Hair Loss and PCOS: Expert Insights and Treatment Options

March 23, 2024
A woman with hair loss.

Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder that affects one in ten women of childbearing age worldwide.1 This complex medical condition is characterized by an imbalance of hormones, notably higher levels of androgens and insulin, along with lower progesterone levels.

Some of the most common symptoms of PCOS include:2

  • Irregular menstrual cycles
  • Severe acne
  • Weight gain
  • Hirsutism (excessive facial and body hair growth)
  • Female-pattern hair loss (previously called androgenic alopecia)

Female-pattern hair loss (FPHL) is the most common cause of hair loss in women. It affects over half of women over the age of 70. In most cases (61.5%), women do not have laboratory evidence of increased androgen levels and therefore do not have PCOS. About one in every four women with FPHL do not have any signs of hormonal irregularities. Women with PCOS and FPHL typically develop hair loss 10 to 20 years earlier than women without PCOS.2

The Connection Between PCOS and Hair Loss

Androgen receptors for testosterone and 5-α dihydrotestosterone (DHT) are found on the hair root and follicle. DHT has a much greater affinity for these receptors than does testosterone. The enzyme 5-α reductase converts testosterone into DHT. People with PCOS have higher testosterone and 5-α-reductase levels and lower SHBG levels. SHBG reduces the active form of DHT in circulation.

While more research is needed to fully understand the connection between PCOS and FPHL, the cause is probably related to excess androgen. Excess DHT, or increased sensitivity to DHT, can lead to hair thinning and hair loss.

On the scalp, androgens cause miniaturization (shrinking) of hair follicles and shortening of the hair growth phase.2,3 Typically, about 90% of your hair follicles are in the anagen growth phase. Excessive androgens shorten the growth phase and cause more hair follicles to enter a resting phase.

In addition to contributing to scalp hair loss, androgens can also convert small, fine, unpigmented hairs on the side of the face, upper lip, chin, inner thighs, and chest into pigmented, coarser terminal hairs.2

The Impact of Estrogen and Progesterone

In addition to androgens, cyclical hormones like estrogen and progesterone also impact hair growth. High levels of estrogen, such as those experienced during pregnancy, can make hair appear thicker and fuller by extending the hair follicle growth phase. Estrogens inhibit the conversion of testosterone into the more potent DHT.3

Similarly, progesterone can also influence hair growth by decreasing the conversion of testosterone into DHT.3 However, in women with PCOS, progesterone levels are often low due to irregular or absent ovulation, contributing to hair loss.

The Role of Insulin Resistance on PCOS and Hair Loss

Many women with PCOS also have insulin resistance. In this condition, the body’s cells become less responsive to the hormone insulin. The pancreas responds by increasing insulin production until it can no longer compensate for insulin resistance.

Elevated insulin levels stimulate the ovaries to produce more androgens, leading to scalp hair thinning and hair loss. Therefore, managing insulin resistance is a critical part of treating PCOS and its associated hair loss.

A handful of hair.

About one-third of women with PCOS have hair loss.4 Hair loss linked to PCOS may manifest in several ways. Common symptoms include:

Increased Hair Shedding

While shedding 50–100 hairs per day is normal, women with PCOS may notice significantly more hair falling out. This could be observed while combing, after washing the hair, or even on the pillowcase in the morning.

Hairs are shed when a hair follicle leaves its growth phase and enters the resting phase. Telogen effluvium is the medical term used to describe excessive hair shedding.

Thinning Hair and Visible Scalp

Over time, hair may become thinner, especially at the crown or near the hairline. The midline part may widen, and the scalp may become more visible. This thinning process may be so gradual that it goes unnoticed until a significant amount of hair has been lost.

Women with FPHL may also develop hair thinning at the temple. Unlike male forms of hair loss, people with FPHL do not have a receding hairline or baldness in the temporal regions.4

Dry, Itchy Scalp and Dandruff

Women with PCOS may also experience a dry, itchy scalp and dandruff due to hormonal imbalances affecting the scalp’s health. Some hair loss may be associated with chronic inflammation in the scalp.4

Increased Hair Breakage

Due to the dryness and brittleness caused by PCOS, hair may break more easily, contributing to overall thinning and hair loss.

A woman with a widened hair part demonstrating PCOS and hair loss.

While PCOS-related hair loss can be distressing, several medical treatments can help manage this symptom. These treatments mainly focus on regulating hormone levels, particularly reducing androgen levels.

Hormonal Contraceptives and Medications

Hormonal contraceptives containing both estrogen and progestin can help regulate androgen levels, thereby reducing hair loss. Hormonal contraceptives can increase androgen activity depending on progestin type and concentration (first-generation products have more potent androgen activity). They are rated based on their androgen index. Hormonal contraceptives can also correct other PCOS symptoms, such as irregular periods and acne.3

Anti-Androgens

Anti-androgens, like spironolactone, block the effects of androgens on the skin and block the conversion of testosterone to DHT, thereby reducing hair loss. They are typically prescribed alongside oral contraceptives.

