Introduction

Hair loss in the postpartum period (the period 6 weeks after childbirth) is a common symptom experienced by new mothers. It usually occurs in the first few months after the birth of the baby.¹ There are many potential causes, one of which is iron deficiency. Iron is a mineral essential for the body's growth and development. Its main function is as a component of haemoglobin, a molecule present in blood which delivers oxygen to the rest of the body.² Iron contributes to hair loss by impacting hair follicles' normal physiological processes.³

Read on to learn more about hair loss in the postpartum period, how it is linked to iron deficiency, and ways to manage and prevent it.

Understanding postpartum hair loss

Causes and mechanisms

 There are multiple possible causes for postpartum hair loss. The most common reason for hair loss during the postpartum period is as a result of the falling levels of a hormone called oestrogen in the blood.¹ Oestrogen is usually produced in large amounts during pregnancy and prevents typical hair shedding. After childbirth, the oestrogen levels return to normal and hair returns to the resting phase of growth. A few months later, it will start to shed.⁴

Nutritional deficiencies can also occur in pregnancy. One of the important nutrients, iron, is often lacking in the diet and can cause iron deficiency anaemia.⁵ Compared to pregnancy, iron requirements usually decline during the postpartum period. However, it is important to replace the reduced stores of nutrients which have depleted during pregnancy, in the postpartum period to prevent further health complications.⁶

Stress on the body can also affect hair growth, although there needs to be further research done on this topic. Certain studies have shown that the hormone released when the body is under stress, cortisol, can inhibit the stimulation of hair growth, working in a similar mechanism to where hair may turn grey when the body is under stress.⁷ Many new mothers experience high levels of stress adjusting to a baby and a new and different lifestyle.² On the bright side, there are support groups and stress management strategies that many mothers find helpful to implement.

Timing and duration

Hair shedding usually peaks about four months after giving birth, and normal hair fullness returns after one year, although many report resolution much earlier.¹ If it is due to iron deficiency, hair shedding may persist longer than expected and be associated with other symptoms.⁵ Resolution of symptoms should typically occur around 6 months following management of the deficiency and maintenance of normal iron levels.⁸

Psychological impact

Being a new mother is a large change that requires adaptation; many feel stressed and anxious adapting to this new lifestyle. Unfortunately, postpartum hair loss can add to this stress and anxiety. However, it is important to note that this condition is common and a normal physiological process that many new mothers experience.⁴ There are also resources such as support groups and lifestyle modifications which you can apply to help ease the psychological impact of postpartum hair loss.

There is no risk to the baby when the mother experiences postpartum hair loss. However, it is important to be wary of hair tourniquets. This is when a hair strand falls out and wraps around a baby’s toe, finger, or other body part. This can cut off the circulation to the body part when tightly wound. If this occurs, the hair strand should be removed gently by hand or with scissors if required. If there continue to be issues, please seek medical help.¹

Exploring iron deficiency

Definition and causes

Iron deficiency is low iron stores in the body.⁸ This is closely related to the amount of blood in your body as iron’s main function is to be a component of haemoglobin in red blood cells.² It is most commonly caused by inadequate dietary intake, but pregnancy and childbirth make you more at risk of low iron levels as well.⁵

New mothers can often lose a lot of blood during childbirth, thus losing large amounts of iron. If a large amount of blood loss has occurred, your obstetric team will inform you, and you may need blood or iron replacement in a medical centre.⁹ There is also an increased demand for iron during pregnancy as the amount of blood increases to supply the baby’s growth.²

Symptoms and diagnosis

People with iron deficiency can present with an array of symptoms which are often not specific. You should visit a medical professional if you are experiencing any of the following symptoms:

• Tiredness and lack of energy
• Paler than usual skin
• Headaches
• Shortness of breath
• Noticeable heartbeats ⁵

