PCOS, Medicine and Hair Loss

Name: Anonymous

Question: I am 37 years of age and have been diagnosed with PCOS.  I've been taking a cocktail of medicine since my freshman year of college to currently include the following:

spironolactone 100 mg 2x daily
metformin 500 mg 2x daily
b control ortho-novum 1/35 tabs 28
levothyroxine sodium 50 mg

My hormonal levels have been normalized, and have been from some time, but I have experienced some general thinning at the crown of my head.  Hair loss is at roughly 25% if not a little over that.

I have no children currently, but have considered becoming pregnant within the next 12 to 24 months.

I was hoping that there was some treatment that I could use to help rejuvenate hair growth on the crown of my head.  Any assistance would be greatly appreciated.

Answer: Hair loss in women is largely affected by hormonal changes. Polycystic Ovarian Syndrome (PCOS) and hair loss are both affected by hormones. PCOS develops when the body produces too many androgens, and hair loss is a common side effect of PCOS due to the excessive amounts of these male hormones.

The list of medicines you mentioned do not affect hair growth but the conditions they were prescribed for can cause hair loss. Levothyroxine, for example, is prescribed for an under-active thyroid and it is this condition that affects hair growth.

Normal hair growth usually resolves once the PCOS is under control. However, because your hair loss is continuing, and particularly as it’s localised to the crown and not diffusely spread, it may be that this medical problem has triggered an inherent genetic trait that makes you susceptible to hair loss. Female pattern hair loss is relatively common among post-menopausal women, but many factors can instigate an earlier onset, such as PCOS.

Once PCOS is being effectively managed, the treatment most likely to provide women with the best opportunity for hair loss stabilisation and regrowth is minoxidil. It is the only product available that is medically and scientifically proven to stabilise female genetic hair loss and stimulate renewed hair growth and is also highly successful in treating other forms of women’s hair loss. However, minoxidil is a dose-dependent medication, so you’ll need to consult a hair loss specialist on which strength you’ll need and find out whether a combination of hair growth boosters will provide beneficial support for the treatment.

If you decide to try for a baby, you can continue applying minoxidil up to the point of conception, but no studies have been conducted to ensure that it is safe to use after the second trimester. You will have to stop the treatment throughout the pregnancy but during that time oestrogen hormone levels are high and hair is usually in prime condition anyway. You can resume the treatment after the birth, or once you finish breastfeeding.