Polycystic Ovary Syndrome (PCOS) and Hair Loss: What You Need to Know

Quick Summary: Polycystic Ovary Syndrome (PCOS) and Hair Loss – What You Need to Know

• What is PCOS? PCOS is an endocrine disorder that affects hormones, leading to elevated androgen hormone levels, and the formation of multiple small cysts in the ovaries.
• PCOS and Hair Loss: Elevated androgens convert to DHT, shrinking hair follicles and disrupting the hair growth cycle which results in hair loss. Certain genetic factors can influence how susceptible a person is to hair loss.
• Symptoms of PCOS: Symptoms include irregular or absent periods, excessive facial or body hair growth (hirsutism), acne, oily skin, weight gain, high cholesterol, and an increased risk of type 2 diabetes.
• Treatment Options:Treatments include hormonal birth control to balance hormones, topical minoxidil to stimulate hair growth, lifestyle changes for hormonal balance, and hair transplants to restore hair density.

Excessive hair loss is a frequent and often emotionally challenging symptom experienced by many women with Polycystic Ovary Syndrome (PCOS). Witnessing increased hair shedding in the shower or noticing a gradually receding hairline can be stressful. This blog post aims to shed light on the connection between PCOS and hair loss, explore the presenting signs, and discuss potential solutions to effectively manage this concern and promote hair health.

What is PCOS?

PCOS is a condition that disrupts the normal balance of hormones within a woman’s reproductive system. This endocrine disorder is characterised by elevated levels of androgen hormones, specifically testosterone. Androgens are present in both men and women but are usually higher in men. They are responsible for stimulating the growth of body hair during puberty. 

In women with PCOS, ovaries produce an excess of androgen hormones. This disrupts the ovulation process, preventing immature eggs from maturing and releasing from the ovaries. This can cause infertility.
The ovaries become enlarged and contain many fluid-filled sacs (follicles) that surround the unreleased eggs¹. The presence of these cysts can further contribute to the overproduction of androgens, creating a cycle that underlies many of the symptoms associated with PCOS, including hair loss.

PCOS affects about 1 in every 10 women of reproductive age in the UK. The exact cause of PCOS is unknown, but it is believed to involve a combination of genetic and environmental factors. One of its manifestations can be inconsistent: while some women with PCOS experience increased hair growth on the face and body (known as hirsutism), others experience hair loss on the scalp. This hair loss often follows a pattern similar to female pattern hair loss, leading to thinning at the crown².

How PCOS is Linked to Hair Loss

The elevated androgen levels associated with PCOS can disrupt the normal hair growth cycle. These androgens are converted into dihydrotestosterone (DHT), which binds to receptors on hair follicles and causes them to shrink down and ultimately stop producing hair, resulting in hair loss³. 

This type of hair loss is characterised by thinning hair across the entire scalp leading to advanced stages of female pattern baldness.
However, not everyone with PCOS experiences hair loss. Individual susceptibility depends on hair follicle sensitivity to DHT, which is largely determined by genetics. If you have a close relative with female pattern hair loss, regardless of whether they have PCOS, you may be more prone to experiencing it yourself.

Symptoms of PCOS

Beyond hair loss, PCOS can present with a variety of symptoms, including⁴:

• Irregular or absent periods
• Excessive facial or body hair growth
• Acne
• Oily skin
• Weight gain

Women with PCOS also have an increased risk of developing other health problems later in life, such as high cholesterol levels⁴. Insulin is a hormone that controls sugar levels in the body. Many women with PCOS are resistant to the action of insulin in their body, increasing the risk of type 2 diabetes. 

Diagnosing PCOS

Diagnosis of PCOS typically involves a combination of medical history taking, physical examination, blood tests to check hormone levels, and ultrasound to examine the ovaries. Physicians typically start by discussing the patient’s menstrual history, weight changes, and symptoms such as hirsutism and hair loss. Blood tests are crucial to measuring hormone levels, and assess glucose tolerance and lipid profiles.
An ultrasound may be performed to examine the ovaries for the presence of multiple cysts, and to check the endometrial lining. According to the Rotterdam criteria, a PCOS diagnosis is confirmed if two out of three of the following are present: 

• Irregular ovulation, 
• Elevated androgen levels
• Polycystic ovaries visible on ultrasound. 