A diagnosis of iron deficiency is often confirmed by a blood test which checks for iron levels. Ferritin levels are the most reliably correlated to relative iron stores in the body. Deficiency is defined as a level less than 30 micrograms/L.⁸ Other blood tests may be taken to check for common vitamin deficiencies that can present with the same symptoms. Anaemia, also known as low red blood count, will be checked, as this is a common consequence of iron deficiency.⁵

It is important to note that pregnancy can affect testing of ferritin levels and blood cell counts due to dilution of the blood and mobilisation of iron which is part of the normal physiological state of pregnancy.⁸

Consequences of untreated iron deficiency

Iron deficiency is closely related to anaemia, which is a lowered red blood cell count. This causes the common symptoms of fatigue and pale skin.⁵ However, severely lowered red blood cell count can cause more serious symptoms and complications such as shortness of breath, mouth ulcers, heart murmurs, and low blood pressure. ^[10] In postpartum mothers, anaemia is a haemoglobin level of less than 100g/L. A haemoglobin level of less than 70g/L is considered severe.⁸

Untreated iron deficiency can also cause issues for specific organ systems in the body. It can increase the risk of complications involving the heart and the lungs such as heart failure and tachycardia (a fast heartbeat).⁵ This is due to the lack of oxygen delivery to vital organs which can impact their functions.¹⁰

Specifically relating to childbirth, untreated iron deficiency can cause greater risks of complications before and after birth.⁵ Mothers can experience fatigue, altered cognition, and depressive symptoms, which in turn can affect the behaviour and development of the infant.⁶

The link between postpartum hair loss and iron deficiency

Iron is part of many physiological processes within the hair follicle, suggesting that iron deficiency can disrupt hair synthesis.¹¹ Some studies suggest iron deficiency may contribute to hair loss via its role at the molecular and gene level as an important component in regulating hair growth.¹² While many studies have investigated the relationship between hair loss and iron deficiency, the clinical evidence remains inconclusive.¹³

However, most doctors agree that a severely low f iron level in the blood can impact the physiological process of hair follicles, damaging them and leading to hair loss. Iron deficiency can trigger a type of hair loss called telogen effluvium, where stress or illness causes widespread hair thinning in both men and women.³ Therefore, it is important to treat iron and nutrient deficiencies if found to help optimise your body when experiencing hair loss or shedding. 

Management and coping strategies

Clinical management

Iron deficiency is usually treated with oral iron supplements. These are taken for 3 months after return to normal iron serum levels and then stopped.⁸ These may have side effects such as constipation, tummy pain, heartburn, nausea, and darker stools.⁵ Taking iron supplements may also interact or interfere with other medications, so please first check with a medical professional before consuming.²

Dietary advice is also given to help maintain adequate iron levels after pharmaceutical treatment is completed. Certain foods are more rich in iron such as:

• Dark-green, leafy vegetables
• Cereals and breads with more iron content (fortified)
• Meat
• Dried fruit
• Pulses (beans, lentils, and peas)⁵

After starting treatment for iron deficiency, repeat blood tests are taken to check an initial response within the first four weeks. Blood tests are then rechecked at 2-4 months to assess for a return to normal iron levels.⁸ If any symptoms were experienced, the return of adequate iron levels should help resolve these symptoms, otherwise, further investigations might be required. 

Lifestyle modifications

Diet is one component of lifestyle modifications which can help optimise iron levels and related postpartum hair loss. Conversely, there are certain foods and drinks which also help iron absorption if cut down, including:

• Caffeine including tea and coffee
• Milk and dairy
• Foods with high phytic acid content including wholegrain cereals⁵

It is important to keep a balanced diet rich in various macronutrients and micronutrients to maintain good health in general.

