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Female pattern hair loss is relatively common and affects about 40% – 50% of women with some degree of thinning in their lifetime. Female pattern hair loss is different from male pattern loss and tends to be more diffuse. Psychologically, the effects of hair loss for women can be significant and negatively affect their self-confidence in both personal and professional environments.

There are a number of causes of hair loss in women. Most commonly, female pattern hair loss is caused by the actions of two enzymes: aromatase (found predominately in women), and 5-alpha reductase (found in both men and women). In many cases, there is no clear etiology for the hair loss in women and an experienced physician should perform a thorough workup. There are several causes of hair loss in women such as thyroid or iron deficiency, hormone imbalances, gynecologic conditions such as polycystic ovary disease, or stress. In some cases, a scalp biopsy may need to be done for the diagnosis.

The pattern of hair loss in women tends to be more diffuse then men. The Ludwig scale is typically used to classify hair loss patterns in women. Additionally, some women develop significant hair loss in the frontotemporal angles, which limits them from pulling their hair back.



Norwood Classification system

Type I: In this stage, the hair loss is considered mild, and most women have difficulty noticing that the hair loss has occurred. Most of the time, the frontal hairline is unaffected.

Type II: Type II hair loss is considered moderate, and women may notice more pronounced shedding, thinning, and a general decrease in hair volume centrally.

Type III: In this stage, the hair loss is considered significant with hair thinning which is difficult to camouflage. Unfortunately, women with this stage of hair loss may not be good candidates for surgery.

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