Where Did All My Hair Go?

Postpartum Telogen Effluvium By Teri Brown

Female hair loss is a relatively common condition experienced by women who have given birth. Understanding hair loss is important, as it can take some of the fear out of finding handfuls of hair in the hairbrush, shower drain and even in the fists of your curious newborn.

"A few months after I delivered my twins, I started noticing a lot of hair in my hairbrush," says Jennifer Hans, mother of three from Fort Wayne, Ind. "The brush, which I cleaned only occasionally in the past, needed to be cleaned every three or four days. It seemed like I was losing a ton of hair!"

Although Hans' hair loss didn't become visually noticeable, there are other women who aren't so lucky. Tenna Perry of Porter, Texas, saw definite signs of a receding hairline and the hair at the crown of her head was also visibly thin.

"It wasn't possible to brush my waist length hair without cleaning the hair out of the brush at least once," says Perry. "The drainage in the bath was a problem because of the hair clogs that would accumulate with each washing. I never realized how much hair I had until I started seeing it coming out on its own!"

Defining Postpartum Hair Loss
A general thinning of the hair, occurring during a period of months, is a medical condition known as telogen effluvium. It is most often caused by a traumatic physical event such as childbirth. The event results in a disruption of the normal hair cycle and subsequent shedding of the hair.

Dr. Thomas J. Waliser, a physician at The Russell Center for Women in Englewood, Colo., says that in order to understand telogen effluvium, we must understand the cycle of healthy hair growth. According to Dr. Waliser, normal hair growth occurs in three cycles:

• The Anagen Phase – The cells of the hair bulb actively divide and produce a growing hair. This phase lasts two years to six years for individual hairs. Normally, approximately 85 percent to 90 percent of all scalp hairs are in this phase.
• The Catagen Phase – The hair stops to grow and the lower portion of the follicle involutes during a two-week span
• The Telogen Phase – This is the resting phase of the cycle. The hair is no longer growing but remains loose in the hair shaft until it falls out. The Telogen phase lasts three to four months.

"During pregnancy, an increased percentage of scalp hairs are in the Anagen, or growing, phase," says Dr. Waliser. "Patients perceive thicker hair because decreased numbers of hairs are entering the Catagen and Telogen phases."

Under normal circumstances, the average person loses about 100 hairs each day. But according to Dr. Waliser, after a woman gives birth, there is a rapid change in these phases and appreciable hair loss occurs as a large number of follicles shed at once. This is termed telogen effluvium. It usually occurs one to five months postpartum and ceases within 15 months as follicles gradually revert to the Anagen growth phase.

A Self-Correcting Condition
Dr. Michael D. Randell, an obstetrician at Northside Hospital in Atlanta, Ga., sees telogen effluvium in about 10 percent of his patients.

He believes that, in general, telogen effluvium is self-corrective, and no treatment is necessary, as it typically disappears after about 15 months postpartum. "Chronic or persistent telogen effluvium requires a medical evaluation to rule out androgen alopecia (male and female pattern baldness) or other metabolic or disease states," says Dr. Randell.

The Breastfeeding Myth
Many women mistakenly connect nursing to their hair loss, because the condition begins several months after giving birth. Nothing could be further from the truth, says Dr. Randell. "Nursing does not have anything to do with telogen effluvium," says Dr. Randell. "Nursing mothers do notice a lot of hair falling out about the second or third month after delivery, but this is not because of breastfeeding. It is due to the stressful event of childbirth."

The most important thing to remember about telogen effluvium is that it is a temporary condition and soon your hair will be growing again.

Jennifer Hans' twins are now ready to celebrate their first birthdays, and she is beginning to notice a definite slowing in her hair loss. "I still clean my brush more often than I did in the past, though," says Hans. "Once in a while, I see one of my babies clutching a few stray hairs in their tiny little hands. That used to bother me, but there wasn't much I could do about it. I suppose this, too, shall pass."

Want to see more?

• Preparing for Postpartum Life: The Joys and Challenges of Life After Delivery
• iParenting Beauty & Wellness
• Terrific Tresses: Pregnancy or Not – You Can Have Great Hair!
• Hair's the Real Story: Expert Advice From Colorist and Salon Owner Shane Talbott
• Talk about it!

About the Author: Teri Brown is a senior contributing writer for iParenting.com.