Common Causes of Hair Loss

hair lossBackground: Hair’s Natural Growth Cycle

Hair grows in three different cycles: anagen, catagen, and telogen. About 90% of the hair on the head is in the anagen, or growth phase, which lasts anywhere from 2 to 8 years. The catagen, or transition phase, typically lasts 2 to 3 weeks, during which the hair follicle shrinks. During the telogen cycle, which lasts around 2 to 4 months, the hair rests.

Most people normally shed 50 to 100 hairs a day. This usually doesn’t cause noticeable thinning of scalp hair because new hair is growing in at the same time. Hair loss occurs when this cycle of hair growth and shedding is disrupted or when the hair follicle is destroyed and replaced with scar tissue.

The exact cause of hair loss may not be fully understood, but it is usually related to one or more of the following factors:

  • Genetics (e.g. family history)
  • Hormonal changes or imbalances (e.g. pregnancy, menopause, birth control pills)
  • Medical conditions
  • Medications
  • Stress (including after surgery)
  • Improper nutrition (vitamin and/or mineral deficiency)

Although hair loss may seem like a more prominent problem in men, women are nearly as likely to lose or have thinning hair.

Common Causes of Hair Loss in Women

1. High Cortisol:

Hair loss is often caused by an imbalance in hormone levels. One of the hormones closely connected with hair loss is cortisol.

Cortisol is a steroid hormone that is normally released in response to events and circumstances such as waking up in the morning, exercising, and acute stress. In its normal function, cortisol regulates a wide range of processes throughout the body including metabolism and immune response. It also has an important role in helping the body respond to stress (i.e. the body’s fight-or-flight response).

However, at sustained high levels, cortisol can be damaging over time. Extended stress leads to extended periods of high cortisol levels. While the adrenal glands are busy making extra cortisol, they make less of the hormones that support healthy hair growth.

2. Low Protein Intake:

Hair loss may occasionally be caused by lack of protein in the diet. When this happens, the body will help save protein by shifting growing hairs into the resting phase. Increased hair shedding can occur two to three months later.

3Elevated Male Hormones:

  • Testosterone: High levels of testosterone has been commonly associated with hair loss. Although women have much lower levels of testosterone than men do, there is enough to potentially cause hair loss, particularly during periods of hormonal change.  However, researchers now believe that it is not only amount of circulating testosterone that leads to hair loss, but more significantly the level of dihydrotestosterone (DHT) binding to receptors in scalp follicles.
  • Dihydrotestosterone (DHT): Testosterone converts to DHT with the aid of the enzyme 5-alpha reductase, which is held in a hair follicle’s oil glands. In high levels, DHT shrinks hair follicles, decreasing hair’s natural growth cycle and ability to replace itself.

4. Thyroid Issues:

Hair loss may be a sign that thyroid hormones are out of balance. Both hypothyroidism and hyperthyroidism can cause hair to shed. Because hair growth depends on the proper functioning of the thyroid gland, abnormal levels of thyroid hormones can result in hair changes if left untreated. When the thyroid gland is overactive (hyperthyroidism), the hair on your head can become fine, with thinning hair all over the scalp. When the thyroid gland is underactive (hypothyroidism), there can be hair loss, not just on the scalp, but also anywhere on the body. In most cases, the hair will grow back once the thyroid disorder is treated.

5. Low Progesterone:

From the time menses begins until menopause, levels of estrogen and progesterone in women ebb and flow to promote reproduction. At about age 35 to 40, women reach the time of perimenopause. This is when their levels of progesterone and estrogen begin to reduce. Progesterone helps to counterbalance the negative effects of estrogen. When there is not enough progesterone to counterbalance estrogen, one may begin to have symptoms of estrogen dominance, such as hair loss.

6. Iron Deficiency:

Iron deficiency hair loss is caused when the body lacks enough iron to produce hemoglobin in the blood. Hemoglobin carries oxygen for the growth and repair of all body cells including the cells that make up hair follicles.

Temporary hair loss such as iron deficiency hair loss is called telogen effluvium. Telogen effluvium is an abnormality of the hair growth cycle that causes hair that would normally be in the anagen (growth) phase of the hair growth cycle to be prematurely pushed into the telogen (rest) phase, causing hair to shed. Because hair is non-essential, hair growth is one of the first processes to be affected when iron or other nutrient deficiencies occur.

7. Zinc Deficiency:

Zinc is a trace mineral that is needed for many important bodily functions in the body such as building healthy cells, regulating hormones, and aiding in the absorption of other nutrients.

Zinc is available through foods such as beef, pork, shellfish, peanuts, and legumes. Zinc deficiency (or hypozincemia) is a nutrient deficiency precipitated by malnutrition or malabsorption of the element. Deficiency may cause weak, brittle nails, diarrhea, slow healing, and hair loss.

