthermore, some of them need a medical prescription. It is best to discuss them with your doctor or dermatologist to find the best solution for you.
Minoxidil
This molecule is used in dermatology for the treatment of androgenetic alopecia in both women and men. It has given its name to the treatment, which comes in the form of a cream to apply locally to the affected area. The effects usually take three months to appear.
Contraceptive Pill
The pill can be prescribed by your doctor to regulate the hormonal imbalance causing hyperandrogenism.
Spironolactone
This diuretic substance increases urine secretion. Spironolactone is commonly used for female hyperandrogenism. Scientific studies have shown that it can block the action of DHT (Dihydrotestosterone) on hair follicles located on the upper part of the scalp.
In the UK, specialists can prescribe it as a hormonal modulator.
Low-Level Laser Therapy
This method can be used in parallel with medical treatment against androgenetic alopecia. This technology uses a laser to stimulate the activity of hair follicles. It is based on the principle of photobiomodulation, similar to plant photosynthesis. The laser provides the necessary energy for hair follicles to regenerate. It increases blood flow to the scalp thereby promoting oxygenation.
The laser can be used for all types of alopecia and can be performed by dermatologists or in dedicated aesthetic centres.
Surgical Treatment
Sometimes a surgical hair transplant can be indicated. It is performed on people suffering from androgenetic alopecia, scarring, cosmetic (traction), or following trichotillomania. Depending on the extent of hair loss, the doctor will choose the number of hair follicles to implant. In women, a particular type of transplant does not require shaving the hair beforehand.
Natural Methods for Alopecia
Whether having a medical treatment for your alopecia or not, lifestyle tips and natural methods for alopecia can greatly improve the situation!
Reminder: The most common alopecia with PCOS is androgenetic alopecia! It will therefore be important to act on hyperandrogenism (the high level of male hormones) to limit symptoms such as alopecia. However, it is possible for your hair loss to also be related to other factors in addition to the PCOS-associated hyperandrogenism, such as vitamin or iron deficiencies, thyroid problems, etc. It is therefore very important to talk to your doctor and do a complete check-up to potentially identify other causal factors, in addition to your PCOS.
Diet
Diet has a major impact on hormonal balance.
70% of women with PCOS suffer from insulin resistance. If this is your case, there is something you need to know: insulin resistance can contribute to producing excess testosterone!
We have an article that allows you to go further on the subject: Insulin Resistance and PCOS: What’s the Link between them? Feel free to read it if you have insulin resistance!
In order not to worsen alopecia, it is important to favour a low glycemic index diet that will limit insulin production and break the vicious circle.
What is a low glycemic index diet and how to implement it? Everything is explained in our article: PCOS and Sugar Consumption!
Essential Micronutrients in Diet
Some foods should be favoured in cases of alopecia to strengthen the health of hair follicles, limit deficiencies, and hyperandrogenism.
- Animal or plant proteins;
- Sources of iron: liver (offals), fish, meat, seafood, legumes, nuts, whole grains, egg yolk, and leafy green vegetables are all full of iron.
- Sources of zinc: oysters, seafood, red meat, dark chocolate, sesame seeds, wheat germ, dried shiitake mushrooms, and pumpkin seeds.
- B vitamins: sources of vitamins B1, B2, B3, B5, B6, B9, and B12 are numerous. In summary, a varied, balanced, and organic diet will provide these essential vitamins!
- Info: jointly taking the contraceptive pill and consuming tobacco promote B vitamin deficiencies. In this case, the diet will not be sufficient to meet daily needs. A multivitamin supplement will then be suitable.
- Sources of magnesium: dark chocolate, seeds and nuts, legumes, seafood, fatty fish, dried fruits, green vegetables.
Favour an Anti-Inflammatory Diet
PCOS can be associated with a low-grade chronic inflammatory process. This inflammation reinforces mechanisms such as insulin resistance and hormonal imbalance.
To learn more about this subject, you can read our article: Inflammatory-Type PCOS - Explanations and Advice.
A Few Steps Can Make All the Difference!
- Curb consumption of
- stimulants such as coffee, alcohol, and tobacco;
- processed foods and favour homemade;
- refined sugars and prefer natural sugars (honey, agave syrup, maple syrup, rapadura sugar, etc.);
- red meat;
- gluten sources (from non-organic wheat, which is less digestible);
- Favour sources of "good fats" - Omega-3 fatty acids: small fatty fish, extra virgin oils (canola, olive, camelina, flax).
If you feel lost about the right diet to implement, don’t hesitate to seek support from a dietitian or a naturopath specialising in PCOS. You can also listen to our podcast on diet made with a naturopath!
The Importance of a Good Hair Care Routine
Let’s hunt down endocrine disruptors!
You know, these are the substances that can interact with or mimic the hormones in our body. Unfortunately, they are found in many cosmetic products if we don’t pay enough attention to the list of ingredients. They can promote hyperandrogenism and the alopecia process over time.
