PCOS and Hair Loss: How to Keep Your Hair Healthy and Strong

Shedding a few strands of hair every day is normal. But when you start seeing more than just a few strands on your pillow or in the shower, it can be distressing to just about anyone. Common causes of hair loss in women include stress, poor nutrition, chemical treatments, genetic predispositions, and hormonal changes. But a lesser-known cause of hair loss in women is polycystic ovarian syndrome, or PCOS. In this article, you’ll learn how PCOS causes hair loss and my top recommendations for slowing down or even reversing PCOS-related hair loss.

What is PCOS?

PCOS is a hormonal condition that affects about 1 in 10 women of childbearing age.1 Women with PCOS often have higher than normal levels of androgens, which can lead to symptoms like:2,3

• Irregular periods
• Acne
• Excess hair growth on face and body
• Infertility
• Large or polycystic ovaries

And yes, female-pattern hair loss, also known as androgenetic alopecia, is a reported symptom of PCOS. In fact, female-pattern hair loss is the most common condition leading to hair loss in adult women.4 You might recognize the term “androgenetic alopecia,” which is also used for male-pattern baldness. Despite the shared use of the term, the distribution of hair loss differs between men and women. Men tend to lose hair in the mid-frontal, temporal, and vertex regions of the scalp. On the other hand, women tend to experience thinning in a “Christmas tree pattern,” in which hair thins along the midline part of the hair. Some women may experience diffuse thinning across the central scalp.5

How Does PCOS Cause Hair Loss?

The three leading contributing factors for PCOS-related hair loss are hormone imbalance, insulin resistance, and inflammation.

Hormone Imbalance

One of the main reasons women with PCOS may experience hair loss is hormone imbalance, namely hyperandrogenism, or excess levels of androgens. Hyperandrogenism is the defining characteristic of PCOS, affecting 60 to 80% of women with the condition.6 There are five types of androgens in women:

• Dehydroepiandrosterone sulphate
• Dehydroepiandrosterone
• Androstenedione
• Testosterone
• Dihydrotestosterone (DHT)

Androgens play various vital roles in the female body, including in the production of estrogens. Under normal conditions, an enzyme called aromatase transforms testosterone into estradiol. Together, testosterone and estradiol maintain the balance of the female reproductive endocrine system.7 What does all of this have to do with PCOS-related hair loss?  Androgens are the main regulators of human hair growth.8 Paradoxically, they can also inhibit specific scalp follicles. Excess DHT is the main culprit behind hair follicle miniaturization (shrinkage) in androgenetic alopecia. To be more specific, your hair cycles through 4 phases:

• Anagen phase, or the growth phase
• Catagen phase, a transitionary period during which active hair growth ends
• Telogen phase, in which strands aren’t actively growing but remain in their follicles
• Exogen phase, in which hair strands are released from their follicles and shed

In a healthy body, approximately 90% of hair follicles are in the anagen (growth) phase.9 When there’s too much DHT around, the increased stimulation of hair follicles actually shortens the anagen phase of your hair. Because of the shorter growth cycle, hair is shed faster than it can grow back. This is why many women with PCOS also experience hair loss. 

Estrogen and Progesterone in Hair Loss

If you’ve gone through a pregnancy, you may have noticed that your hair was thicker and fuller. That’s because estrogen levels rise during pregnancy, and estrogen is also known for prolonging the anagen phase.10 Higher estrogen levels also increase sex hormone-binding globulins (SHBGs), which bind up androgens and remove them from circulation. Progesterone can also influence hair growth by blocking the activity of an enzyme called 5-alpha reductase (5AR). This is important because 5AR is responsible for converting testosterone to DHT.11 Women with PCOS may have normal or elevated levels of estrogen, but they often have low progesterone. That’s because women with PCOS don’t ovulate, which is required for the production of progesterone.

Insulin Resistance

Insulin resistance occurs when the cells in your muscles, fat, and liver don’t respond normally to the hormone insulin. Because of the weak response from your cells, your blood glucose level rises, forcing your pancreas to produce more and more insulin to overcome it. Over time, insulin resistance can lead to:

• Prediabetes
• Type 2 diabetes
• Obesity
• Cardiovascular disease
• Metabolic syndrome

Insulin has also been shown to be involved – directly and indirectly – in the development of PCOS. Its synergistic actions with luteinizing hormone results in testosterone circulating in its unbound, active form.12 Insulin resistance is also linked to increased inflammation in the body.13 And increased inflammation leads to more insulin resistance, creating a vicious cycle. As you can see, insulin resistance can have devastating effects on your hair and overall health. That’s why optimizing insulin levels should be a core focus in treating PCOS and PCOS-related hair loss.

Inflammation

Another hallmark of PCOS is chronic, low-grade inflammation.14 As discussed above, more inflammation can lead to insulin resistance, type 2 diabetes, and other serious health outcomes – all of which are common in women with PCOS. Although male- and female-pattern hair loss has traditionally been thought of as unrelated to inflammation, recent research studies have found that inflammation may trigger the earliest events in the disease pathway.15 Inflammation also impacts hair growth by promoting the progression from anagen phase to telogen phase.16 Studies suggest that inflammation decreases the anagen to telogen ratio from 12:1 (normal) to 6:4 or 5:5.17 If you’ve been diagnosed with PCOS, minimizing inflammation should be at the forefront of your treatment plan. By getting inflammation under control, you may find that your insulin resistance and hormonal imbalance(s) improve as well.