It’s important to rule out other conditions that could mimic PCOS, such as thyroid dysfunction or hyperprolactinemia, through additional blood tests⁵. This comprehensive approach ensures an accurate diagnosis and informs a tailored treatment plan. If you experience unexpected hair loss along with other symptoms that might suggest PCOS, please don’t hesitate to schedule a consultation with a healthcare professional.

Treatment Options for PCOS-Related Hair Loss

Treatment options for PCOS-related hair loss typically focus on addressing the underlying hormonal imbalance, and promoting hair growth. Here are some potential approaches:

• Hormonal birth control: Combined oral contraceptive pills (oestrogen and progesterone) can be a treatment option for women experiencing both hirsutism and alopecia (hair loss)⁶.
• Anti-Androgens: Medications, such as spironolactone, can block the effects of androgens on hair follicles, slowing hair loss and promoting regrowth.
• Topical minoxidil: Minoxidil solution applied directly to the scalp can also be an option for treating hair loss. Minoxidil potentially widens tiny blood vessels in the scalp, which improves blood flow to hair follicles. This process revives and extends the anagen (growth) phase of the hair cycle, shortens the telogen (resting) phase, stimulates hair follicle activity, increases follicle size, and boosts the production of crucial growth factors for hair development. It’s important to remember that this medication is not suitable for women who are pregnant or trying to get pregnant⁷.
• Lifestyle Changes: Maintaining a healthy weight, eating a balanced diet, and managing stress levels can all contribute to improved hormonal balance and potentially benefit hair health⁴.
• Hair Transplants: While not a treatment for any underlying hormonal imbalances, hair transplants can be a viable option to restore lost hair density in women with significant hair loss due to PCOS. The procedure involves taking hair follicles from a donor area (usually the back of the scalp) and transplanting them to thinning or bald areas⁸. It’s essential to consult with a specialist to determine the suitability of a hair transplant, as factors like your age, gender, hair colour, hair type and hair loss area need to be considered to provide a personalised solution. Please feel free to reach out to our friendly team at The Treatment Rooms, as we’re here to help you explore your options and address any concerns you may have.

Conclusion

Understanding the connection between PCOS and hair loss is crucial for effective management. By recognising the hormonal imbalances and symptoms associated with PCOS, women can seek appropriate treatments to address hair loss and improve overall health. A combination of medical interventions, lifestyle changes, and professional consultations can help manage PCOS symptoms and promote better hair health. If you experience unexpected hair loss along with other PCOS symptoms, consult a healthcare professional to explore your treatment options. While this condition can be stressful to manage, a clear understanding of the underlying mechanisms behind PCOS-related hair loss and the available treatment options can be empowering. 

References

1. Rasquin, L.I. (2022) Polycystic ovarian disease, StatPearls. Available at: https://www.ncbi.nlm.nih.gov/books/NBK459251/. 
2. Herskovitz, I. and Tosti, A. (2013) ‘Female pattern hair loss’, International Journal of Endocrinology and Metabolism, 11(4). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3968982/
3. Grymowicz, M. et al. (2020) ‘Hormonal effects on hair follicles’, International Journal of Molecular Sciences, 21(15), p. 5342. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432488/
4. Polycystic ovary syndrome. NHS choices. Available at: https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/ 
5. Christ, J. P. and Cedars, M. I. (2023) ‘Current Guidelines for Diagnosing PCOS’, Diagnostics (Basel),13(6), pp. 1113. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10047373/
6. Melo, A. et al. (2017) ‘Hormonal contraception in women with polycystic ovary syndrome: Choices, challenges, and noncontraceptive benefits’, Open Access Journal of Contraception, 8, pp. 13–23. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774551/
7. Hair Loss. NHS choices. Available at: https://www.nhs.uk/conditions/hair-loss/ 
8. Dunkin, M. and Gardner, S. (2022) Hair Transplants: What to Expect. WebMD. Available at: https://www.webmd.com/skin-problems-and-treatments/hair-loss/hair-transplants
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