Hair Loss and Pregnancy with Tips for Keeping Luscious Locks Dr Clare Thompson 28 September, 2015 Features, Health and Symptoms, Pregnancy You rarely hear about the bad skin and hair loss that can happen during pregnancy; people are usually talking about that radiant glow. I have to say, I was the opposite, and looked like a spotty teenager meets Worzel Gummidge. Hair loss and pregnancy is quite a common problem, there are three cycles of hair growth during the trimesters and everyone is affected differently during pregnancy, and almost more importantly, post partum. My Baba’s expert Dr Clare Thompson explains the reasons behind hair loss during and after pregnancy, common causes and top tips for improving the quality of your pregnancy hair. Ever wondered why women have that glow during pregnancy? What is it about being pregnant that makes your skin and hair look so lustrous and full? Pregnancy is a time when women are supposed to be radiant and glowing but often women will complain that they are at the mercy of their hormones and struggle to adapt to the changes their bodies are going through. Pregnancies vary so much between women and even subsequent pregnancies can be completely different within the same woman. The sensitivity of the hair follicles can also change with each pregnancy and this can make it hard to predict in advance how a woman’s hair will react. As a general rule most women will report that their hair is thicker and fuller towards the second and third trimester. Not all women notice dramatic changes to their hair in pregnancy but it is more obvious in women with longer hair. So let’s look at the science behind hair growth, and specifically, what exactly happens to hair follicles during the different stages of pregnancy. The Three Cycles of Hair Growth Approximately 90% of your hair is growing at any one time, whilst the other 10% is entering a resting phase. Every 2-3 months the resting hair falls out and allows new hair to grow in its place. During pregnancy a reduced number of hairs go into the resting phase, which is part of the normal hair-loss cycle. 1/ Anagen – growing phase 2/ Catagen – transition phase 3/ Telogen – resting phase This also explains why some girls are the envy of us all and manage to grow out their tresses to long, thick lengths with minimal breakage whilst others of us struggle to make it past a shoulder-length bob. Simply put, some women’s hair has a longer Anagen (growing) phase in their natural hair cycle which means less of their hair is in the resting phase at any one time and hence it grows longer and gives the appearance of a thick and healthy mane. Much of this is genetic but diet and taking care of your hair properly will also help prolong this Anagen phase. Now let’s take a closer look at pregnancy and how that impacts directly on what is going on at scalp-level. The Effects of Pregnancy on Hair In an average non-pregnant woman approximately 100 hairs are shed each day through brushing and washing. During pregnancy there is an immediate increase in circulating levels of oestrogen which causes hair follicles to remain in the Anagen phase for longer and reduces shedding. Hardly any hairs are lost and the majority of women report that their hair is generally thicker and has more shine, especially as the pregnancy progresses. However, because of the reduction of circulating male hormones during pregnancy there is less sebum (oil) production and you may notice that your hair is also drier and more brittle. As such, it is important to moisturise and hydrate your hair as the pregnancy progresses to put back some of the oils needed for shine and vitality. A growing foetus requires a large amount of energy and your body will prioritise your baby’s needs over that of your hair. Therefore, diet during pregnancy is even more important to ensure that both you and your baby are getting the right balance of nutrients and energy for good health. Post Partum After delivery the circulating levels of oestrogen take a rapid dip and this triggers more hair follicles to enter into the resting phase than before. ‘Telogen Effluvium’ is the excessive shedding of hair that occurs 3-4 months after delivery as the pregnancy hormones return to normal levels and trigger hair to fall out and return to the normal cycle. If affects 40-50% of women, but like most changes in pregnancy, it is temporary and by your baby’s 1st birthday your hair growth-shed cycle should be back to its normal state. The usual hair loss that was delayed during pregnancy may all seem to fall out at once. Up to 60% of the hair that is in the growth phase may enter into the resting phase and this results in the hair falling as the follicles regenerate themselves once again. Celebrity Hairstylist and Director at Lockonego Salon in Chelsea, Jonathan Long, has worked in the industry for over 20 years and says he often sees Clients who have breakage at their roots around the hairline once they stop breastfeeding. He advises that women should expect to see this pattern of hair loss postpartum and reassures that it often grows back within the year with a good diet and use of high quality hair care products. He muses ‘women spend so much money on their skincare and yet often neglect to spend time researching the quality of the products they put in their hair, often using cheaper brands which may be drying out and breaking the hair’. He also advised that women who suffer this type of temporal pattern hair loss postpartum could consider adding in a ‘faux-fringe’ to layer across the temples to better disguise some of the breakage. Jonathan is a big believer in eating organically and advises that sourcing your food this way in pregnancy is the best way to obtain the optimal balance of nutrients for you and your baby and has a direct impact on hair and nail