Postpartum hair loss, classed as ‘telogen effluvium’, is a fairly common phenomenon that is estimated to affect between 40-50% of women after giving birth. As telogen effluvium-type hair loss typically occurs in response to some systemic shock, such as physical injury, sepsis, childbirth or emotional trauma, it is generally temporary in nature and can be reversed (although the timeframe of this may vary depending on the causes and extent of the trauma).
Causes of Postnatal Hair Loss
Most women will notice a marked difference in hair quality during pregnancy versus post-parturition. This is due to changes in female hormone activity that affect the hair cycle. A normal hair cycle consists of the anagen ‘growing’ phase, the ‘transitional’ catagen phase and the final ‘resting/shedding’ telogen phase(1,2), with these lasting an average of 3-5 years, 2 weeks and 3-6 months, respectively(2,3). During pregnancy, elevated levels of oestrogen(4) prematurely push the hair follicles into catagen and the early ‘resting’ stage of telogen for an extended period of time(1,5). This means the hair does not fall out as per normal. Significant increases in circulating maternal blood volume also result in thickening of new hair due(3) to increased nutrient delivery to the hair follicles. This combination of factors gives the impression of a fuller, thicker head of hair during pregnancy.
After childbirth however, there is a significant drop in hormone levels(4,6) as the body slowly
regulates back to normal levels. This means that all the extra hair that was kept on the head during
pregnancy (beyond its original lifespan) will now fall out as the normal hair cycle resumes.
This can seem scary, as for some women the hair may thin beyond your pre-pregnancy density or, in some cases, recede slightly at the temples, or even show glimpses of the scalp.
How Long Does Hair Loss Last After Having a Baby?
Postpartum hair loss commonly peaks around four months following childbirth and tends to last between 1-5 months(7), although it is not uncommon for women to experience hair loss up to one year (or even two years) after giving birth, depending on various factors such as whether they are breastfeeding, the quality of their nutrition, sleeping patterns, stress, and more.
Hair Loss and Breastfeeding
If you are breastfeeding, your hair loss may take a little longer to settle back to normal levels due to changes in the delicate balance of hormones such as oestrogen and progesterone. Oestrogen is high during pregnancy(8,9), but its levels drop after birth(6,9), while prolactin hormone increases(9) to stimulate milk production in preparation for breastfeeding. Continued breastfeeding will maintain high prolactin concentrations and suppress oestrogen and progesterone, and this imbalance in turn will suppress hair growth(9,10). Once you stop breastfeeding, oestrogen and progesterone levels should start to regulate again and hair loss should stabilise(9,10), provided there are no other factors contributing to your hair loss.
Hair Loss and Nutrition
Nutrition is an important component in the wellbeing of mother and baby. It is crucial not only during pregnancy, but also after birth as the body goes through the process of healing and milk production. Lack of sufficient vitamins and minerals may contribute towards prolonged hair loss because the body prioritises delivery of limited nutrients to the organs over expendable traits such as the hair and nails. Increased intake of nutrients is therefore required to bridge this deficit.
Hair Loss and Stress
Stress is another factor recognised to play a major role in hair loss. As a new mother, stress may be an inescapable fact of life, particularly if your baby is not sleeping through the night or
you suffer from interrupted or poor quality sleep.
When the body is under stress, the adrenal glands produce and release cortisol. This is a steroid hormone that stimulates release of adrenaline, leading to the well-recognised ’fight-or-flight’ response. Studies have shown lack of sleep can increase cortisol production the following evening(11) – meaning it becomes harder to fall asleep when you are suffering from sleep deprivation because the body becomes alert.
In modern society, stress is a fairly ubiquitous phenomenon that affects people of all ages and backgrounds. Compounding of stress can lead to sustained high cortisol levels, which may suppress production of other hormones required for healthy hair growth. Over an extended period of time, overproduction of cortisol may eventually tire out the adrenal glands and result in the system underproducing cortisol and other hormones(12), which may again lead to hair loss. Long-term stress is also associated with various other health conditions(12,13) such as an impaired immune response, impaired cognitive function, slower metabolism and decreased cell generation.
