Tolerating a range of side effects caused by contraceptives can all just feel part and parcel of being a woman. But hair loss might just feel like a step too far. We take a look at the phases of hair growth, the science behind the contraceptive pill and hair loss, and how some contraceptives could actually do the exact opposite – hello long, luscious locks!
TL;DR: what’s the lowdown?
- Hair loss can have a myriad of causes, so consult your doctor for a diagnosis
- The progestin in hormonal contraceptives has the ability to be androgenic and may cause hair loss as a result
- Oestrogen in combined methods could have the benefits of improving hair thickness
What is hair loss?
Removing small bundles of hair from the plughole post-shower or cutting long strands free from the hoover may be a common occurrence for a lot of us. The regularity at which we carry out this somewhat icky chore may not be that surprising when you consider we all lose between 50 and 100 hairs a day. But for some, hair loss can happen on a much more severe – and distressing – level.
Alopecia is the medical term given to describe hair loss. It is a general term used to cover all types of hair loss; from diffuse thinning, where there is a general loss of hair across the whole scalp, to localised hair loss, a condition only affecting specific patches.
Finding hair on your pillow or noticing a bald patch can be emotional, to say the least. But hair loss is not usually a sign of anything serious, although it can be an indicator of an underlying issue. Causes can be wide-ranging, from hormonal imbalances or illness to cancer treatment or stress. Pinpointing the cause is crucial to receiving the right treatment, which is why a diagnosis from your GP is so important.
What are the stages of hair growth?
The hair growth cycle involves four phases:
- Anagen, or growth phase
- Catagen phase
- Telogen, or dormant phase
- Exogen phase
In the first phase of the growth cycle, hair will grow approximately 1cm a month for around 3 to 5 years. The length of the phase varies between individuals and for different areas of the body. Eyebrow hairs will have a much shorter anagen phase, for example, hence why they don’t grow as long as the hair on your head!
Next, we move to the catagen phase. This only lasts around 10 days; hair growth slows, the follicle shrinks, and the hair detaches from the follicle, although it remains on the scalp.
The telogen phase lasts a little longer, at around 3 months. The hair no longer continues to grow, but a new hair will start to form in the follicle.
The final phase involves the shedding of the hair and continues for between 2 and 5 months. This is the phase in which50-100 hairs a day will fall out!
Hair loss and stress on the body
When a trigger such as childbirth, illness, or a major trauma occurs, an increased number of hairs move from the growing phase to the telogen phase resulting in an increase in hairs shed over this time. This is called telogen effluvium. Hair will generally appear thinner with less volume and is most commonly seen in women 1-3 months after giving birth. Hair will grow back and will return to its pre-baby thickness after a few months, but contact your doctor if your hair continues to thin.
Other common triggers of telogen effluvium include significant weight loss and extreme dieting, or starting new medication, however no cause is found in around a third of people diagnosed with telogen effluvium. Hair volume will gradually return to normal after a few months but can recur if the underlying trigger returns or is not treated.
Let’s talk about androgens
Androgens are hormones typically associated with men, with testosterone, perhaps, the most famous of the androgens. So, why are we talking about them in relation to female contraception? Despite their well-known relationship with the male body, they are also found in lower quantities in women and play a crucial role in the female body.
PCOS and hair loss
The most common form of alopecia in women is female pattern hair loss (FPHL). Due to both genetic and hormonal influences, affected follicles produce hairs that become shorter and smaller, and lighter in colour. Ultimately, these follicles completely shrink and no longer produce hairs.
Polycystic ovary syndrome can give rise to elevated androgen levels and can result in FPHL. Whilst there is currently no cure for PCOS, symptoms, such as hair loss, can benefit from topical or oral treatments
What does all this have to do with the pill?
The combined contraceptive pill contains artificial versions of oestrogen and progesterone. The synthetic form of progesterone is called progestin. This has the ability to be androgenic, meaning it can create an androgenic response, triggering symptoms such as hair loss, hirsutism (abnormal hair growth) and acne or oily skin to name a few.
Androgens play a major role in the regulation of hair follicles; in puberty, they trigger pubic hair growth in both men and women. But, due to their ability to alter the growth phase of a hair and the length of time the hair is in this phase, the progestin in the pill, and its androgenic response, may have the potential to cause hair loss.
Can all contraceptive pills cause hair loss?
Because progestin is the possible culprit, the progestogen-only pill (aka mini- pill), as well as the combined contraceptive pill, both have the potential to cause hair loss as a side effect.
But it’s not necessarily that simple. Hormonal contraceptives can often be talked about collectively, but they can still vary hugely in terms of their side effects due to their differing active ingredients, and in this case, their androgenic effects.
One user of The Lowdown left a review of her experience with Cerazette (the progestogen only pill):
“Slightly more hair loss from my head but not hugely noticeable or impactful. Just more falls out when I brush it”
One Lowdown user told us about her experience with Microgynon:
“Really good with mood and balancing side effects. Only negative was skin and hair loss. My hair thinned to less than half the volume it was before so I am coming off it to go on something else. My skin was ok but more spotty than my previous pill.”
The Lowdown’s guide to androgens explains the complexities regarding data on androgenic activity. Whilst we know the potential effects of androgens in the body, a lot more research is needed to determine a greater understanding of the role hormonal contraceptives may play in causing hair loss.
Can contraceptives improve hair growth?
There is no doubt hormones play a vital role in the hair growth cycle and the follicle structure. We’ve looked at the possible effects of progestin, but combined hormonal contraception contains another component: oestrogen. This is also known to impact hair growth and is usually credited with the changes experienced in pregnancy. During this time, hair can be thicker and fuller due to an extension of the growth phase. Combine this with a reduction in hair shedding and an increase in hair diameter and many women will notice more voluminous hair whilst pregnant.
Menopause can also have an impact on a woman’s hair growth. With reduced levels of oestrogen and a change in oestrogen and androgen production, women may experience female pattern hair loss during this time.
Does this mean, then, that the oestrogen in our contraceptives could have beneficial effects on our hair? Possibly. Some women do find their hair appears thicker whilst using combined contraception. Women may also therefore experience some ‘hair loss’ when they stop using this method and their hair returns to normal.
One The Lowdown user wrote of her experience with Lucette:
“My skin is clear, and I have not put on any weight which is great. I think this pill tricks your body into thinking it’s pregnant, so makes your hair nice and shiny, boobs grow etc. The down side is the slight loss of sex drive and I would sometimes get upset over nothing.”
Hormonal changes are complex and as such can make pinpointing exact causes difficult. Oestrogen is thought to work by extending the hair growth phase whilst also reducing androgens and thereby their ability to cause hair loss. The combined contraceptive pill is therefore particularly useful for helping treat hair loss and thinning associated with PCOS.
More research is needed!
Unfortunately, and maybe not surprisingly, this women’s health issue needs more research. The psychological and emotional impacts of hair loss on a woman can be devastating, and the link between hormonal contraception and the hair growth cycle should be explored further.
Discovering contraceptive side effects experienced by others can be hugely beneficial in making the right choice for you, and The Lowdown is a great place to access this information. Read reviews submitted by our incredible community or book an appointment with our Ask A Doctor service, where Dr Mel and Dr Fran are available to discuss your concerns and queries.
If you’ve noticed changes to your hair whilst using contraception please leave a review! We’ve noticed many of you commenting about this in your reviews and have recently added a specific section on our review form so we can collect more data!
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