The pill and hair loss

It’s been three months since you stopped the pill. For a few weeks now, the shower drain has been filling up faster than usual, and so has your brush. You make the connection, then you doubt it: can it really be that, so long afterwards? And above all, will it stop?

The pill can affect your hair in both directions. The French Society of Dermatology (SFD) puts it simply: some poorly suited pills can make hair loss worse, others can improve it, and starting or stopping hormonal contraception can alter the hair cycle¹. Here’s how it works.

Why the pill affects your hair

A so-called combined pill pairs two hormones: an oestrogen and a progestogen². For your hair, it’s mostly the progestogen that makes the difference, because they don’t all have the same effect on male hormones.

Women make these male hormones, the androgens, too, in small amounts. In people who are prone to it, they shorten the hair’s growth phase, and each new hair grows back finer. That’s how androgenetic alopecia, common pattern hair loss, works, alongside genes and time³.

A combined pill tends to have an anti-androgen effect. It raises the level of a protein in the blood, SHBG, which binds androgens and makes them less active. The effect is stronger when the progestogen is itself anti-androgenic². On the other hand, some progestogens have a high androgenic potential: they act a bit like those male hormones⁴.

The one that helps, the one that harms

Hence the two possible effects. A 2018 review of female pattern hair loss lists, among the causes to look for, taking a pill whose progestogen is strongly androgenic⁴. The SFD, for its part, counts “certain contraceptive pills” among the factors that encourage or worsen androgenetic alopecia in women³.

In the other direction, the SFD says a combined pill containing an anti-androgenic progestogen can be effective in mild to moderate female pattern hair loss³. It’s an option your gynaecologist or dermatologist can consider, taking into account your contraception, your health and each pill’s contraindications².

Keep it in proportion, though. The European guideline on androgenetic alopecia finds the evidence for hormonal treatments weak⁵. The pill is first and foremost a contraceptive. It can tip things one way or the other for your hair, but it’s no substitute for a proper look at your hair loss.

Hair loss after stopping the pill

This is the most common situation, and the most confusing one. Stopping the pill is a known trigger of telogen effluvium, a diffuse, temporary shedding⁶. The 2018 review specifically mentions recently stopping an oestrogen-containing pill taken for a long time⁴. The American Academy of Dermatology (AAD) explains that stopping some types of pill can cause a temporary hormonal imbalance, which makes hair fall out⁷.

It works much like shedding after childbirth. Normally, about 15% of your hairs are resting and will fall out in the coming weeks⁶, which adds up to 50 to 100 hairs a day¹. A sudden hormonal change pushes many more hairs into the resting phase at once. They stay put for a few weeks, then fall out together.

Hence the delay that fools everyone: shedding shows up two to three months after the trigger according to the SFD¹, two to four months according to DermNet⁶. You stop your pill in January, and it’s in April that the shower starts to worry you.

This shedding is temporary. The SFD says this form is reversible in the vast majority of cases and that hair usually grows back within a few months¹.

What other women say

On forums, women describe both situations: shedding after stopping, and shedding they put down to the pill they were taking.

Posted on the Cathe⁸ and Mumsnet⁹ forums.

In the first case, her doctor said it was probably a hormonal response to stopping the pill⁸. In the second thread, several members also suggest getting your iron and thyroid checked with a blood test⁹. A useful reflex, as you’ll see.

Should you switch pills?

If you think your pill is affecting your hair, it’s tempting to stop it overnight. Bad idea: the AAD advises against stopping a prescribed medicine without talking to your doctor first⁷. Stopping can trigger the very shedding you wanted to avoid, and leave you without contraception.

The decision belongs to your GP, gynaecologist or midwife. Tell them how long your hair has been falling out, how long you’ve been on the pill or when you stopped, and whether you have acne, more body or facial hair than before, or irregular periods. These signs can go with an excess of male hormones¹⁰, and the SFD says a hormone test is sometimes ordered in these situations³. If your pill no longer suits you, they can offer you another.

For shedding after stopping, there’s usually nothing to treat: it stops on its own. In the meantime, DermNet advises handling your hair gently, without vigorous combing or brushing⁶.

What if it isn’t the pill?

Shedding that coincides with a change of pill isn’t necessarily caused by it. The SFD lists other common factors in women: low iron or vitamin B12, polycystic ovary syndrome, the menopause, certain medicines³. An underactive or overactive thyroid is also a trigger for effluvium, as is severe stress⁶. And if stopping the pill comes before a pregnancy, shedding after childbirth will follow its own timeline.

There’s also a trap. A drawn-out effluvium can hide female pattern hair loss that was setting in. DermNet notes that chronic telogen effluvium is often confused with this condition, even though the two are managed differently¹⁰. And it’s far from rare: according to the SFD, it affects about one woman in five by the age of 40³.

When to see a doctor

Female pattern hair loss is mainly diagnosed by examination³. The earlier you go, with a clear timeline, the more useful the appointment.

Seeing whether your hair comes back

After stopping the pill, everything plays out over months: the shedding arrives late, and regrowth shows late. The mirror only shows you today, in different light every time.

Take the same photo every week: same room, same light, hair dry and styled the same way. Aim at your parting and the top of your head, where volume shows best. In Calvap, last week’s photo appears as a see-through overlay so you can frame the shot exactly the same, and your journal keeps the date you stopped or switched pills on the same timeline as your photos.

After a few months, you can see whether the shedding has eased and whether short new hairs are growing back along your parting. And when you talk to your doctor, you show them dated photos instead of an impression.