Postpartum hair loss treatment
Generally speaking, postpartum hair loss should gradually resolve within 6-12 months, although it can take longer depending on factors such as duration of breastfeeding, stress, lack of sleep, poor nutrition, whether you suffered from hair loss before giving birth, and more.
We have ample experience treating women with postpartum hair loss as well as women who reportedly did not have any issues prior to giving birth, but whose hair did not return to its pre-pregnancy thickness or who suffered from lingering hair loss some years later.
- Hu H-m, Zhang S-b, Lei X-h, et al. Estrogen leads to reversible hair cycle retardation through inducing premature catagen and maintaining telogen. PloS one.2012;7(7):e40124. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0040124
- Stenn KS. Molecular insights into the hair follicle and its pathology: a review of recent developments. International Journal of Dermatology. 2003;42(1):40-43. https://www.ncbi.nlm.nih.gov/pubmed/12581142
- Nissimov J, Elchalal U. Scalp hair diameter increases during pregnancy. Clinical and experimental dermatology. 2003;28(5):525-530. http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2230.2003.01331.x/full
- Montelongo A, Lasunción MA, Pallardo LF, Herrera E. Longitudinal study of plasma lipoproteins and hormones during pregnancy in normal and diabetic women. Diabetes. 1992;41(12):1651-1659. http://diabetes.diabetesjournals.org/content/41/12/1651
- Ohnemus U, Uenalan M, Inzunza J, Gustafsson J-Ak, Paus R. The hair follicle as an estrogen target and source. Endocrine reviews. 2006;27(6):677-706. https://academic.oup.com/edrv/article/27/6/677/2355194
- Buckwalter JG, Stanczyk FZ, McCleary CA, et al. Pregnancy, the postpartum, and steroid hormones: effects on cognition and mood. Psychoneuroendocrinology. 1999;24(1):69-84. https://www.ncbi.nlm.nih.gov/pubmed/10098220
- SCHIFF BL, KERN AB. Study of postpartum alopecia. Archives of dermatology. 1963;87(5):609-611. https://jamanetwork.com/journals/jamadermatology/article-abstract/527997
- Wuu J, Hellerstein S, Lipworth L, et al. Correlates of pregnancy oestrogen, progesterone and sex hormone-binding globulin in the USA and China. European journal of cancer prevention. 2002;11(3):283-293. https://www.ncbi.nlm.nih.gov/pubmed/12131662
- Bonnar J, Franklin M, Nott P, McNeilly A. Effect of breast-feeding on pituitary-ovarian function after childbirth. Br Med J. 1975;4(5988):82-84. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1674910/pdf/brmedj01468-0026.pdf
- Dorrington J, Gore-Langton RE. Prolactin inhibits oestrogen synthesis in the ovary. Nature. 1981;290(5807):600-602. https://www.ncbi.nlm.nih.gov/pubmed/6783964
- Leproult R, Copinschi G, Buxton O, Van Cauter E. Sleep loss results in an elevation of cortisol levels the next evening. Sleep. 1997;20(10):865-870. https://watermark.silverchair.com/sleep-20-10-865.pdf
- Miller GE, Chen E, Zhou ES. If it goes up, must it come down? Chronic stress and the hypothalamic-pituitary-adrenocortical axis in humans. American Psychological Association; 2007. https://cpb-us-e1.wpmucdn.com/sites.northwestern.edu
- Meerlo P, Sgoifo A, Suchecki D. Restricted and disrupted sleep: effects on autonomic function, neuroendocrine stress systems, and stress responsivity. Sleep medicine reviews. 2008;12(3):197-210. http://www.smrv-journal.com/article/S1087-0792(07)00098-6/fulltext