This story is a part of The Truth About Hair Loss, an exploration into why we lose our hair, the emotional and monetary costs that come along with the experience, and what the future of treatment (and acceptance) could look like.
A week or so after losing a pregnancy I very much wanted, I began to notice patches of hair loss near my hairline. A day or so later, another discovery: a larger-than-normal amount of hair collecting at the base of my shower, and more and more hair being pulled from the bristles of my brush. Instantly, panic set in. Having felt like I already failed to uphold a societal standard thrust upon women and femme-presenting people (though it's worth noting that people all along the gender spectrum want to, and do, get pregnant) of carrying my pregnancy to term, feeling anxious and overwhelmed became my defacto state as I started to contemplate the ramifications of losing my hair, too.
I had lost what I considered to be a significant amount of hair after the birth of my son years earlier. While also alarming and objectively icky, my OB-GYN — as well as countless online mom groups and a few been-there-done-that friends — had warned me that this was common, and to be expected. Like other less glamorous potential postpartum experiences — depression, anxiety, incontinence — postpartum hair loss has become more of a mainstream topic, helping new moms like myself wade into new parenthood with a more realistic set of expectations. My reaction was more leveled, as I could quickly identify what was happening and why; the mental health ramifications of losing my hair at a time of such significant and jarring change, stifled.
A reported one out of every four pregnancies will end in a miscarriage, yet how our bodies change post-miscarriage is rarely discussed — just like pregnancy loss itself. And under a veil of secrecy, where stories are only shared in hushed whispers if at all, a culture of stigma, shame, self-doubt, and confusion has thrived. Given how little most people know about miscarriage, from the causes to its commonality, it's no wonder my innate reaction to post-miscarriage hair loss was to blame my body for another perceived failure. In reality, it was simply reacting to a traumatic event.
Why does post-miscarriage hair loss happen?
"Any stressor — be it physical, emotional or both — can have some negative effects on skin and hair," says Amy Wechsler, a board-certified dermatologist and psychiatrist practicing in New York City. "When it comes to hair, any stressor can cause something called telogen effluvium, which happens when more of the hairs are shifted into the resting phase [of hair growth] than usual."
There are four phases of hair growth: anagen, the growth phase; catagen, the transition phase; telegen, the resting phase; and exogen, considered to be an extension of the resting phase, also known as the shedding phase. Typically, the resting phase lasts around three months, but in the case of a traumatic event, more hairs can suddenly shift into the resting phase, thus causing more hairs to shed.
"Usually, every day we lose about 80 to 100 hairs that go into the resting phase and shed," explains Wechsler. "And when you have telogen effluvium you could lose hundreds. So there's nothing wrong with the hair, it's just that too many are being shifted into the resting phase. That happens after a lot of different stressors — miscarriage is one of them."
There are two additional reasons why someone may lose their hair after pregnancy loss: alopecia areata and trichotillomania.
"A variety of factors are thought to cause alopecia areata, possibly including severe stress. With alopecia areata, white blood cells attack the hair follicle, stopping hair growth and making hair fall out," says Hadley King, a board-certified dermatologist based in New York City. "Trichotillomania is an irresistible urge to pull out hair from your scalp, eyebrows, or other areas of your body. Hair pulling can be a way of dealing with negative or uncomfortable feelings, such as stress, anxiety, tension, loneliness, fatigue or frustration."
The mental health ramifications of pregnancy loss have been well documented. Nearly 20 percent of people who have miscarried will experience symptoms of anxiety and/or depression, some persisting for one to three years. And one 2019 study of 650 women, by Imperial College London and KU Leuven in Belgium found that one in six women who lose a baby in early pregnancy will experience post-traumatic stress symptoms.
As hair loss can increase anxiety, it's not uncommon to feel trapped in a vicious cycle that could lend itself to more unwanted hair loss. "The additional loss of hair often leads to self-doubt and affects a person’s self-esteem," says Mina Guirguis, a licensed clinical psychologist and founder of the Emotional Wellness Center for Skin Disorders. Guirguis says it's common for people to experience negative thoughts associated with hair loss, including the belief that their partner "will not accept me looking like this," as well as a sense of being rejected by others due to their appearance. "Such negative thoughts will often be associated with negative emotions, such as depression and anxiety," Guirguis added, which can, in turn, cause more hair to enter the resting phase.
What occurs to and inside our bodies impacts our mind, and how our mind reacts can, in turn, impact what occurs to and inside of our bodies.
"All you have to do is go back to embryology — the skin and the brain, or the central nervous system, are formed by the same layer of cells," explains Wechsler. "So of course they're inter-connected; they have multiple vascular and nerve interconnections because they're actually created from the same layer of cells from early on in an embryo formation."