In addition to slowing hair loss, spironolactone may reduce unwanted hair growth (hirsutism). Discuss the risks and benefits of spironolactone use with your doctor, especially in terms of fertility planning.3

Minoxidil

Minoxidil, also known as Rogaine, is the only approved treatment for female-pattern baldness. Applied topically to the scalp daily, it promotes hair growth and can even give hair a thicker appearance.

Minoxidil is believed to promote hair growth by increasing blood flow to the hair follicle and lengthening the hair growth phase. However, minoxidil may not be an ideal treatment for women with PCOS and hair loss because about 4% of people who use topical minoxidil develop increased facial hair growth.3

After starting minoxidil treatment, many people notice an increase in hair shedding before seeing hair regrowth. It generally takes 2 to 4 months of consistent use to see benefits from minoxidil use.5

Finasteride and Dutasteride

While not explicitly approved for female-pattern hair loss, finasteride (Propecia) and dutasteride (Avodart) are sometimes prescribed off-label to women with PCOS. These medications decrease the conversion of testosterone to DHT. These medications are teratogenic. They cause the feminization of external genitalia in a male fetus.3

Home Remedies for PCOS and Hair Loss

In addition to medical treatments, certain lifestyle changes and home remedies can also help manage PCOS-related hair loss.

Dietary Changes

A well-balanced diet rich in vitamins, minerals, and proteins is essential for healthy hair. Foods rich in iron, zinc, biotin, and vitamins A, B, D, and E can support hair health and growth.

Vitamin D deficiency is common in women with PCOS. Restoring healthy vitamin D levels can have beneficial effects on androgen levels.2

In one study, 29% of people with FPHL had ferritin deficiency. Iron deficiency is typically more common in premenopausal women than in postmenopausal women. It is currently not known whether iron supplementation can restore hair growth in women with FPHL.4

Consume fiber-rich foods to support a healthy microbiome and increase satiety. Avoid highly processed foods and sugary foods with low nutritional value.

Exercise

Regular physical activity can help manage insulin resistance, thus reducing androgen levels and hair loss.

Experts recommend a minimum of 150 minutes of moderate-to-intense exercise each week, along with two strength-building sessions each week. Increase this to about 300 minutes per week for increased calorie burn.

Consistent exercise in moderation is best. Overexercise can increase stress and negatively affect ovulation and reproductive health.

Proper Hair Care

Using gentle, moisturizing shampoos and conditioners can protect hair from breakage. Avoiding heat styling tools and harsh chemical treatments can also help maintain hair health.

Consultation with a Specialist about PCOS and Hair Loss

If you’re experiencing hair loss and suspect PCOS might be the cause, consult with a specialist. A gynecologist, endocrinologist, or dermatologist can provide an accurate diagnosis and suggest appropriate treatment options.

More research is needed to understand FPHL and the potential association between increased androgen levels in PCOS and hair loss. Weight management and improved insulin sensitivity can decrease androgen levels and reduce hair loss. Talk to a treatment specialist at Invigor Medical about weight management treatment plans.

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Frequently Asked Questions

Can you regrow hair loss from PCOS?

Hair loss due to PCOS, often caused by hormonal imbalances and high levels of androgens, can sometimes be managed and potentially reversed. Treatment options like hormonal therapies, lifestyle changes, and medications to reduce androgen levels may help in regrowth. However, the effectiveness varies from person to person, and it’s best to consult a healthcare provider.

What are the 4 stages of PCOS?

PCOS doesn’t have defined stages. It’s a complex condition with a range of symptoms that can vary widely among individuals. The symptoms and their severity differ, and the condition is typically characterized by a combination of symptoms such as irregular periods, excess androgen levels, and polycystic ovaries.

Can you reverse PCOS?

While there is no cure for PCOS, its symptoms can be managed and sometimes reversed with lifestyle changes, medications, and treatments. Lifestyle modifications like diet, exercise, and weight management can significantly reduce symptoms and improve quality of life.

Does PCOS ever go away?

PCOS is a chronic condition and, as of current medical understanding, does not completely go away. However, symptoms can be managed effectively with the right treatment and lifestyle adjustments. The severity of symptoms may change over time, especially with interventions like diet, exercise, and medical treatment.

Author: Leann Poston, M.D.
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Sources

  • Klein EJ, Oh CS, Karim M, Shapiro J, Lo Sicco K. A practical approach to the management of hair loss in patients with polycystic ovary syndrome. J Eur Acad Dermatol Venereol. 2023 Jan 6. doi: 10.1111/jdv.18842. Epub ahead of print. PMID: 36606524.
  • Grymowicz M, Rudnicka E, Podfigurna A, Napierala P, Smolarczyk R, Smolarczyk K, Meczekalski B. Hormonal Effects on Hair Follicles. Int J Mol Sci. 2020 Jul 28;21(15):5342. doi: 10.3390/ijms21155342. PMID: 32731328; PMCID: PMC7432488.
  • Carmina E, Azziz R, Bergfeld W, Escobar-Morreale HF, Futterweit W, Huddleston H, Lobo R, Olsen E. Female Pattern Hair Loss, and Androgen Excess: A Report From the Multidisciplinary Androgen Excess and PCOS Committee. J Clin Endocrinol Metab. 2019 Jul 1;104(7):2875-2891. doi: 10.1210/jc.2018-02548. PMID: 30785992
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