Low estrogen levels are most common during menopause, but it can happen to women at any age. As estrogen levels decline, the greater influence of testosterone shortens the growth phase, and the subsequent hair loss is usually gradual but can become noticeable over time. Hair loss caused by changing estrogen levels tends to be visible all over the scalp or evident in a widening part, rather than missing patches of hair or a horseshoe pattern as with male pattern baldness.
While female hair loss may not cause physical pain, it does cause mental anguish. Fortunately, in many cases, female hair loss can be successfully treated with today’s advanced nonsurgical and surgical treatment options. After a diagnosis has been confirmed, Dr. Yaker will create a customized treatment plan depending on one’s hair characteristics, the level of hair loss and the aesthetic goals of the patient.
Topic prostaglandin analogues are used for the treatment of glaucoma. Uniocular increase in length, thickness, and pigmentation of the lashes were described by Johnstone in 1997 by patients using latanoprost in one eye. There are reports of a response of alopecia of eyelashes to cutaneously administered latanoprost,[185,186] though others report limited success. Eyelash growth has also been reported following bimatoprost 0.03% topically to the base of the eyelashes in healthy individuals[188–190] and in individuals with alopecia areata. Bimatoprost ophthalmic solution 0.03% is the only Food and drug administration (FDA)-approved product to safely and effectively enhance the growth of a patient's own eyelashes.[192,193]
Giorgos Tsetis: There are really two industries at work here that have to be separated. First, there's the drugs, the pharma, which is the FDA world. Then, you have the naturals, the formulas, and the actual supplements industry. The supplement industry is really not properly regulated in this country. More surprisingly, starting a supplement company is very easy. That's why you see all of these supplements popping up, and the FDA doesn't even have the capacity to monitor them all and make sure people are able to substantiate proper claims. As a supplement manufacturer, all you have to do is create your products in a FDA approved facility, and there thousands of them in the United States. That means anyone can put a formula together and get away with claims until they get challenged by consumers or competitors. When you step into these factories, you see it's messy. You're not talking about state-of-the-art factories where people are doing the work. It's really scary.
The photo included here shows an example of one condition which could affect the eyebrows, eyelashes, facial hair and pubic hair. This is a type of thinning hair found in women that are regularly seen at Sussex Trichology in West Sussex. These symptoms obviously cause the sufferer much distress as the appearance has dramatically altered the hairline since the eyebrows define the face. Shuna Hammocks, our Consultant Trichologist, is able to diagnose your condition and discuss it at length and then design a treatment plan for you. It may be suggested that you attend the clinic for hair treatments which involve a combination of creams, steam and massage.
In an article on menopause, the University of Maryland Medical Center states, “Estrogen loss can contribute to slackness and dryness in the skin and wrinkles. Many women experience thinning of their hair and some have temporary hair loss.” Meanwhile, this study reports, “It has long been known that estrogens also profoundly alter hair follicle growth … the time has come to pay estrogen-mediated signaling the full attention it deserves in future endocrinological therapy of common hair growth disorders.”
Alopecia areata is a patchy hair loss associated with immune disturbances. In this condition the immune system attacks the hair follicles thereby impairing hair growth. It is more likely to occur in people with other immune-related disorders and has also been linked to psychological stress as well as with certain drugs like some types of ARVs used for HIV treatment. Alopecia areata does not only affect the scalp as commonly thought. The eyebrows and beard area, as well as hairy parts anywhere on the body may be affected.
Lichen planopilaris and frontal fibrosing alopecia inflammatory conditions, in which the inflammation destroys the hair follicle, can cause a scar or permanent hair loss (usually present as red patches with redness and scale around each hair follicle). In the very advanced stages, they may appear as smooth, bald patches where the hair follicles have been destroyed. Androgenetic hair loss is another non-scarring type. The most common type of hair loss, it is due to the complex interplay of genes, hormones, and age.
Eyebrow loss, also known as superciliary madarosis, can occur with a variety of medical conditions. Madarosis can affect one or both eyebrows with partial or complete hair loss. Infections, chronic skin disorders, hormone disturbances, autoimmune diseases and medications are among the many medical reasons for eyebrow loss. In most cases, identification and treatment of the underlying condition leads to regrowth of the eyebrows. Permanent eyebrow loss can occur with disorders that permanently damage the hair follicles.
Toxic alopecia occurs when there is a disruption of hair growth in the anagen phase. This usually occurs following chemotherapy and radiotherapy. Radiotherapy for various types of ocular tumors, eyelid and choroidal tumors have been reported to produce madarosis.[95–97] Hair loss due to radiation is usually reversible, but may be permanent when the dose of radiation is in the range of 50 to 60 Gy.
Inflammation can play into thyroid related hair loss as can increased oxidative stress when the cause of the low thyroid is Hashimoto’s or autoimmunity. Immune activation in Hashimoto’s increases both of these additional causes of hair loss. As well it’s not uncommon to have multiple nutrient deficiencies when you have a low thyroid ranging from iron to B12 to a host of minerals including zinc and selenium.
Insulin regulation is also a big factor in hair health, as an imbalance can lead to various hormonal effects. Insulin helps to regulate blood sugar levels, which effects fat storage and hormone balance. Fat storage and hormone balance play a role in hair growth because fat storages will secrete excess estrogen in the body, and can desensitize hormone signals.
