Questions about hair loss and blackouts

By Howard LeWine, M.D.

Q: Since menopause, my hair keeps getting thinner. Why do older women lose their hair? What treatments are available?

A: Among postmenopausal women, as many as two-thirds develop hair thinning or bald spots.

The main type of hair loss in women is the same as it is in men. It’s called androgenetic alopecia, or female (or male) pattern hair loss.

In women, the condition begins with gradual thinning at the part line, followed by increasing diffuse hair loss radiating from the top of the head. A woman’s hairline rarely recedes, and women rarely become bald.

There are many potential causes of hair loss in women, including medical conditions, medications and physical or emotional stress.

If you notice unusual hair loss of any kind, it’s important to see your primary care provider or a dermatologist to determine the cause and appropriate treatment.

Almost every woman eventually develops some degree of female pattern hair loss. It can start any time after the onset of puberty, but women tend to first notice it around menopause, when hair loss typically increases. The risk rises with age, and it’s higher for women with a history of hair loss on either side of the family.

Medications that can help with hair loss in women include:

Topical minoxidil. The FDA originally approved over-the-counter 2% minoxidil to treat hair loss in women. Since then, a 5% solution has also become available when a stronger solution is needed for a woman’s hair loss.

While it can produce some new growth of fine hair in some — not all — women, it can’t restore the full density of the lost hair. It’s also not a quick fix for hair loss in women. You won’t see results until you use the drug for at least two months.

The effect often peaks at around four months, but it could take longer, so plan on a trial of six to 12 months. If minoxidil works for you, you’ll need to keep using it to maintain those results. If you stop, you’ll start to lose hair again.

Anti-androgens . Androgens include testosterone and other “male” hormones, which can accelerate hair loss in women.

Some women who don’t respond to minoxidil may benefit from the addition of the anti-androgen drug spironolactone (Aldactone) for treatment of androgenic alopecia. This is especially true for women with polycystic ovary syndrome (PCOS) because they tend to make excess androgens.

Iron supplements . Iron deficiency could be a cause of hair loss in some women. Your doctor may test your blood iron level. If you do have iron deficiency, you will need to take a supplement and it may stop your hair loss.

However, if your iron level is normal, taking extra iron will only cause side effects, such as stomach upset and constipation.

Q: My husband blacked out at home and has no memory of what happened. I found out later and by then he was fine. Did he have a seizure?

A: A seizure is one possibility. But he should contact his doctor to report the episode.

The most common reason for temporarily blacking out is fainting from an overly sensitive response by the nervous system known as reflex syncope. That occurs when the nervous system tells the heart to slow down and the blood vessels to dilate, which lowers blood pressure and diminishes blood flow to the brain.

The most common type, vasovagal syncope, refers to the effects of the vagus nerve (which regulates heart rate and blood pressure, among other things).

Most people remember feeling lightheaded before they pass out from reflex syncope. However, people who have a seizure often have no memory of what happened just before and just after the event.

If he has another episode witnessed by