PCOS hair loss: what is happening, and what a doctor can do

How PCOS affects your hair

Polycystic ovary syndrome (PCOS) is a common hormonal condition, affecting about 5 to 10 per cent of women of reproductive age. Its skin and hair signs include acne, extra facial or body hair, dark velvety patches of skin, and thinning of the scalp hair. Higher androgen (so-called male hormone) activity and insulin resistance are both thought to play a part.

The thinning usually follows a female pattern: the parting widens and the top of the head looks less full, while the front hairline tends to stay in place. Doctors call this female pattern hair loss, or androgenetic alopecia.

One finding surprises many people. Female pattern hair loss is more common in women with PCOS, yet many women with it have normal androgen blood tests. A normal report does not rule out pattern thinning, and an abnormal one does not explain everything on its own.

Pattern thinning or shedding: two different problems

Losing about 50 to 100 hairs a day is normal. Shedding, which doctors call telogen effluvium, is a rise above that, with hair falling from all over the scalp. It often follows a trigger such as illness, childbirth, major weight loss, stopping the pill or a stressful period, and usually settles within six to nine months once the trigger has passed.

Pattern thinning is slower. Each hair grows back a little finer and shorter than the one before, so the parting widens over months and years. With PCOS you can have both at once: a slow pattern change underneath, and a burst of shedding on top after a stressful time or a change in weight. Telling them apart matters, because they are treated differently.

• Shedding: Many hairs on the pillow, in the shower and on the comb, falling from all over the scalp, often a few months after a trigger.
• Pattern thinning: A wider parting or a see-through crown, with finer hairs in that area. It changes slowly and tends to continue without treatment.
• Both together: Common in PCOS. A doctor can look at the scalp under magnification (trichoscopy) to see which is present.

Tests a doctor may order

There is no single test for PCOS hair loss. Your doctor starts with your history: periods, weight changes, acne, facial hair, recent illness or stress, diet, medicines and family history. They then examine your scalp, often with a dermatoscope, to see the pattern and the size of the hairs.

Blood tests are chosen for you rather than taken from a fixed list. In general they may include:

• Hormones: Tests that look at androgen levels and other hormones linked to PCOS, timed to your cycle where needed.
• Thyroid: Thyroid problems can cause hair fall and are worth checking alongside PCOS.
• Iron and vitamins: Iron stores (ferritin), and sometimes vitamin D or B12, so that any deficiency can be corrected.
• Blood sugar: Markers of insulin resistance, which is common in PCOS and matters for your general health as well as your hair.

Treatments a doctor may consider

Treatment is planned around you: how much thinning there is, your other PCOS symptoms, and whether you are trying for a pregnancy now or soon. Pregnancy plans come early in the conversation, because several hair medicines are not suitable in pregnancy. Care often involves a gynaecologist or endocrinologist as well as the doctor treating your hair.

• Topical minoxidil: A lotion or foam applied to the scalp. It is an established first treatment for female pattern hair loss, and trials in women show more hair growth than with a placebo. It is avoided in pregnancy and breastfeeding.
• Anti-androgen medicine: Spironolactone is a prescription medicine that blocks some androgen effects. Reviews of hair loss in PCOS describe it as a common option for female pattern hair loss, alone or with minoxidil. It needs monitoring and is avoided in pregnancy, so your doctor decides whether it suits you.
• Hormonal treatment: Some women are offered the combined pill or another hormonal treatment for PCOS as a whole, usually with their gynaecologist. Your doctor explains how this fits with any hair treatment.
• Insulin resistance: Where it is present, your doctor may discuss weight, activity, diet or medicines that target it. This supports your general health; any effect on hair is slower and less certain.
• PRP or GFC: Scalp injections prepared from your own blood. In PCOS-related thinning the evidence is limited, so they are at most an add-on to medical treatment for some people, not a first step.

How long it takes

Hair grows slowly, and pattern hair loss responds slowly. Trials of minoxidil measure change over roughly 16 to 48 weeks, so it is fair to give a treatment at least six months before judging it, and a year gives a clearer picture. With minoxidil, extra shedding in the first two months is common and usually settles.

Treatment works only while you continue it. Pattern hair loss is long term, so the aim is to slow it, hold what you have and regrow what can be regrown. When minoxidil is stopped, the hair it was supporting is usually shed within three to four months.

What you can do now

At Clinic Eximus, the first visit is about finding the cause before choosing a treatment. You can make that visit more useful, and protect your hair in the meantime, with a few simple steps.

• Take a photo of your parting in the same light once a month, and note your periods and any big changes in health, weight or medicines.
• Avoid crash diets. Rapid weight loss is a known trigger for shedding, on top of any pattern thinning.
• Be gentle with your hair while it is shedding: loosen tight ponytails and buns, and pause harsh chemical treatments.
• Bring previous blood reports and a list of every medicine and supplement you take.
• Be cautious about anyone who offers injections or a package before checking your hormones, iron and thyroid.

Hair fall treatment for women