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Blepharitis is a chronic primary eyelid inflammation. It is fairly common in occurrence and being a condition with remissions and relapses, results in a decreased quality of life if adequate measures are not taken. Chronic blepharitis is the most common condition associated with madarosis. Though there are various ways of classifying blepharitis, the most useful is the one proposed by Wilhelm, wherein blepharitis can be classified based on whether there is a predominant involvement of the part of the eyelid anterior to the gray line (anterior blepharitis), or posterior to the gray line (posterior blepharitis). The gray line is an imaginary line dividing the eyelid into an anterior part consisting of the skin and muscle, and a posterior part consisting of the tarsus and conjunctiva.
Trichotillomania is a hair pulling disorder associated with anxiety, stress, depression, boredom and frustration. It is where a person manually removes hairs with their finger, either a few strands throughout the day or sometimes many strands at one time during an emotional outburst. This behavior is usually a means of coping with stress or emotional turmoil. However, it can sometimes become a habit that is difficult to break. The eyebrows is a commonly targeted area as is the scalp.
The real culprit appears to be dihydrotestosterone (DHT), a more potent form of testosterone. DHT is made from testosterone by a specific enzyme in the body, and while both testosterone and DHT are known to have a weakening effect on hair follicles, there appears to be something unique about the conversion process of testosterone to DHT that relates to thinning hair. This is why some drugs that are marketed for hair loss block the conversion of testosterone to DHT. (It’s important to note, however, that these drugs tend to be less effective in women than men, and that one of them—finasteride—is only approved for hormonal hair loss in men, not women. What’s more, the drug has been associated with increased risk of sexual side effects, depression, nausea, hot flashes, and increased estrogen levels—and too much estrogen is its own risk factor for thinning hair; more on that below.)
Optimal levels of estrogen help to grow full thick hair, while low estrogen levels lead to thin and stalled hair growth, which eventually leads to hair loss. Through the years, a women will go through various cycles of highs and lows in estrogen levels. Puberty is typically associated with high estrogen levels as a woman starts to cycle through menstruation. Pregnancy typically increases hormone production, but once the baby has been delivered the mother can experience a drop in estrogen levels, which can result in thinning and loss of hair. Typically, this corrects itself as the woman's body heals and hormonal regulation returns to normal. The largest decline in estrogen levels is during menopause. Estrogen is secreted through the ovaries and adrenal glands. When a woman hits menopause, the ovaries’ estrogen production is significantly diminished, which puts an excess burden on the adrenals to produce it. However, as the adrenals are typically overburdened due to stress, symptoms of menopauses like hair loss and hot flashes occur prematurely and excessively for some. Nourishing the body and balancing stress levels will support gentle and graceful transitions.
Balancing your hormones is not an easy process, whether you are in perimenopause, menopause, or post-menopause. You may find that just one of these herbs is sufficient to do the trick, but in many cases you will achieve the best results by taking a combination of herbs. Start gradually and track your results carefully to make sure you are choosing the right products to balance and adjust your particular hormone profile.
Telogen effluvium is a condition where a large number of hair follicles enter the resting phase known as telogen. As these hairs may fall off, it is not replaced with new hair at the same area and this leads to a bald patch on the eyebrows. A number of hormonal factors (like with hypothyroidism and pregnancy) may be responsible and it is also related to certain diseases, nutritional deficiencies, chronic medication use and even metal toxicity. It is now also known that stress can push many more hair follicles than normal into this phase.
The normal cycle of hair growth lasts for 2 to 6 years. Each hair grows approximately 1 centimeter (less than half an inch) per month during this phase. About 90 percent of the hair on your scalp is growing at any one time. About 10 percent of the hair on your scalp, at any one time, is in a resting phase. After 2 to 3 months, the resting hair falls out and new hair starts to grow in its place.
*Photograph used with permission of the Journal of the American Academy of Dermatology. This photograph was published in the Journal of the American Academy of Dermatology, Vol. # 60, Gathers RC, Jankowski M, Eide M, et al. “Hair grooming practices and central centrifugal cicatricial alopecia,” 660-8. Copyright Elsevier (2009). Journal of the American Academy of Dermatology.
Eight of 69 eyes receiving intra-arterial chemotherapy with melphalan for retinoblastoma were found to develop a cutaneous periocular erythema with partial loss of eyelashes. Gobin et al. also reported a 12.6% incidence of madarosis following intra-arterial chemotherapy for retinoblastoma. Moti and Fausel described a case of cyclical alopecia areata including the eyebrows and eyelashes after treatment with paclitaxel and carboplatin. Other drugs which have been implicated in hair loss due to anagen effluvium are adriamycin, cyclophosphamide, daunorubicin, epirubicin, etoposide, ifosfamide, irinotecan, topotecan, vindesine, and vinorelbine.[98,113]
The term superciliary madarosis is often used describe abnormal eyebrows and eyelash hair loss which can be partial or total. Depending on the cause, the can be weird since besides the hair breaking and falling out easily, some people may end up with a part, half, inner, outer third or one on or both eyebrow missing. In fact, thinning at ends is common.
While these factors contribute to hair loss for any woman, it’s particularly dicey for those of us with PCOS because when the follicle is exposed to our elevated androgens such as DHT (di-hydro testosterone, an active metabolite of testosterone) it gets damaged. Whenever a cell is damaged it generates oxidative stress which further alters the androgen receptor in the follicle perpetuating the issue.