Oral contraceptives are one of the most widely used forms of birth control. Birth control pills effectively prevent pregnancy by modulating the body’s production of hormones. Unfortunately, this method of hormonal birth control can have undesirable side effects, including hair loss. With nearly one in four women using hormonal contraceptives, it’s important to understand the link between birth control pills and hair loss.
With a lot of conflicting information online, it’s first important to understand the answer to this fundamental question: Can birth control cause hair loss?
Unfortunately, according to a number of peer-reviewed studies, the answer is yes. Studies have shown that hormonal birth control methods, including oral contraceptives, have a direct link to hair growth and can contribute to hair shedding and female pattern hair loss.
Birth control pills work by modulating hormones in the body to prevent unwanted pregnancy. All oral contraceptives contain progestin, a synthetic form of progesterone – a naturally occurring sex hormone.
Progesterone plays an important role in regulating the menstrual cycle and the early stages of pregnancy. When levels of progesterone are too low, it can cause irregular menstrual bleeding. However, when levels of progesterone are too high, it can have the opposite effect – halting menstruation altogether. This is ultimately the desired affect of a hormonal contraceptive.
While high progesterone levels effectively prevent pregnancy, they can also impact other bodily functions and cause unwanted side effects. Some of the side effects from hormonal birth control include weight gain, acne, mood changes, decreased libido, and hair loss.
The progestin in hormonal contraceptives have been clinically shown to bind to androgen receptors – which results in increased androgenic activity. Androgens are male “sex hormones” that are present in both men and women in small amounts. When levels of these male hormones (including testosterone levels) rise, they can increase the production of Dihydrotestosterone (DHT), a testosterone metabolite that has been shown to cause hair loss by interfering with hair follicles.
The increased production of androgen hormones, and consequently DHT, on the scalp is believed to be directly related to hair shedding in women. It’s believed that there is even a greater risk of hair thinning and hair shedding for women with a strong predisposition to androgen sensitivity, including women with PCOS.
Our hair grows in a natural cycle when our bodies are healthy and producing normal hormone levels. During this normal process, each follicle produces a new strand of hair which will grow for years until it eventually falls out.
The first phase is known as the anagen phase or “growth phase,” which is when the hair follicles are growing longer. This growth period can last anywhere from two to six years. After the hairs fall out, they enter what’s called the catagen stage – a transitional phase that only lasts for two or three weeks. The final stage in this hair growth cycle is referred to as telogen phase, or the “resting phase,” where the hair remains very tiny before re-entering into the growing phase again.
The hair follicle resting stage usually lasts a few months. However, during times of increased DHT production due to hormonal contraception use, the hair follicle can enter an extended resting phase, causing a lack of hair regrowth and eventually leading to hair thinning and female pattern hair loss. The effects of DHT on hair thinning are likely more prevalent in women with a genetic hair loss predisposition – including a family history of hair thinning issues.
It’s important to note that not all birth control pills contain the same type or amount of progestin. There are two main types of contraceptive pills:
Contraceptive pills known as “mini-pills” contain only synthetic progestin, and no estrogen. They are often used by women who cannot take estrogen for medical reasons.
Combination pills contain both progestin and estrogen. Estrogen is thought to offset some of the negative side effects associated with progestin, including hair loss. Studies have shown that estrogen can counteract the androgenic effects associated with hair loss by increasing sex hormone binding globulin (SHBG). SHBG binds to testosterone in the body and ultimately, is believed to reduce the production of hair damaging DHT. For this reason, combination birth control pills may be less likely to lead to hair loss than progestin mini-pills.
When choosing a birth control pill, it’s important to consider the androgen index – which is a measure of how androgenic a given pill is. Androgenic refers to the degree to which a hormone or medication can cause masculinizing side effects like hair loss. The androgen index is represented on a scale from 1 to 100.
Norethindrone oral contraceptives, sold under the brand names Ortho Micronor and Aygestin are progestin-only birth control pills. Often called “mini-pills,” these first-generation birth control pills contain no estrogen have have the highest androgen score among any prescription contraceptive pills.
Levonorgestrel is a progestin used in some second-generation combination birth control pills that fall within the medium androgen index. Levonorgestrel is the progestin used in some hormone-releasing IUD’s, including the Mirena IUD. Levonorgestrel is also the active ingredient in the emergency oral contraceptive Plan B.
These low androgenic third-generation birth control pills include those that use the progestin Desogestrel – which is sold under the brand names Mircette, Kariva, Desogen, and Ortho-Cept. Other low androgen birth control pills are those containing the active ingredient Norgestimate, which is sold under the brand names Ortho Tri-Cyclen and Previfem.
There is a new class of Antiandrogenic birth control pills that recently gained FDA approval. Drospirenone is one of these new progestins and it is the active ingredient along with ethinyl estradiol in the contraceptive pill Nextesllis. This new class of birth control pills containing drospirenone ethinyl estradiol are designed specifically to reduce the androgenetic hair loss and other negative side affects associated with androgenic contraceptives.
For women who are considering stopping birth control pills due to hormone related hair loss, it’s worth considering alternative birth control techniques.
Non-hormonal birth control options include copper IUDs, barrier methods, spermicide, and natural family planning.
Copper IUDs are a non-hormonal form of long-acting reversible contraception (LARC). IUDs are inserted into the uterus and work by releasing copper which creates an unfavorable environment for sperm.
Barrier methods include condoms, diaphragms, and cervical caps. These methods work by physically blocking sperm from entering the uterus.
Spermicide is a chemical that kills sperm and is often used in conjunction with barrier methods.
Natural family planning is a method of contraception that relies on tracking a woman’s menstrual cycle in order to avoid intercourse during fertile periods.
For women who have already seen hair loss or hair thinning from taking birth control, there are a variety of therapies and lifestyle changes that may help treat hair loss. Perhaps most obviously, would be to stop taking any oral contraceptive birth control pill that might have increase the male hormones that worsen hair loss.
While this change alone may stimulate hair growth in some women, others may find that the hair loss caused by their birth control pill doesn’t fix itself. If the body is unable to regrow lost hair on it’s own, there are other possible solutions:
Multiple medications can help with hair loss, two popular ones being minoxidil and finasteride. Minoxidil is a vasodilator that improves blood flow to improve scalp health and is available over-the-counter for men and women. Studies show that Minoxidil will increase hair growth in some patients, but it comes with potential nasty side effects.
Numerous options are available to people who wish to combat hair loss caused by the pill, including PRP injections, steroid injections, laser therapy, and hair transplant surgery. The relative efficacy of each option has been proven in clinical studies; however, results will vary based on each individuals health and the skill of the medical provider.
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