After the Baby Comes the… Telogen Effluvium
Postpartum hair loss, clinically known as Telogen Effluvium (TE), is a common condition affecting up to 90% of women after childbirth. The severity of hair shedding varies, with some individuals experiencing minimal or unnoticeable changes, while others may suffer significant hair loss. In more pronounced cases, this shedding can be distressing and may lead to heightened emotional stress, self-consciousness, anxiety, and social withdrawal.
Pathophysiology
Telogen Effluvium is a temporary, non-scarring type of alopecia that occurs when a larger-than-normal number of hair follicles enter the telogen (resting) phase of the hair growth cycle simultaneously. The term “effluvium” refers to an abnormal or excessive amount of shedding. Though concerning, this condition does not cause permanent damage to the hair follicle. Associated symptoms may include hair thinning and dry, brittle strands that are easily dislodged.
During pregnancy, the high levels of estrogen prolong the anagen (growth) phase of the hair cycle, resulting in fuller hair. After delivery, hormonal shifts—primarily the reduction in estrogen and progesterone—trigger a synchronized entry of hair into the catagen (involution) and subsequently the telogen phase, causing increased shedding.1 Research also suggests fluctuations in prolactin and thyroid hormones may contribute, although further investigation is required to establish a definitive hormonal link.1
Duration and Prevalence
The duration of TE varies between individuals, generally lasting 2 to 12 months. On average, the onset occurs at 2.9 months postpartum, peaks at 5.1 months, and resolves by approximately 8.1 months.1
A questionnaire-based cross-sectional study involving 271 women identified two factors strongly associated with postpartum hair loss: delayed cessation of breastfeeding and preterm labor.1 Breastfeeding can delay the resumption of normal ovarian function and hormonal balance, thus disrupting the hair growth cycle. Additionally, systemic inflammation, a potential factor in preterm labor, may also contribute to the development of TE.1 However, most current research relies on retrospective analysis and self-reporting, highlighting a need for more robust, prospective studies.
Contributing and Exacerbating Factors
Additional contributors to postpartum TE include psychological stress related to childbirth and infant care, disrupted sleep patterns, genetic predisposition, and nutritional deficiencies.
Management Strategies
There is no single cure for TE, but several approaches can support recovery:
Lifestyle modifications: Stress reduction, optimizing sleep, and self-care practices help regulate hormonal balance.
Nutrition: A well-balanced diet rich in protein, vitamins, and minerals is essential. Supplementation with biotin, a vitamin involved in keratin production, may also be beneficial and is generally well tolerated.
Topical care: Use of gentle shampoos, conditioners, and routine scalp massage can improve blood flow to hair follicles and minimize breakage.
Emerging Therapies
Low-Level Laser Therapy (LLLT): This FDA-approved treatment has shown efficacy in reducing inflammation, promoting circulation, and stimulating hair regrowth. The red light photons are absorbed by mitochondrial chromophores, enhancing ATP production and triggering cellular repair processes.2
Folix Laser Therapy: A newer, non-ablative fractional laser treatment, Folix uses the immune system to stimulate growth factors and enhance follicular regeneration. The technology is FDA-cleared for safety and efficacy.4
Conclusion
Telogen Effluvium is a prevalent yet temporary condition that can significantly impact the postpartum experience. Understanding its physiological basis and contributing factors can empower patients and clinicians to adopt supportive interventions. While most cases resolve spontaneously, multiple strategies—including nutritional support, stress management, gentle hair care, and advanced therapies such as LLLT and the Folix hair restoration laser can help mitigate severity and duration.
References
Hirose M, Nakamura T, Mori K, et al. Investigation of exacerbating factors for postpartum hair loss: a questionnaire-based cross-sectional study. Int J Womens Dermatol. 2023;9(3):1-7. doi:10.1097/JW9.0000000000000084.
Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10846762/Avci P, Gupta A, Clark J, et al. Low-level laser (light) therapy (LLLT) in skin: stimulating, healing, restoring. Semin Cutan Med Surg. 2014;33(4):199-210. doi:10.12788/j.sder.0087.
Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4126803/Postpartum Hair Loss. Johns Hopkins Medicine.
Available from: https://www.hopkinsmedicine.org/health/wellness-and-prevention/postpartum-hair-loss
Folix by Lumenis.
Available from:https://lumenis.com/aesthetics/products/folix/
