Hair loss in women after childbirth (postpartum alopecia or postpartum telogen effluvium)

Hair loss in women after childbirth (postpartum alopecia or postpartum telogen effluvium)

Posted by Arthur Chan, Regenerative Health Consultative Pharmacist Activance Clinic on 10th May 2022

Soon after the birth of their baby, new mums can find that they are losing a lot more hair than usual. Although a somewhat alarming occurrence, this excessive hair shedding, commonly referred to as postpartum hair loss, is totally normal and will resolve itself over time or more quickly with our range of hair nutrient treatments.

Postpartum hair loss - everything you need to know

Diffuse hair loss can best be described as hair loss or thinning that occurs across all areas of the scalp, leaving only a thin, low volume hair coverage.

Postpartum alopecia and Postpartum telogen effluvium (PPTE) are forms of diffuse hair pattern loss that occur 2-4 months after childbirth or a triggering event for a self-limited time.

Different types of stresses are related to telogen effluvium (TE), such as febrile (fever) states, stress, major surgery, increased androgen and estrogen hormones, hyperthyroidism and many others [1]. Additionally, it's well studied that hormone levels during and after pregnancy are dramatically distinct and can contribute to postpartum alopecia and Postpartum telogen effluvium (PPTE).

How to identify postpartum hair loss

Postpartum hair loss is excessive hair loss or shedding of up to 400-500 hairs per day (average hair loss is 80-100), often peaking four months after childbirth and lasting not more than 15 months. In addition, many patients suffer from telogen effluvium 2-4 months after delivery. PPTE, a commonly described phenomenon, is synchronised hair shedding that continues for six to twelve months; very rarely, it can persist for up to 15 months*.

Hormones, pregnancy and hair loss

Significant hormonal changes take place during pregnancy and after childbirth. The importance of hormones on hair follicles and their growth is well established [3].

During pregnancy, high levels of estrogens, progesterone, and growth factors are maintained to sustain a healthy pregnancy, foetal growth and development.

Since all these hormones and growth factors promote overall growth, including hair follicles, there are increases in the hair growth rate, hair diameter, and anagen/telogen ratio as the number of hair follicles in the growth phase is increased/raised.

On the other hand, the hair growth-inhibiting effect of androgens like testosterone (T) and dihydrotestosterone (DHT) is also reduced by the counter effect of estrogens, progesterone, and growth factors which increase during pregnancy.

As a result, women's hair is usually at its best during pregnancy, including those who suffered from hair loss before pregnancy who benefit the most from increased estrogens, progesterone, and growth factors.

Conversely, after childbirth, hair loss might be experienced by 2 out of 10 women who did not suffer from hair loss before pregnancy and nearly double i.e. 4 out of 10 who suffer from hair loss before pregnancy. Alarmingly that rate can get worse with each subsequent childbirth.

Estrogens, progesterone and growth factors drop dramatically 2-3 days after childbirth and the removal of the placenta. Hair loss after childbirth is not only limited to the reversal of the changes that estrogens, progesterone and growth factors have had. Along with changes to thyroid hormones, prolactin (the hormone that promotes breast tissue development and breast milk production) and the stress hormone cortisol, plus other factors like rest, emotional support, and nourishment, also play an important part in hair growth after childbirth.

Thyroid hormones and hair growth

The thyroid is a butterfly-shaped endocrine gland located in the lower front of the neck. The thyroid makes hormones that help the body to regulate metabolic processes, including growth and energy expenditure for staying warm and keeping organs such as the brain, heart, and muscles working properly.

During pregnancy, the hormones made by a correctly functioning thyroid play an important part in foetus development, especially the foetus brain, foetus hair follicle development and proper healthy hair growth for the mother.

Inflammation of the thyroid gland is known as thyroiditis. Postpartum thyroiditis* is not uncommon and usually results in hyperthyroidism (high thyroid hormone levels in the blood). It peaks four months after delivery and is very often followed by hypothyroidism (low thyroid hormone levels in the blood) that usually normalises 12-15 months after childbirth.

Unfortunately, both Hyper and Hypothyroidism can induce hair loss, and an abnormal functioning thyroid could contribute to excessive hair shedding in mothers after giving birth.

*Who gets postpartum thyroiditis?

Postpartum thyroiditis is an uncommon condition that affects some women after pregnancy. An estimated 5% of women may experience this in the year after giving birth.

Women with Type 1 diabetes or those with a personal or family history of thyroid dysfunction may be more likely to develop postpartum thyroiditis. Additionally, microsomal antibodies (thyroid-specific antibodies) if present, make women more susceptible to thyroid dysfunction, including postpartum thyroiditis, resulting in excessive hair shedding after childbirth.

