When Does Postpartum Hair Loss Stop?

Pregnancy and Hair Changes

Pregnancy induces a variety of hormonal and metabolic changes vital to the development of the fetus. There are a plethora of downstream effects to these changes. Hair physiology is amongst those affected.

During pregnancy women often report thicker and healthier hair. Structurally, the hair shafts develop thicker diameters. Additionally, the anagen (growth) phase of the hair cycle lasts longer during pregnancy. A longer growth phase leads to increased length of the individual hairs in addition to a larger proportion of follicles in growth phase thus increased density.

The head isn’t the only place where hair growth is encouraged during pregnancy. Most pregnant women undergo some degree of hypertrichosis, or excessive hair on the body. Some of these hairs may disappear around 6 months after delivery.

What Happens During Delivery?

During delivery there is a sudden alteration in the hormonal levels in the body. It is theorized that this sudden change can lead to premature progression to telogen (rest) phase in a process called telogen effluvium. Telogen effluvium is a diffuse hair pattern loss which occurs a few months after a triggering event and is self-limited in time.

What Happens To The Increased Anagen Follicles From Pregnancy After Delivery?

As a result of the increased number of follicles in anagen during pregnancy, the telogen supply becomes seemingly more robust in post-partum. After delivery anagen cycle length shortens leading to further follicles in the telogen (rest) phase. This was seen in Gizlenti et al 2013 where comparison of women at 4-month postpartum vs time points during pregnancy demonstrated a lower anagen (growth) rate and higher telogen (rest) rate in the post-partum state. This is congruent with the perceived anecdote that hair quality during pregnancy is improved and with the postpartum perception of thinning hair. There is some evidence that these numbers may shift more towards growth in women that breastfeed.

Postpartum Telogen Effluvium

Anecdotal reports have suggested a more robust shedding consistent with telogen effluvium. Dubbed postpartum telogen effluvium, recent studies have questioned the actual incidence of telogen effluvium in the postpartum state. An analysis of the literature in 2015 suggests the incidence of telogen effluvium may be undetectable. The reality is, there are not enough studies to make a determination. The analysis was based on two studies with a minimal number of participants.

Postpartum telogen effluvium may be a clinically valid observation or an overestimation of what occurs. To date, postpartum telogen effluvium has not been supported by any serious evidence and requires further investigation.

Postpartum Effects on Hair

Irrespective of how it occurs, or what we call it, it is distressing. The hair loss, or perception of hair loss in the postpartum period can last several months to even a year after pregnancy.

Observational reports have suggested hair loss peaks at 4 months postpartum. The hormonal changes lead to a return of the hair shaft diameter and density to pre-pregnancy levels. Some have reported changes lasting up to 15 months after pregnancy.

The Mental Toll of Postpartum Hair Loss

This occurrence, perceived or real, can lead to psychological disruption during a vulnerable period of time. Given the incidence and prevalence of postpartum depression, all avenues should be pursued in pursuit of solutions towards better psychological health during the postpartum period. Many reports suggest significant correlations between changes in hair health and psychological health. This could potentially be an opportunity for future research.

If you are experiencing postpartum depression, speak to your provider about options. Find a person you trust and speak to them about your thoughts and feelings. Consider pursuing therapy as an option.

Possible Management Options

Management options are broad and should match each individual’s characteristic needs.

Hair Systems

Hair systems have come a long way from your uncle’s toupee and are viable options, particularly on a temporary basis.

Products

Optimization of hair maintenance products should be performed irrespective. Avoid heavy conditioners and focus any conditioning to the tips of the hair. Consider volumizing shampoos. As always, avoid sodium lauryl sulfate, sulfates, parabens and propylene glycol-based products.

Supplements

Supplements are being increasingly used for a variety of causes; hair health is no exception. As our knowledge as a society increases, relevant to the benefit of botanicals and the organo-nutrients they contain, we will continue to advance in this regard as a community. These should be reviewed with a provider particularly in women breast feeding or looking to become pregnant again.

Medications

A variety of medications have been used to slow hair growth. The FDA approved versions including oral finasteride and topical minoxidil. Variations of these have been used such as oral minoxidil and topical finasteride with varying degrees of success. Other categories such as prostaglandin analogues have also been used with varying success. All and any of these medications should be weighed against any risks that come along with taking these medications. These discussions should be had with your primary care provider in establishing a care plan that is right for you.

Procedures

Other agents which are more invasive procedures include platelet rich plasma, exosomes and hair transplantation. Platelet rich plasma and exosomes are still in their infancy. Caution should be practiced in utilizing these agents during the postpartum period given the lack of information on them thus far.

Hair transplantation is a viable option but should not be pursued for processes that lead to temporary hair loss. Postpartum hair loss while not well characterized is consistently noted to be self-limited. Intervening surgically during this period could possibly cause destruction of viable native grafts, the ethicality of which is questionable.

In Conclusion

Hormonal variation during pregnancy affects hair follicle physiology. During pregnancy hair is observed as being thicker individually and denser collectively. It is widely believed that hair suffers in quality and thickness during the postpartum period. The mechanism of this continues to be uncertain and requires further investigation. The psychological effects of hair loss can be damaging during the postpartum period. Management options exist, patients should take care to discuss these findings and potential options with their providers.