What is Female Pattern Hair Loss (FPHL)?
Female pattern hair loss (FPHL), also known as androgenetic alopecia (AGA), is a hair loss that affects more than two-thirds of postmenopausal women. Compared to male pattern baldness that causes M-shape receding hair-line starting from the front and leaving temporal hair, female pattern baldness manifests as generalized thinning and loss of hair. By the age of 65, more than half of the women will have some kind of alopecia. Many treatment options are available for FPHL that can decrease the misery and help boost confidence in women. There are many causes of hair loss in women including stress, medications, hormonal imbalance, and medical conditions.
Several treatment options are available for female pattern hair loss. Some of them decrease the level of circulating hormones while others work to increase the rate of hair growth. Nonetheless, the choice of treatment lies in the efficacy, cost-effectiveness, compliance and side effects of the products used. The options include:
- Minoxidil (2% and 5% topical solutions)
- Diuretics (Spironolactone)
- Diet Supplements
- Platelet Rich Plasma (PRP)
- Laser comb
- Hair transplant
Research Evidence of 5% Minoxidil for Female Pattern Hair Loss
The FDA approved 5% minoxidil foam for the treatment of male pattern baldness since 2006 after a clinical trial demonstrated that the 5% minoxidil foam stimulates hair growth after 48 weeks of twice-daily usage. Until recently, the FDA approved had only 2% minoxidil for female pattern loss whereas both the 2% and 5% solutions were available for men. The occurrence of side effects with 5% foam was also less than the same dose solution formulation. This lead to its increased popularity in treating androgenetic alopecia in men and a dire need of research to evaluate its role in female pattern hair loss.
In a randomized trial, the once-daily application of 5% minoxidil foam was compared against 2% minoxidil solution in their efficacy for treating frontotemporal hair loss in women. During this study, 5% minoxidil foam applied once daily was found to be non-inferior to the use of 2% minoxidil foam twice-daily. Also, the women in the 5% foam group agreed more strongly that treatment did not interfere with grooming routines than did women in the 2% solution group. In separate studies, both the twice-daily use of 5% minoxidil solution and once-daily use of 5% minoxidil foam were found to have comparable results to the twice-daily use of 2% minoxidil solution.
Recent Trials & FDA approval
In 2014, two randomized, double-blind, and parallel trials of 5% minoxidil foam were completed. Both trials assessed the efficacy of once-daily use of 5% minoxidil foam in female participants aged 18 years and older.
In the first trial, half of the participants were given once a day treatment with 5% minoxidil foam and the remaining half were given placebo foam for 24 weeks. Efficacy was assessed at weeks 12 and 24 and safety and adverse events were monitored every 6 weeks. At weeks 12 and 24, changes in target area hair count (TAHC) from baseline were significantly higher in the minoxidil-treated group than the placebo group. Also at 24 weeks, the patient-reported assessment of scalp coverage was determined to be significantly higher with minoxidil treatment compared to placebo.
In the second trial, participants were given once a day treatment with 2% minoxidil solution or 5% minoxidil foam twice daily for 52 weeks. The change in TAHC from baseline in the 5% minoxidil group was shown to be similar to that of the 2% topical minoxidil solution group.
Since both regimens are equally efficacious, treatment with 5% Minoxidil is associated with several aesthetic and practical advantages. Thus with the availability of compelling evidence, the FDA approved the once-daily use of 5% minoxidil for female pattern hair loss from 2014 and onwards.
Minoxidil is considered relatively safe and has minimum side effects which can include dryness, redness, and itching. Sometimes, the new hair differs in color and texture from surrounding hair. Another side effect is excessive hair growth in undesirable places — hypertrichosis — such as the cheeks or forehead.
Female pattern hair loss (FPHL) is rather a more common disease affecting women; with more than half of them having some extent of baldness in their 60s. Amidst a lot of treatment options available, topical foam application of 5% minoxidil remains the mainstay of treatment with the research proving to be in favor of once-daily dosing. This results in better compliance with treatment and superior clinical outcomes. But the hair loss may return after a person stops using the product.