How can I treat post-miscarriage hair loss?
While it's common to have a visceral reaction to unexpected and unwanted hair loss, it's best to keep in mind that any hair loss as a result of a traumatic event, i.e. miscarriage, is not likely permanent.
"Know that it's just going to be temporary," Wechsler explains. "So just having hope and knowing that the woman is not going bald. Women worry, like, 'Oh my god I’m losing all my hair.' You're not. Know that you're not — it's temporary."
Easier said than done, of course, which is why Wechsler also suggests some arguably more practical solutions that could help stimulate hair growth and slow down the amount of hairs that shift from the transition phase to the resting and shedding phase.
"Getting enough sleep is very key," she says. "We heal in our sleep." Cortisol, also known as the "stress hormone," is at its lowest in a person's body when they're sleeping, while the pituitary gland releases the highest number of growth hormones, allowing a person's body to heal and grow. Finding other ways to minimize cortisol output in the body, be it exercising, connecting with a friend or family member, breathing exercises, meditating, or listening to music can also be very helpful.
Iron deficiencies have also been associated with hair loss, and as some people lose a significant amount of blood during miscarriage, it may be helpful to "make sure you're not anemic by [running] some labs, checking your thyroid," Wechsler suggests. If so, those issues can easily be rectified by medications and other diet changes that your doctor can recommend.
While some suggest taking biotin, a B vitamin, to stimulate hair growth, Wechsler says "there are some studies that show it does help hair growth, and there are some studies that show it doesn’t do much." She adds that "it certainly can’t hurt, so taking a little biotin every day" can also be an option. Just make sure to talk to your doctor first, as you should when adding any sort of supplement to your routine. A 2015 study suggested rosemary oil may also stimulate hair growth, possibly "due to rosemary oil's enhancement of microcapillary perfusion," explains King. However, "the bottom line is that for oils, we need bigger, better studies in order to evaluate whether or not these ingredients may help with hair growth."
During this time, it's also best to avoid the following, King says, in order to decrease the risk of hair damage and breakage:
- Products that dehydrate the hair
- Tight braids or buns
- Shampoos with harsh detergents
- Hair gels and sprays that contain alcohol
- Heat and chemical styling
How can I take care of my mental health when I'm losing my hair after losing a pregnancy?
The loss of my hair in the wake of the loss of a wanted pregnancy compounded the anxiety and depression I already felt. In a culture that has assigned so much political, cultural, and sexual meaning to a woman or femme-presenting person's hair, to feel as if I was failing on multiple fronts as a "Woman In America" was downright debilitating. And given that I didn't want to discuss my miscarriage openly, the options to discuss my post-miscarriage hair loss also felt limited at best.
"I think that there's a lot of pressure on women to perform and to be reaching these different milestones in terms of what you might kind of imagine your life to look like, and what you maybe expect your body to look like or your appearance," says Pooja Lakshmin, a clinical assistant professor of psychiatry at the George Washington University School of Medicine and founder of Gemma, a digital education platform dedicated to women's mental health. "So when both of these things happen at the same time, it's kind of another way where you feel like you're sort of falling short to achieve some sort of objective or goal that you had set for yourself."
This is why the best thing you can do for both your mental and physical health is to talk about it: with your partner(s), with a friend, family member, or support group, or with a trusted physician. "It really helps to be able to share this burden and not carry it alone, in both cases," Lakshmin explains.
It's also important to be kind to yourself during this time — to give yourself permission to mourn what you've lost — a pregnancy and your hair — and to acknowledge that those feelings of grief are not misplaced or vain. "These periods are going to be difficult," says Lakshmin, "so you want to be gentle with yourself and compassionate with yourself." Seeking out the care of a mental health care professional to discuss your feelings openly and free from judgment can be extremely helpful, and there are a number of low-cost options for those who don't already have affordable and reliable access to mental health care.
It's also helpful to be aware of, and make those who support you aware of, some red flags to consider that would require additional professional support, including experiencing the following feelings two or more weeks after your miscarriage and hair loss:
- You can't get out of bed
- You’re consistently showing up late to work
- Unable to be present for the kids you do have
- You’re still consumed by your feelings
- Loss of appetite
- Increase in alcohol and drug consumption
- Noticing other ways your functioning has been impacted
Additionally, it can be helpful to recognize the mind-body connection to aid you in better understanding why you’re experiencing post-miscarriage hair loss, and how taking care of your mental health can promote healthy hair growth.
"I think the biggest myth is that there is no mind-body connection — some people still really think that," says Wechsler. "That it's hocus pocus, that it’s BS, that it's new-agey, and that it's weird. No, it's true."