There are also recommended hair care practices for postpartum hair loss in general. These include:

• Using a volumising shampoo and conditioner
• Avoid ‘conditioning shampoo’ which can weigh down hair
• Use conditioner formulated for fine hair
• Use conditioner primarily on the ends of the hair
• Avoid ‘intensive conditioner’¹
• Try a different hairstyle⁴

Additionally, stress is known to exacerbate hair shedding. In this case, stress management techniques may help reduce anxiety related to hair loss. These include:

• Eating healthy
• Exercising
• Getting plenty of sleep
• Giving yourself a break if feeling stressed out
• Taking deep breaths, stretching, or meditating
• Avoiding excessive alcohol, tobacco, and substance use
• Taking time to do other activities you enjoy
• Talking with others
• Connecting with your community or faith-based organisations¹⁴

Support systems

Hair loss is particularly difficult for women and as described above, the psychological impact cannot be underestimated. There are formal ways to help cope with hair loss such as peer support groups and counselling or therapy. It may be useful to share your experience and hear those of others.¹⁵ It is important to remember that hair loss in the postpartum period and due to iron deficiency are temporary conditions and will improve in the long term with the right care and treatment. 

Should you feel that you are having trouble coping, your local healthcare professionals can guide you to available resources to help.

FAQs

Should I be concerned about postpartum hair loss?

The short answer is no, you should not be concerned. This is a normal physiological process which is very common for new mothers due to pregnancy hormones. It is important to watch out for secondary complications like a hair tourniquet, or if hair loss may be due to another cause, such as underlying nutritional deficiencies.

What deficiency causes postpartum hair loss?

The hair growth process relies on many nutrients and minerals to function normally. The most common cause of postpartum hair loss is iron deficiency. This is because dietary intake is usually reduced in pregnancy and childbirth.

Can low iron cause hair loss?

Yes, low iron can cause hair loss. Although the exact mechanism is largely unknown, iron is an important nutrient involved in hair growth and deficiency can trigger or exacerbate hair shedding. 

What are the signs of low iron deficiency?

Common signs of low iron deficiency include:

• Tiredness and lack of energy
• Paler than usual skin
• Headaches
• Shortness of breath
• Noticeable heartbeats (palpitations)

Please see a medical professional if you are experiencing any of these signs or symptoms.

Does iron deficiency hair loss grow back?

Yes, following appropriate treatment and management, hair loss caused by iron deficiency can grow back to normal fullness. If hair shedding persists after a course of treatment for iron deficiency, another underlying cause may be contributing to your symptoms. Please seek medical advice if you are unsure.

Does everyone experience postpartum hair loss?

Although it is not guaranteed to happen in every new mother, postpartum hair loss is a common condition. It is most commonly caused by a drop in oestrogen levels which are produced in the last trimester of pregnancy. As every new mother undergoes this process following childbirth, postpartum hair loss can occur in many.

When does postpartum hair loss stop?

Postpartum hair shedding often peaks at 4-6 months, and normal hair fullness is expected to return by the baby’s first birthday. Many new mothers report earlier resolutions than this as well. If hair shedding persists longer than this, it might be helpful to investigate other causes such as iron deficiency.

What can I do to stop or prevent postpartum hair loss?

Unfortunately, there are no proven practices to stop or prevent postpartum hair loss. It is advised to let it take its course and allow time for hair to grow back in its own time. There are, however, coping strategies and lifestyle modifications which can help as one experiences the symptoms. A healthy lifestyle (including eating well and regular exercise) is advised, and good hair care (using volumising shampoos and conditioners and trying a different hairstyle). If you are struggling with the emotional and psychological component of your symptoms, it might help to talk about it in a support group, in counselling, or with your local healthcare professional.

Summary

Hair loss is a common occurrence in the postpartum period. This is temporary and hair growth and fullness will return. Postpartum hair loss is usually due to hormonal changes, however, it can be associated with iron deficiency as well. It is important to have your iron levels checked if hair shedding goes on for longer than 4 to 6 months, or if you are experiencing other symptoms of iron deficiency. If iron supplements are required, then these can help hair loss, but the majority of management involves lifestyle changes and addressing any psychological impact of the condition.