How to Stop PCOS Hair Loss Naturally

Here are my top recommendations to get you started on treating hair loss due to PCOS.

Optimize Your Menstrual Cycle

I recommend working with a women’s hormone specialist to optimize your hormone balance. A proper hormonal balance serves as the strong foundation for you to naturally restore ovulation and the menstrual hormones that create healthy, full hair. Critical to this foundational support are:

• Balancing blood sugar levels
• Avoiding high stress
• Sleeping and waking at a regular schedule
• Cycle syncing
• Supporting your liver and gut health
• Building and maintaining a lean muscle mass

Eat a Well-Balanced, Whole-Food Diet

The vast majority of women with PCOS consume a diet deficient in many key nutrients, including:18

• Fiber
• Omega-3
• Calcium
• Magnesium
• Zinc
• Vitamins C, B12, and D

If you’re looking to gain control of insulin resistance, I recommend eating a well-balanced, whole-food diet with the key nutrients listed above. It’s particularly important that you avoid highly processed foods. Although there’s no one ideal diet that fits everyone, research suggests that a reduced-calorie, low-glycemic index diet may help manage symptoms of PCOS. A review of 10 randomized clinical trials found that low-glycemic index diets improved various markers of metabolic health, including insulin sensitivity, total and “bad” cholesterol levels, and triglyceride levels.19

Get Regular Exercise

Exercise causes temporary damage to muscles, unleashing an inflammatory response from the body. But this is a good thing, according to a recent Harvard study. Scientists found that exercise is a natural way to boost your body’s own immune responses to cool inflammation.20 Furthermore, exercise has been shown to improve insulin sensitivity in women with PCOS.21 The Androgen Excess & PCOS Society recommends at least 150 minutes of moderate activity or 75 minutes of vigorous activity per week to maintain your current weight. If you need to lose weight, they recommend at least 300 minutes of moderate activity or 150 minutes of vigorous activity per week.22 It’s also important to engage in strength training at least two times a week. Increased lean muscle mass can help improve insulin sensitivity and lower inflammation, making exercise a powerful way to help manage PCOS symptoms.23,24

Natural Remedies That Stop or Reverse Hair Loss

Herbal and other natural remedies can be used to stop or reverse hair loss naturally. Here are some of my favorites:

• Stinging nettle root: Stinging nettle root blocks 5AR activity, which prevents the conversion of testosterone to DHT. It also contains a constituent called beta-sitosterol, which has been shown to help treat androgenetic alopecia in men.25
• Saw palmetto: This hearty palm has been used for hundreds of years to relieve a variety of ailments, including male- and female-pattern hair loss. Saw palmetto is rich in fatty acids, phytosterols (including beta-sitosterol), beta-carotene, polysaccharides, and more.26 Studies show that fatty acids in saw palmetto directly inhibit 5AR activity and decrease DHT’s receptor binding capacity by nearly 50%.27 One review of 7 studies found that saw palmetto improved overall hair quality in 60% of the participants who used it to treat hair loss.28
• Spearmint: Spearmint exhibits antiandrogenic properties in women, which may help improve hormonal imbalance in women with PCOS. In one 30-day study, women who drank spearmint tea showed significant reduction in free and total testosterone levels. The subjects also reported less facial hair (hirsutism), though the study duration was not long enough for investigators to confirm this benefit using an objective rating scale.29
• Reishi: Widely known as the “mushroom of immortality,” reishi has numerous health benefits. Women with PCOS-related hair loss may be particularly interested in reishi’s anti-androgenic effects, which are accomplished by reducing 5AR levels.30
• Omega-3 fatty acids: Several studies indicate omega-3 fatty acid supplementation may help with hair loss. A 2015 study involving 120 participants showed that those who took omega-3 and omega-6 fatty acid supplements had more hair in the active growth phase compared to the control group.31
• Fenugreek: This versatile herb can counteract the effects of proinflammatory cytokines and reduce hair loss by intervening in the anagen-to-catagen and catagen-to-telogen phases of the hair cycle.32 A trial involving 60 men and women demonstrated that fenugreek seeds may improve low to moderate hair loss.33
• Peony: Traditional Chinese and Korean herbalists have long admired peony for its anti-inflammatory effects and its ability to stabilize hair loss in people deficient in the “essence of blood.”34
• Licorice: Constituents of licorice include isoflavonoids, flavonoids, and tritepenoid glycosides, all of which are highly regarded in the cosmetic industry.35 A review of 22 studies found that licorice exhibits some antiandrogenic properties, which may benefit women diagnosed with PCOS.36
• Amla: Also known as Indian gooseberry, amla has been used as a hair tonic in traditional Persian medicine. Investigators of one randomized clinical trial reported that Amla syrup significantly increased the anagen-to-telogen ratio in women with female-pattern hair loss.37

As always, consult with your healthcare provider before starting any herbs or supplements.

Stop Hair Loss From PCOS With a Women’s Hormonal Health Specialist in Boston

Mild hair loss may not seem like a big deal to most, but many women with PCOS feel that it negatively affects their self-esteem, daily activities, or relationships. If you’re suffering from PCOS and hair loss, you’re not alone. And you may be able to slow it down or stop it from getting worse. Talking to a women’s hormonal health specialist can help clarify what’s causing your hair loss and which treatment options are available. It’s important to identify the root cause of your hair loss. If you’re feeling lost or unsure of where to begin, schedule a 15-minute complimentary consultation to learn more.