quality. He also touched upon colouring hair in pregnancy and advised that women should stay away from harsh full-regrowth tints that will enter the hair at the follicle. Highlights should never be so close as to touch the root and so may be the better option, but if you cannot forgo your hair colour for the 9 months then putting lots of low-lights through may be a safer alternative to your full tint. One big no-no he mentioned was using too many heated products on your hair in pregnancy as this makes it even more likely to dry out and break at the roots. Simple Tips for Improving the Quality of Your Hair in Pregnancy Aim to eat as fresh and organically as you possibly can to give your baby the best start. This will also boost your own energy levels and have a positive effect on your hair and nails. Taking a specially formulated and FDA approved pregnancy multi-vitamin (Eg/ Pregnacare) is an easy way to make sure that you are getting the correct balance of vitamins and minerals needed to meet both you and your baby’s nutritional needs throughout the pregnancy. Try not to over brush your hair which will prevent further breakage. However studies have disputed that reducing frequency of shampooing stops hair from falling, rather it just increases the amount falling in subsequent shampoos which can fuel fear of balding. Use a mild shampoo and conditioner. Invest in some decent products which are formulated for your hair type to put back any moisture loss. Minimise tying your hair up tight in hair bands which may snag and break your hair at the roots. Limit the use of chemicals, dyes and heated styling products which can leave hair feeling even more dry and brittle. Consider adding in a light fringe to hide any hair breakage at the hairline post partum. Other Causes of Hair Loss in Pre-Menopausal Women Hormonal Imbalance Polycystic Ovaries Diabetes Anaemia (important to check ferritin level) Thyroid issues Hormonal birth control Unusual Hair Loss in Pregnancy More worryingly if you are finding that your hair is becoming unusually thin during the pregnancy or is falling in patches from your scalp (alopecia) then it is important that you consult with your GP to identify other possible causes which could be contributing such as thyroid issues and having a low ferritin level (anaemia). Alopecia is an auto-immune condition in which the body attacks its own hair follicles and affects 2 in every 100 people in the UK. Many women will turn to hair extensions to cover up the hair loss but this can actually make the problem worse. ‘Traction Alopecia’ is where the use of a product which pulls the hair, such as straighteners or extensions, traumatises the follicle and causes the hair to fall. One of the most common triggers for thinning hair in young women is iron deficiency anaemia which affects 20% of British women aged 19-45. Iron in the body binds to ferritin which is a protein that acts as a buffer against iron deficiency. Red meat is one of the best nutritional sources of iron and often vegetarians may be deficient. I have also seen many women with heavy periods and those over-exercising have very low ferritin levels on their blood tests. Dr Hugh Rushton, one of the top trichologists in the UK, has been studying the effects of ferritin on hair loss for over 20 years. He recommends that ferritin levels should be done on a fasting sample first thing in the morning and suggests that the reference ranges that the UK laboratories are using are actually far too low and based on a population of women who are already iron deficient. Ideally the ferritin should be at a level of 40 or above to support healthy hair follicles. Most laboratories in the UK suggest that ferritin should only be above 29 in women of child bearing age. He has extensively researched the role of ferritin in hair loss and believes that as much as 10% of unexplained subfertility may also be due to low iron. The importance or serum ferritin in pregnancy is well known as is foetal demand at the expense of maternal stores. Interestingly when he is treating his anaemic patients for their alopecia he notes that lots of women return to him reporting that not only is their hair much thicker but that they have fallen pregnant in the process. He has also looked at the role of Placental Isoferritin which is a protein that is positive when a woman falls pregnant. Rushton hypothesizes that women with depleted iron stores may inhibit Placental Isoferritin synthesis which results in early foetal rejection and miscarriage as the serum ferritin levels are just too low to support a healthy and viable pregnancy. Contrary to popular belief there is actually no evidence in the studies to support a view that low Zinc or low vitamin B12 causes hair loss. However, studies have actually shown that adding L-lysine supplements, which is an essential fatty acid, to a woman’s diet can result in a significant increase in the ferritin levels. Another key issue that Dr Rushton has noticed is that women are delaying motherhood well into their late thirties and spend more years menstruating which results in lower iron stores and possible subsequent hair loss. Rest assured changes to your hair in pregnancy are rarely permanent and hair will usually return to pre-pregnant state within the first year of your baby’s life. If your GP is particularly concerned with the pattern of hair loss or degree of loss then they should organise some basic blood tests and refer you onto a registered Dermatologist or Trichologist who will be best placed to investigate and manage you further. By Dr E Clare Thompson, The Courtfield Private Practice, South Kensington. The Courtfield Private Practice’s head partner is Dr Tim Ladbrooke, the GP in Tatler’s Best Doctor Guide. The practice is expanding and and concentrating its focus on mothers and children.