Resources:

  • Mayo Clinic: http://www.mayoclinic.org/diseases-conditions/hair-loss/basics/definition/con-20027666
  • http://www.mayoclinic.org/drugs-supplements/zinc/background/hrb-20060638
  • You & Your Hormones: http://www.yourhormones.info/Hormones/Cortisol.aspx
  • Today’s Dietician: http://www.todaysdietitian.com/newarchives/111609p38.shtml
  • WebMD: http://www.webmd.com/skin-problems-and-treatments/hair-loss/hair-loss-causes-women

Fertility Awareness: An Alternative to the Pill

Looking for a hormone-free form of birth control?

What are the risks of taking the birth control pill?

  • Increased risk of developing blood clots (especially with pills such as Yaz and Yasmin)
  • High blood pressure
  • Increased breast cancer risk

While the pill may be an effective and suitable option for some women, many are seeking natural and safer alternatives to contraception and family planning, such as fertility awareness based (FAB) methods. FAB methods rely of looking at several indicators of fertility that change throughout the menstrual cycle in response to changing levels of estrogen and progesterone. Three of the most commonly observed indicators of fertility are basal body temperature, cervical secretions, and cervical positioning.

1. Basal Body Temperature

Basal body temperature is the body temperature measured immediately after awakening and before any physical activity has been undertaken.  During the phase before ovulation, waking temperatures range from 97.0 ̊ F to 97.7 ̊ F (36.1̊ C – 36.5̊ C); postovulatory waking temperatures tend to rise about 0.4 ̊ F or higher and they usually stay elevated until the next period. Temperatures rise within a day or so of ovulation and are associated with the surge in progesterone, a heat releasing hormone, which occurs at the time of ovulation. When interpreting temperatures, it is important to look at the big picture and not to focus too much on the day to day changes. The key is to look for a pattern of highs and lows: temperatures before ovulation will go up and down in a low range while the temperatures after ovulation will go up and down in a high range.

There are certain factors that can increase your waking temperature, including: having a fever, drinking alcohol the night before, getting less than three consecutive hours sleep before taking it, taking it at a substantially different time than usual and using an electric blanket or heating pad that you don’t normally use.

2. Vaginal Secretions

The quality and quantity of vaginal secretions are influenced by estrogen and progesterone. The different types of secretions either impede or facilitate sperm motility and this determines the state of fertility. When estrogen levels are low, cervical secretions may be minimal, thick, white, and sticky. The acidic environment of the vagina rapidly destroys sperm. Rising levels of estrogen alter the cervical secretions from white and sticky gradually becoming more transparent, stretchy, and wetter (due to increased water content), similar to the consistency of egg whites. Immediately after ovulation, the rise of progesterone causes the secretions to thicken to form a sticky plug which is antagonistic to sperm penetration.

3. Cervical Positioning

Estrogen and progesterone also cause subtle changes in the muscle and connective tissue of the cervix. Women can learn to recognize these changes by gently palpating the cervix at about the same time each day. As ovulation approaches, the cervix tends to rise, soften, and open. It progresses from feeling like the tip of the nose to feeling soft like lips as ovulation approaches. The cervix will drop abruptly into the vagina when estrogen levels fall, and progesterone becomes dominant after ovulation. The fertile time starts at the first sign of the cervix becoming high, soft or open and ends after the cervix has been low, firm and closed for 3 days. These subtle changes can be detected by simply inserting a clean middle finger into the vagina and assessing the following conditions: softness, height, opening, and wetness.

How effective is it?

Studies have found that when using temperature as a single indicator of fertility, the overall failure rate was 5.4% compared with a method failure rate of 1% (this refers to perfect use). This illustrates that using this method alone is only effective if used by highly motivated couples who are able to tolerate lengthy time of abstinence or are willing to use a barrier method during the fertile time. Cervical secretions were found to have a failure rate of around 3% if couples were given good fertility awareness teaching and followed the instructions correctly. However, with imperfect use the failure rate rose to nearly 20%. There are no effectiveness studies using the cervical positioning indicator alone.

These studies find that the failure rate tends to be lower when combining indicators. The most common combination is cervical secretions and temperature which has been found to have a failure rate between 0.43% (perfect use) and 2.2% (overall pregnancy rate). Perfect use refers to using abstinence during the fertile time and therefore is a measure of true effectiveness. Interestingly, one study found that there was no difference in failure rates between the learning phase (first 3 months) and subsequent months of use.  For a contraceptive method to be rated as effective as the hormonal pill, it requires a failure rate of less than 1%. The studies mentioned above found FAB to be as effective as the birth control pill when used perfectly.

What are the benefits?

Despite the limited scientific evidence, there are several advantages to FAB methods. It does not involve the use of chemical agents or physical devices and had no side effects. Educating patients on this method is empowering and fosters a sense of shared responsibility and increased communication for the couple. Also, it is not dependant on medical intervention after the initial visit, thus keeping costs low.

What are the limitations?

There are also some limitations to FAB methods. It can take time to learn and some women find charting difficult. Both partners must be committed to the practice and some couples find abstinence difficult. Times of stress or hormone changes can make charting more difficult and may affect efficacy.

If you are interested in learning more about fertility awareness methods
please contact Dr. Sarah Vadeboncoeur.