Choosing the right natural treatment for PCOS hair loss
Both hair loss and polycystic ovary syndrome (PCOS) are common issues that affect women of reproductive age. Estimates of how many women experience hair loss vary due to the subjective nature of most assessment methods, but figures suggest that around 6-12% of women aged 20-30, and 55% of women over 70 years old, are affected.1
There are different reasons why a woman might experience hair loss and different ways her hair loss might be categorised clinically. Elevated levels of androgen hormones — also known as ‘male’ hormones for their role in the presentation and function of ‘male’ characteristics — is one factor that is said to bring on hair loss.2 Excessive androgen levels (‘hyperandrogenism’) is one of the three main features of PCOS.
This type of hair loss might be known as ‘female androgenic alopecia’ (FAGA),3 however, some use the broader term ‘female pattern hair loss’ (FPHL) because the role of androgen hormones in affecting hair loss is not fully established.4
Experiencing hair loss can be very stressful and significantly impact our confidence and sense of self. While there is a need for more research investigating the causes of hair loss, nutrition has been shown to play a role. You should always consult with your doctor before embarking on a new treatment plan, including any lifestyle changes.
Why does PCOS cause hair loss?
Hyperandrogenism can cause a higher amount of testosterone to circulate throughout the body, which can bind to receptors in our hair follicles to cause miniaturisation,5,6 a process that causes hairs to shrink in size, i.e., to thin.
While hair thinning and loss can be affected by hyperandrogenism, there are many women who experience hair loss who show no signs of androgen excess.7 In fact, some have found that androgen levels in women with female pattern hair loss are mostly within the normal range, and suggest instead that hair loss is due to the ratio of androgens and oestrogen rather than the androgens themselves.8
The impact various nutrients have on hair loss has been subject to debate but it is generally accepted that nutrition does play a role in hair health, loss, and growth. However, more research is needed: particularly in looking at hair loss specifically in women with PCOS.
Omega 3 has been investigated for its impacts on PCOS symptoms and has been shown to reduce androgen levels in women with PCOS. One study of 45 non-’obese’ women with PCOS were treated with 1,500mg of omega-3 for 6 months, and saw a decrease in testosterone levels.9 Another study of 78 women with PCOS gave participants 3 grams of omega-3 per day for 8 weeks, and found that testosterone concentration was significantly lower than in the placebo group after supplementation.10 While these studies were not specifically measuring scalp hair loss or density, they indicate a reduction in hyperandrogenism — which could be linked to hair loss.
There is nothing shameful or embarrassing about exploring the possibility of or choosing to wear a wig. If you think that it will make you feel better then that is enough of a reason to consider doing it
Other trials and studies have shown that supplementation with omega-3 has contributed to a decrease in hair shedding in women11 and indicated the benefit of omega-3, 6, and 9 as part of a wider nutritional plan in improving hair volume, strength, and reduction of greasiness,12 as well as a reduction in the proportion of hair that had been minimised.13 The majority of these studies have been done with women who did not have PCOS.
Inositols — B-group vitamins that naturally occur in plants, animals, and people — are known for their beneficial impacts on PCOS symptoms. Myo-inositol is a type of inositol that has been shown to have positive effects in reducing testosterone levels, regulating the menstrual cycle, and reducing physical symptoms such as hirsutism (increased body hair where it usually doesn’t grow) and acne in women with PCOS.14
While there is little research on the direct impacts of myo-inositol on reducing scalp hair loss, as it has been shown to reduce testosterone levels in women with PCOS, it follows that it could work towards reducing hyperandrogenism and hair loss.
Hair loss can also be a symptom of iron deficiency anaemia, although it is not one of the most common symptoms. Our iron levels are usually measured through our levels of ferritin, which is a blood cell protein that contains iron. The exact role that iron plays in hair loss has not yet been fully established: while some studies have demonstrated the link between ferritin levels and female hair loss,15 others have found the correlation not to be statistically significant.16
One study of 80 women aged 18-45 years old with hair loss found that women with female pattern hair loss had significantly lower ferritin levels than the control group,17 a result echoed by another study of 113 women with hair loss that found ferritin concentration to be lower in women with hair loss than in healthy women.18
Reasons for the differences in results is unclear, but it could be due to the wide variety of individual factors that cause hair loss, including medications, stress, and weight loss.
