Preparing for Pregnancy: Considerations for Women with Androgenetic Alopecia

Planning a Pregnancy with Female Pattern Hair Loss

Many women with genetic hair loss are worried about getting pregnant and how the pregnancy and delivery will affect their hair. It's an area that really isn't talked about very much. Some women feel it's difficult to talk opening with their partner or family about their hair when all the focus is on the pregnancy, the baby and the new or expanding family.  But these issues are important and issues that I help patients with on frequent basis. 

 

Preparing for the Pregnancy

For women who are planning when to become pregnant, there are a number of considerations that are related to the hair. I encourage all patients with hair loss who are considering pregnancy to have a good discussion with the dermatologist and of course the physician caring for the pregnancy as well.  

Most of the time, hair improves in pregnancy.  However, some women do experience hair loss during the pregnancy. A significant proportion of women experience some degree of hair shedding after delivery. Hair regrowth occurs 6-7 months later but may or may not return to pre-pregnancy densities.  

1. Deciding to Stop Medications

Many of the medication used for treating female pattern hair loss (androgenetic alopecia) can't be used during pregnancy. This includes minoxidil, Rogaine, platelet rich plasma, anti-androgens. The only treatment that can be used are vitamins and low level laser therapies. 

Minoxidil should ideally be stopped two weeks before the time that a women decides to start trying. However, there are many women world-wide who become pregnant while using minoxidil and simply stop minoxidil once they miss their period. There is no evidence that this method has any harm for the pregnancy or the baby.  However, minoxidil must not be used during the pregnancy and anytime after the first period is missed. Many physicians will strictly recommend that their patients stop minoxidil if they are trying to conceive. However, there is no good evidence to support this recommendation. 

Anti androgens, however, need to be stopped several months before the pregnancy. The most common anti-androgen used in women of child bearing age is Spironolactone (Aldactone) and this must be stopped ideally 2 months before any planned pregnancy. Spironolactone can not be used during pregnancy as it could cause harm to a developing baby. Other anti-androgens, including saw palmetto, and finasteride need to be stopped long before as well. Dutasteride is not typically be used in women of child bearing ages. However due to it's very long half life, any woman who is using dutasteride and considering pregnancy should speak to their physician and dermatologist about how long they need to be off the medication before trying to get pregnant. 

 

2. Blood tests

For some women, pregnancy can lead to changes in the levels of many key mineral and vitamins relevant to hair growth. Blood tests can help identify these deficiencies. Deficiencies of vitamin D and iron are among the most common during pregnancy and levels may need to be followed during the pregnancy. Other deficiencies are less common but can include biotin and zinc. If there are concerns about thyroid stratus or diabetes these will also need to be monitored.

3. Supplements

All women considering pregnancy should speak to their physicians about appropriate supplements. These will generally include appropriate folic acid. However, other supplements may be very relevant depending on the patient's history. As mentioned above, these may include vitamin D, iron, biotin and zinc.

4. Scalp Inflammation

I am a strong believer that scalp inflammation needs to be addressed at any time during the course of hair loss. This is also true during pregnancy. Prolonged scalp inflammation from various sources has the potential to accelerate androgenetic alopecia (AGA). Inflammation can come from many potential sources including seborrheic dermatitis, psoriasis and various eczemas. 

We don't have much information on the safety of anti-dandruff shampoos in pregnancy. The data would suggest that periodic use of zinc pyrithione and ciclospirox have reasonable safety and these are frequently my top choices for many of my own patients.  If dandruff (or seborrheic dermatitis) is troublesome, I generally advise use once every 2 weeks and to be left on the scalp for 60 seconds before rinsing off. Small amounts of betamethasone valerate scalp lotion can be used once weekly if itching persists.  

Ketoconazole shampoos don't have much in the way of data. Patients interested in using should check with their OB or the physician caring for the pregnancy. There is no good data to really suggest a problem with periodic use of topical shampoos containing ketoconazole. It's not the top choice for my practice as they have the potential to affect testosterone synthesis.  Oral ketoconaole is certainly not advised. It increased the risk of cardiovascular, skeletal, craniofacial and neurological problems in many studies.  I don't recommend coal tar shampoos during pregnancy. Animal studies show that high doses are associated with perinatal mortality, cleft palate, small lungs and other developmental issues. I avoid them in my practice. 

Conclusion

Patients with androgenetic alopecia (female pattern hair loss) who are considering pregnancy should review their general health and scalp heath with their physicians. Blood tests may be recommended and periodic monitoring of the scalp may be appropriate during the pregnancy.