“My hair is coming out in handfuls.” “My plait is half as thick as it was.” “I can see my scalp under the bathroom light.” These are among the most common things women tell us, and the worry is real: for many women, hair is closely tied to how they feel about themselves.
The good news is that most hair fall in women has a cause that can be found, and much of it settles or improves once that cause is treated. The key is working out which kind of hair fall it is, because the seven causes below need quite different things.
First: shedding, thinning or both?
Every hair grows for a few years, rests for a few months and then falls out, and a new hair grows from the same root. So losing 50 to 100 hairs a day is normal, more on wash days or when you comb out long hair.
Dermatologists separate two patterns:
- Shedding: many hairs fall at once, all over the head, usually two to three months after a trigger. The roots are fine, so the hair grows back.
- Thinning: the hairs themselves gradually become finer and fewer, most often over the top of the head, so the parting widens. This does not settle on its own.
Many women have both at the same time, for example shedding after a fever on top of early pattern thinning. That is one reason a proper examination helps.
The 7 common causes
1. After childbirth
Pregnancy holds more hairs in the growing phase, so many women notice thicker hair. After delivery, those hairs move into the resting phase together and then fall. Shedding usually starts about two months after delivery and peaks around four months. It is alarming, but it is normal and temporary: for most women, hair returns to its usual fullness within six to nine months.
What helps: eating well, checking iron if you lost blood at delivery or feel tired, gentle hair care, and patience. If shedding is still heavy after a year, see a dermatologist to look for a second cause.
2. Low iron
Low iron stores are one of the most common findings in women with hair fall. Heavy periods, pregnancy, breastfeeding, a vegetarian diet with little iron, frequent fasting and some stomach problems all lower iron. Your ferritin (iron stores) can be low before your haemoglobin falls, so a “normal” blood count does not rule it out.
What helps: a blood test first, then iron through food and, if needed, tablets for a set time, with a re-test. Finding why iron is low matters too; heavy periods, for instance, may need your gynaecologist.
3. Thyroid problems
Both an underactive and an overactive thyroid can cause diffuse hair fall, often with tiredness, weight change, dry skin or changes in periods. Thyroid problems are common in women, and they are easy to test for.
What helps: treating the thyroid with your physician. Hair usually improves over the following months once levels are steady.
4. PCOS
In polycystic ovary syndrome, higher androgen (“male hormone”) activity can thin the hair on the scalp while increasing hair on the face and body. Irregular periods, acne on the jaw and chin, or extra facial hair alongside thinning are clues worth mentioning to your doctor.
What helps: managing PCOS itself (with your gynaecologist or endocrinologist), plus scalp treatment for the thinning. Our post on adult acne in women and our guide to laser hair removal for PCOS facial hair cover the skin side of PCOS.
5. Female pattern thinning
Female pattern hair loss is the most common cause of long-term thinning in women. It often runs in the family and becomes more common around and after menopause, but it can start in the twenties. Unlike men, women usually keep their front hairline; instead the parting widens, the top looks see-through and the ponytail gets thinner. It is gradual and does not go away on its own.
What helps: treatment started early, while the roots are still active, and continued. Minoxidil lotion or foam is the most widely recommended first step. Some women notice extra shedding in the first two to eight weeks, and it takes six to twelve months of regular use to judge the result. For some women, a dermatologist may add a prescription tablet, such as spironolactone, after a check of your health and medicines; these tablets are not used in pregnancy or when planning one. In-clinic options such as PRP for hair can be added to the plan; our post on PRP vs GFC vs exosomes explains what the evidence shows for each.
6. Illness, fever, stress and crash diets
A high fever, dengue, typhoid, COVID, surgery, a crash diet or a very stressful few months can push many hairs into the resting phase at once. The hair then sheds two to three months later, often just when you have started to feel better, which is why people rarely connect the two. This is called telogen effluvium.
What helps: time, regular meals with enough protein, and correcting anything low. It usually settles within about six months of the trigger, and the hair grows back. Stopping or changing the contraceptive pill and some medicines can do the same; talk to your doctor before stopping any medicine.
7. Tight hairstyles and harsh treatments
Tight plaits, buns and ponytails worn every day, especially over oiled hair, pull on the roots at the hairline and parting. Over months this causes traction hair loss: thinning at the temples and along the edges. Straightening, smoothening, rebonding, bleaching and frequent heat make the hair shaft brittle, so it breaks partway down. Breakage is not true hair loss, but it can make hair look much thinner.
What helps: looser styles, changing where you tie your hair, soft hair ties, less heat and fewer chemical treatments. Traction loss that is caught early can recover; long-standing traction can become permanent, so don’t ignore a receding edge. Our hair care tips cover everyday habits.
Other causes your dermatologist will look for
- Round, smooth bald patches may be alopecia areata, an immune condition that needs early treatment.
- A scaly, itchy or red scalp may be severe dandruff, psoriasis or a fungal infection. See our oily scalp and dandruff guide.
- Some medicines and supplements, and recent changes in them.
Tests that may help
Not every woman needs tests. When the cause isn’t clear, or shedding is heavy or long-lasting, your dermatologist may suggest a blood count, ferritin, thyroid tests, vitamin D and B12, and, if periods are irregular or there is acne or extra hair, hormone tests. A close look at the scalp with a dermatoscope (trichoscopy) shows whether the hairs are shedding normally or becoming finer, and helps tell the types apart.
When to see a dermatologist
See a dermatologist, rather than trying oil after oil, if:
- heavy shedding has lasted more than two to three months, or more than a year after childbirth;
- your parting is widening, your scalp shows through or your ponytail is thinner;
- you notice bald patches or thinning at the hairline;
- your scalp is itchy, scaly, red or sore;
- hair fall comes with irregular periods, acne or extra facial hair, or with tiredness and weight change;
- it is affecting how you feel.
Treatment works best while the roots are still active, so an early visit makes a difference.
What not to do
- Don’t start biotin or “hair vitamin” supplements without a reason. Biotin deficiency is rare, and high doses can upset some blood tests, including thyroid tests.
- Don’t take iron for months without a blood test.
- Don’t believe products that promise regrowth in weeks. Hair grows about a centimetre a month, so any real change takes months to see.
- Don’t stop a prescribed medicine on your own because you suspect it of causing hair fall; ask the doctor who prescribed it.
The short version
Most hair fall in women comes from one or more of seven causes: childbirth, low iron, thyroid problems, PCOS, pattern thinning, a recent illness or stress, and tight hairstyles or harsh treatments. Shedding often settles by itself; thinning does not. If it has lasted more than a few months, or your parting is widening, see a dermatologist to find the cause. At OrnaSkin Madhur Nagar in Rajkot, the dermatologist finds the cause first. Read about how we treat hair fall, with typical sessions and costs, or our full hair fall guide.