Limited studies have been done to investigate the role of vitamin D in the hair cycle, however a deficiency in vitamin D receptors — sites where other cells are able to respond to vitamin D — has been shown to affect the hair follicle cycle, especially the growth (anagen) phase.19 This may indicate that vitamin D contributes, at least in part, to the growth of hair.
An analysis of case notes from a study of 210 patients with female pattern hair loss, between the ages of 8-86 years old, found that just 38% had normal levels of vitamin D.20
Other aesthetic options
If your hair loss is having a significant impact on your health and wellbeing, you might also consider speaking to your doctor about aesthetic options, such as hairpieces and wigs, that are available to you. There are some circumstances in which women may be eligible for free or reduced cost wigs on the NHS.
There is nothing shameful or embarrassing about exploring the possibility of or choosing to wear a wig. If you think that it will make you feel better then that is enough of a reason to consider doing it.
Support groups and counselling are available if your hair loss has impacted your mental health. Visit the Alopecia UK website for more information. You should always speak to your doctor about any mental health symptoms that are affecting you.
1. Mesinkovska, N.A., and Bergfeld, W.F., Hair: what is new in diagnosis and management? Female pattern hair loss update: diagnosis and treatment, Dermatologic Clinics, 2013, vol 31, issue 1, pp 119-127
2. Camacho-Martínez, F.M., Hair loss in women, Seminars in cutaneous medicine and surgery, 2009, vol 28, issue 1, pp 19-32
4. Birch, M.P., et al., Female pattern hair loss, Clinical and experimental dermatology, 2002, vol 27, issue 5
5. Brough, K.R., and Torgerson, R.R., Hormonal therapy in female pattern hair loss, International journal of women’s dermatology, 2017, vol 3, issue 1, pp 53-57
6. Price, V.H., Androgenetic alopecia in women, Journal of investigative dermatology symposium proceedings, 2003, vol 8, issue 1, pp 24-27
7. Birch, M.P., et al., Female pattern hair loss, sebum excretion and the end-organ response to androgens, British journal of dermatology, 2005, vol 154, issue 1
8. Riedel-Baima, B., and Riedel, A., Female pattern hair loss may be triggered by low oestrogen to androgen ratio, Endocrine Regulations, 2008, vol 42, issue 1, pp 13-16
9. Oner, G., and Muderris, I.I., Efficacy of omega-3 in the treatment of polycystic ovary syndrome, Journal of obstetrics and gynaecology, 2013, vol 33, issue 3, pp 289-291
10. Nadjarzadeh, A., et al., The effect of omega-3 supplementation on androgen profile and menstrual status in women with polycystic ovary syndrome: a randomized clinical trial, Iran Journal of Reproductive Medicine, 2013, vol 11, issue 8, pp 665-672
11. Rajput, R.J., Role of non androgenic factors in hair loss and hair regrowth, Journal of Cosmetology & Trichology, 2017, vol 3, issue 2
12. Zanzottera, F., et al., Efficacy of a nutritional supplement, standardized in fatty acids and phytosterols, on hair loss and hair health in both women and men, Journal of Cosmetology & Trichology, 2017, vol 3, issue 2
13. Le Floc’h, C., et al., Effect of a nutritional supplement on hair loss in women, Journal of Cosmetic Dermatology, 2015, vol 14, issue 1
14. Zacchè, M., et al., Efficacy of myo-inositol in the treatment of cutaneous disorders in young women with polycystic ovary syndrome, Gynecological Endocrinology, 2009, vol 25, issue 8, pp 508-513
15. Rushton, D.H., Nutritional factors and hair loss, Clinical and experimental dermatology, 2002, vol 27, issue 5, pp 396-404
16. Olsen, E.A., et al., Iron deficiency in female pattern hair loss, chronic telogen effluvium, and control groups, Journal of the American Academy of Dermatology, 2010, vol 63, issue 6, pp 991-999
17. Rasheed, H., et al., Serum ferritin and vitamin D in female hair loss: do they play a role?, Skin pharmacology and physiology, 2013, vol 26, pp 101-107
18. Park, S.Y., et al., Iron plays a certain role in patterned hair loss, Journal of Korean medical science, 2013, vol 28, issue 6, pp 934-938
19. Amor, et al., Does D matter? The role of vitamin D in hair disorders and hair follicle cycling, Dermatology online journal, 2010, vol 16, issue 2, pp 3
20. Siah, T.W., Female pattern hair loss: a retrospective study in a tertiary referral center, International Journal of trichology, 2016, vol 8, issue 2, pp 57-61