PCOS and hair loss: why it happens and how it is treated

Key takeaways

• The same androgens that cause acne and facial hair in PCOS can, at the same time, thin the hair on the scalp.
• Reports suggest a significant share of women with PCOS have some hair thinning, though most women with PCOS do not lose noticeable hair.
• Hair loss is often noticed only after a fair amount has already gone, so early assessment helps.
• Tablets that reduce androgen effects are prescription decisions with pregnancy precautions, and usually need contraception.
• Hair treatment works best alongside care for periods, weight, insulin resistance and fertility plans.

How does PCOS cause hair loss?

Polycystic ovary syndrome (PCOS) is a hormonal condition. Its main features include irregular or infrequent periods, signs of higher androgen levels such as acne and excess hair growth, and polycystic-looking ovaries on ultrasound. The NHS lists both excess hair growth (hirsutism) and hair loss among its main symptoms.

Women often say to me, "Doctor, this makes no sense. More hair on my chin and less on my head?" It does sound contradictory. See, what happens is, follicles in different parts of the body respond to androgens differently. Facial and body follicles are stimulated to grow thicker, darker hair. Genetically sensitive scalp follicles do the opposite. Their growth phase gets shorter and they shrink with each cycle, producing finer, shorter hairs. This is called androgenetic alopecia, or pattern hair loss.

In PCOS, the pattern is usually thinning at the crown and along the parting, with the front hairline intact. Some women also notice thinning at the temples.

How common is hair loss in PCOS?

Estimates vary widely. A patient guide in Contemporary OB/GYN cited reports ranging from 40% to 70% of women with PCOS, while noting that the true figure is not clearly defined. DermNet points out the other side: most women with PCOS do not lose hair, and most women with female pattern hair loss have normal hormone levels.

PCOS itself is common in India. Studies report a wide range, from around 4% to over 22% of women, depending on the population and the criteria used.

The same guide notes that hair loss is often noticed only after about 20 to 25% of scalp hair has gone. That is very important to understand. If you also have irregular periods or acne, take the early signs seriously: more hair in the comb, a wider parting, a thinner plait.

Which signs suggest PCOS is behind my hair loss?

If you have several of these, the hair loss is unlikely to be "just stress", whatever anyone has told you.

Which tests are needed?

The NHS describes blood tests for hormone levels and insulin resistance, and an ultrasound of the ovaries for women over 18, often arranged with a gynaecologist or endocrinologist. For the hair itself, I also check: - Iron stores (ferritin), particularly if periods are heavy when they do come - Thyroid function, since thyroid problems can cause shedding and irregular periods - Blood sugar or HbA1c, if insulin resistance is suspected

A scalp examination with a dermoscope helps confirm pattern thinning and rules out other causes. My guide to blood tests for hair fall explains each test.

How is PCOS hair loss treated?

Basically, we work on the hormones and the scalp together. All tablets below are prescription decisions made after assessment.

Managing androgen excess - Combined oral contraceptive pills with a low androgenic profile help regulate periods and lower androgen activity. The Contemporary OB/GYN guide notes that the pill combined with spironolactone is commonly used, and that either alone has limited value for hair. - Spironolactone blocks androgen effects. It is used off-label for hair. The guide describes slowing of hair loss over four to seven months. It needs monitoring, and it must not be taken during pregnancy. - Finasteride is sometimes used in women who are not planning pregnancy, always with reliable contraception, because it can affect a male baby's development. - Metformin helps insulin resistance and may be added, but the same guide notes it is not very useful as a primary hair treatment.

Treating the scalp directly - Topical minoxidil can be used alone or with tablets. The benefit fades if it is stopped. See minoxidil explained. - In-clinic treatments such as laser-assisted or mesotherapy sessions with growth-factor solutions are used alongside these medicines, not instead of them.

Lifestyle and weight The NHS recommends a healthy diet, regular exercise and weight loss if you are overweight, because these improve many PCOS symptoms. Strength training and enough protein (dal, paneer, curd, eggs, soya) help here. If weight is a major factor, medical weight loss may be discussed; see our weight loss programme. One caution from me: fast weight loss can itself trigger temporary shedding, so we plan the pace.

What if I want to get pregnant?

Then the plan changes, and I want to know on day one. Androgen-blocking tablets such as spironolactone and finasteride can affect a developing baby. The Contemporary OB/GYN guide advises stopping them at least four to six months before trying to conceive. Topical minoxidil is also avoided in pregnancy and breastfeeding. Tell your doctor about your plans at the first visit, so the hair treatment fits around your fertility care rather than working against it.

How we approach this at Dr Tvacha

PCOS hair loss is best treated by looking at the whole picture. At a Rs 499 hair diagnosis at our Thane, Andheri, Bandra or Dahisar centre, my team and I examine your scalp and ask about periods, skin, weight and pregnancy plans. Where hormones or fertility need specialist care, Dr Anagha Karkhanis, Gynaecologist and Fertility Specialist, sees women at Cocoon × Dr Tvacha in Thane. Hair treatment through the 5-Year Time Machine Hair Plan is quoted in writing first, and the decision is yours. See our hair page.

Written by

Dr Amit KarkhanisAesthetic Physician · MBBS, Dip. Dermatology (UK) · Reg. No. 2001/02/1124

Founder of Dr Tvacha, practising in Thane since 2005. Leads the weight loss and hair programmes.