The prolactin hormone and hair growth

Elevated prolactin levels, the hormone associated with the growth of mammary glands during late pregnancy and breast milk production after the baby's delivery, have been proven to be a potent hair growth inhibitor and premature catagen (hair degeneration) inducer [4]. It also could be a major contributing factor to inducing excessive hair loss and shedding after childbirth.

Cortisol, the stress hormone and hair growth

Cortisol is a steroid hormone produced by the adrenal glands. It plays a role in a wide range of processes in the human body. However, its main function is to get the body ready for duelling with and getting over stress, a crisis or an emergency for survival. In essence, it controls the body's 'coping' stress response.

When we experience stress, all energy reserves and nutrients, including our cellular building blocks, are diverted to vital organs like the brain, lungs, and the heart, leaving the non-vital organs like hair and its repair and growth on hold.

High cortisol levels induced by stress have recently proven to be a potent hair growth inhibitor [2]. The presence of cortisol in high levels is connected to reducing the synthesis and premature degradation of two important modulators of hair follicle growth and function (hyaluronans and proteoglycans). Interestingly, low cortisol levels can actually lead to positive effects on hair growth by slowing down the degradation of these two skin components [3].

There are many sources of stress experienced by mothers in the months after giving birth. For example, interrupted or insufficient sleep, tiredness, an unsettled baby, postnatal depression, and a lack of physical and emotional support can raise cortisol levels that might contribute to or be the key triggering factor of Postpartum telogen effluvium (PPTE).

Recently, particular focus has been given to hair cortisol concentration (HCC) as a promising diagnostic instrument in clinical practice. Hair cortisol concentration has also been reported to impact correct hair growth [2].

Nutrition, a balanced diet, and hair growth

Nutrients are primarily used by cells to generate energy to sustain life. Repairing or making new cells or organs in non-vital areas like hair follicles is secondary.

At times of nutrient deficiency, all resources, including energy and cell building blocks, are diverted to vital organs (i.e. brain, heart and lungs) to keep you alive, leaving nothing for follicles to grow and causing hair loss to occur.

Over 80% of a hair strand is a specialised hair protein made up of sulphur-rich amino acids known as hair keratin. At the same time, a balanced diet is essential in forming cholesterols, the initial building block for most hormones.

The protein synthesis, including hormones or hair keratin, involves the proper cellular energy supply, the right building blocks and micronutrients, including vital, balanced minerals such as selenium, zinc and copper.

During pregnancy, energy, cell repair, and building blocks are diverted to the developing foetus at the mother's expense. With an insufficient nutrient supply during pregnancy, the mother's reserve will be very low after childbirth and breastfeeding, exposing the mother to a heightened risk of being unable to maintain healthy tissues and organs, with outcomes ranging from weakening teeth and bones to excessive hair shedding.

Nutrient replacement therapy with the right hair growth nutrient molecules plays an important part in rectifying or preventing postpartum alopecia or postpartum telogen effluvium (PPTE) hair loss in women after childbirth.

Rhodanide in Activance improves the follicle energy supply, extending the hair growth phase and the exogen, hair shedding phase, thus reducing the synchronised hair shedding that often occurs after childbirth.

With the right nutrient intake and regular use of the micro-nutrient molecules in Activance, any hair shedding after childbirth will be minimised, and hair growth regenerated, resulting in improved hair density, fullness, strength, and aesthetics.

Please contact us with any questions or queries regarding this blog.

*Activance Clinic offers specialised, truthful, independent advice, health perspectives inside and outside of orthodox medicine and treatment plans if requested for all hair and scalp concerns as well as other degenerative health issues.

For further details and to make an appointment for a consultation, please contact the Activance office for assistance.

References 

[1] Malkud S. Telogen effluvium: a review. J Clin Diagn Res. 2015;9:9. [PMC free article] [PubMed] [Google Scholar]

[2] Xiang L., Sunesara I., Rehm K.E., Marshall G.D., Jr. Hair cortisol concentrations are associated with hair growth rate. Neuroimmunomodulation. 2016;23:287–294. 

[3] Int J Mol Sci. 2020 Aug; 21(15): 5342. PMCID: PMC7432488 PMID: 32731328 Hormonal Effects on Hair Follicles 

[4] Foitzik K., Krause K., Conrad F., Nakamura M., Funk W., Paus R. Human scalp hair follicles are both a target and a source of prolactin, which serves as an autocrine and/or paracrine promoter of apoptosis-driven hair follicle regression. Am. J. Pathol. 2006;168:748–756.