Here is a non-exhaustive list of these harmful molecules when it comes to hormonal balance:
- 4-Methylbenzylidene Camphor;
- Benzophenone;
- BHA;
- Butylphenyl methylpropional;
- Cyclopentasiloxane;
- Diethyl Phthalate;
- Ethylhexyl Methoxycinnamate;
- Nonylphenol;
- Oxybenzone;
- Parabens;
- Phenoxyethanol;
- Resorcinol;
- Triclosan.
If reading labels becomes a bit too challenging for you, you can use apps like Yuka and INCI Beauty. They analyse scanned products for you and give you a score based on the product’s ingredients. An essential app for your smartphone!
Choose Your Hair Care Products Wisely
Pamper yourself with a hair care routine adapted to hair loss. The first step is shampoo. Don’t hesitate to choose those designed for hair loss that will have a targeted action on strengthening hair bulbs. Choose organic ones with the cleanest ingredient list possible.
Alopecia makes the hair thinner. It is, therefore, important to also treat the hair length to preserve them and add density. To achieve this, choose a conditioner or mask adapted to your hair type, whether it is thin, curly, or frizzy; they have different needs!
Women with PCOS often have wavy to curly hair! You can rely on La Belle Boucle's eShop to guide you towards an adapted routine with a healthy ingredient list!
Scalp Massage
Both pleasant and useful, it stimulates blood circulation and cell oxygenation of the scalp. It will improve hair follicle health and reduce hair loss. Take the time to gently massage your scalp with each shampoo.
A Serum For Hair Loss
Using a serum to strengthen follicles will allow you to see great results after a few weeks. Some active ingredients such as nettle, red clover, pea sprout extract, or spirulina have proven effective in fighting alopecia! Use once or twice a day, for several weeks, with a gentle massage that will oxygenate the scalp while providing the necessary ingredients for its health.
At SOVA, we have created a serum for DHT-related hair loss!
Be Careful with Care that Damages Hair!
Straightening, blow-drying, dyeing, bleaching, and regular tight hairstyles should be avoided as much as possible. They will thin, weaken, and dry out the hair, which should be avoided if you want to improve alopecia. If you are a fan of dyes, prefer plant-based dyes that tend to protect the hair in addition to reviving their colour!
Be Careful with Hats and Caps
If you are tempted to hide your hair loss with a headcover, know that it won’t help! In fact, it will prevent the scalp from getting oxygen and enjoying sunlight, essential for hair health… So avoid overusing caps/hats when not necessary!
Find Peace: The Link Between Stress and Alopecia
Androgenetic alopecia can both be challenging for a woman and lead to psychological issues such as low self-esteem, anxiety, or even depression. It is therefore important to also take care of your mental health since PCOS also affects your well-being.
First, know that you are not alone in experiencing this very common symptom with PCOS. The actions you can take will help improve the situation.
It can all turn into a vicious circle though as stress triggers the production of cortisol. This hormone, if excessively produced, will promote chronic inflammation, hormonal imbalance, and demineralization. So what should we do? Pamper ourselves!
Do You Feel Stressed or Anxious? The Right Reflexes:
- Take time to breathe with cardiac coherence via the Respirelax app.
- Use soothing dietary supplements like Serenity Booster.
- Strengthen your Magnesium Bisglycinate intake as magnesium levels tend to be deficient in cases of high cortisol production.
- Inhale or massage with soothing essential oils like Sweet Orange or True Lavender, but make sure they’re diluted in a vegetable oil.
Do check for contraindications or ask for advice from a professional before using an essential oil.
Dietary Supplements Against Alopecia
Multivitamins and mineral
These are mixtures of vitamins and plenty of minerals (zinc, iron, magnesium, vitamins C, B) that allow you to replenish deficiencies which promote hair loss. Many labs market these. Find the one that suits you best.
Herbal Medicine Against Alopecia
Spirulina
- This blue microalga is highly remineralizing and allows good hair follicle oxygenation. It is protein-rich and promotes the synthesis of keratin, your hair’s cement. It is also a good antioxidant which will strengthen the health of hair cells. You can choose it organic and of local culture for optimal quality!
Furocoumarin-free Grapefruit Essential Oil
- Use it diluted in a shampoo to stimulate hair growth and tone hair follicles.
- Caution: Choose an organic one and do not use it on children or in the first three months of pregnancy.
Castor Oil
- It nourishes and stimulates hair growth. This viscous-textured oil should be mixed with other vegetable oils to facilitate its use (jojoba oil, argan oil, or sweet almond oil, for example). Apply it while massaging with your finger tips for a few minutes and leave it on for at least an hour, then rinse with an appropriate shampoo.
- Precaution: Do not ingest castor oil, which is toxic when drunk, especially for children and pregnant or breastfeeding women.
Don't Lose Hope!
Androgenetic alopecia in PCOS requires a holistic approach to lifestyle and local care with appropriate treatments. Many things exist to improve hyperandrogenism and thus reduce alopecia. We are often asked if hair can grow back and the answer is yes! Keep the faith and stay motivated as an appropriate and tailored routine will allow you to regain beautiful hair over time.
