Hormonal Contraceptives and Hair Loss
Hormonal contraceptives are among the most widely used medications by women of reproductive age. Although these medications are generally safe and effective when appropriately prescribed, their potential effects on hair growth deserve considerably more attention, particularly among women with a genetic predisposition to female pattern hair loss, also known as androgenetic alopecia.
Hormonal birth control can be associated with changes in hair shedding, particularly when a contraceptive is started, changed or discontinued. For women who are genetically susceptible to androgenetic alopecia, these changes also raise important questions about whether hormonal contraception may reveal previously unrecognized thinning or potentially accelerate progressive hair loss. Although the precise relationship has not been fully established through independent clinical research, these distinctions are particularly important for younger women who may begin using hormonal contraception years before female pattern hair loss would otherwise become apparent.
Hormonal contraceptives influence the body’s reproductive hormones through different combinations of estrogen and synthetic progesterone-like hormones known as progestins. These medications can affect ovarian androgen production, circulating hormone levels and the hormonal environment surrounding hair follicles. Different contraceptive formulations have different biological effects, and their potential influence on hair growth cannot be determined simply by whether they contain hormones.
Two important forms of hair loss must be distinguished. Telogen effluvium is a disruption of the normal hair growth cycle that can produce increased shedding following a hormonal change. Androgenetic alopecia, or female pattern hair loss, is a progressive condition involving the gradual miniaturization of genetically susceptible hair follicles. Hormonal changes may coincide with, reveal or potentially contribute to the progression of androgenetic alopecia, but the extent to which individual contraceptive methods cause or accelerate this process has not been adequately established.
A woman may experience temporary shedding after starting or discontinuing a contraceptive, while another may notice progressive thinning, a widening part or a gradual reduction in hair density. These presentations should not automatically be considered the same condition. Persistent or worsening hair loss deserves an accurate diagnosis rather than reassurance that it will necessarily resolve.
Understanding the Androgenic Effects of Birth Control Pills
Oral contraceptives generally fall into two categories: combined pills containing estrogen and a progestin, and progestin-only pills. Combined oral contraceptives usually suppress ovulation and can also reduce circulating free testosterone through their effects on ovarian hormone production and sex hormone-binding globulin. For some women, these effects may improve androgen-related conditions such as acne and excessive facial hair growth.
Progestin-only pills do not produce the same estrogen-related increase in sex hormone-binding globulin as combined oral contraceptives. Consequently, the overall hormonal effects of a particular progestin may differ depending on whether it is delivered with estrogen or used alone. This distinction is important when discussing the potential effects of different contraceptive methods on hair growth.
Not all progestins have the same properties. Some have relatively greater androgenic activity, while others have low androgenic activity or antiandrogenic effects. Androgens are hormones that include testosterone and dihydrotestosterone (DHT), both of which can influence susceptible hair follicles. However, the relationship between circulating androgen levels and female pattern hair loss is complex, and many affected women have normal hormone levels.
Progestins such as levonorgestrel and norgestrel are considered relatively more androgenic. Norethindrone generally has intermediate androgenic activity, while norgestimate and desogestrel have comparatively lower androgenic activity. Drospirenone has antiandrogenic properties. These differences provide useful information when discussing contraceptive options, but they do not establish a reliable ranking of the likelihood that an individual pill will cause or prevent hair loss.
The effects of a contraceptive depend on the complete formulation, including estrogen content, progestin dose and how the hormones influence androgen activity in the body, rather than the progestin’s androgenic properties alone. A lower-androgenic or antiandrogenic formulation is not a guarantee against hair loss. A woman’s genetic susceptibility, existing follicular miniaturization, hormonal changes accompanying a medication change and other medical factors may all influence what happens to her hair.
Birth Control Pills and Their Androgenic Properties
Birth control pills are often compared according to the androgenic activity of the progestin they contain. However, these classifications describe general hormonal properties rather than a scientifically established ranking of hair-loss risk. Brand names, formulations and availability can also change, making the identity of the active progestin more useful than a brand-name ranking alone.
- Drospirenone: Has antiandrogenic properties and is found in combined oral contraceptives such as Yaz and Yasmin, as well as drospirenone-only pills such as Slynd. The absence or presence of estrogen changes the overall hormonal effects of these formulations.
- Norgestimate: Has relatively low androgenic activity and has been used in combined oral contraceptives such as Ortho-Cyclen and Ortho Tri-Cyclen, as well as generic equivalents.
- Desogestrel: Has relatively low androgenic activity and has been used in combined oral contraceptives such as Desogen and Ortho-Cept, along with generic equivalents.
- Norethindrone and norethindrone acetate: Have some androgenic activity and are used in several combined and progestin-only oral contraceptives. Their effects cannot be assessed solely by comparing brand names or estrogen doses.
- Levonorgestrel and norgestrel: Have relatively greater androgenic activity and are used in certain combined and progestin-only contraceptives. Their androgenic properties do not establish that these products will necessarily cause hair loss in susceptible women.
These classifications should never be used as the sole basis for selecting contraception. A method with lower androgenic activity may be appropriate for some women but unsuitable for others because of medical history, contraindications or other safety considerations. Some combined contraceptives may also have beneficial effects in women with certain androgen-related conditions.
Women concerned about hereditary hair loss should discuss the specific hormones in their contraceptive with a knowledgeable healthcare professional. For women with existing female pattern hair loss or a strong family history, the discussion should include potential hair-related effects, medical suitability and the availability of nonhormonal alternatives. Changing contraception without medical guidance can create additional risks, including unintended pregnancy.
Other Hormonal Contraceptive Methods and Hair Loss
Hormonal contraception is not limited to oral medications. Implants, hormonal intrauterine devices, injections, vaginal rings and transdermal patches deliver hormones through different routes and at different doses. Although some methods produce lower circulating hormone concentrations than others, this does not necessarily mean that they are incapable of influencing hair growth.
Progestin Implants
Contraceptive implants are small, flexible rods placed beneath the skin of the upper arm. Modern implants such as Nexplanon release the progestin etonogestrel over an extended period to prevent pregnancy, primarily by suppressing ovulation.
Because implants deliver a progestin without estrogen, their hormonal effects differ from those of combined oral contraceptives. Hair loss has been reported with progestin implants, although the available evidence does not establish how often an implant causes androgenetic alopecia or whether an individual woman’s progressive thinning is directly attributable to the medication.
A temporal association between implant insertion and hair loss warrants investigation, particularly when thinning continues or follows a recognizable pattern. However, the timing alone cannot establish that the implant caused the condition.
Intrauterine Devices (IUDs)
Intrauterine devices are small contraceptive devices placed inside the uterus. There are two fundamentally different types: hormonal IUDs that release levonorgestrel and nonhormonal copper IUDs.
Hormonal IUDs, including Mirena, Liletta, Kyleena and Skyla, release levonorgestrel, a progestin with androgenic activity. Although much of the contraceptive effect occurs locally within the reproductive system, some levonorgestrel enters the bloodstream. Hormonal IUDs should therefore not be described as having exclusively local effects.
Hair loss has been reported among users of levonorgestrel-releasing IUDs and is identified in the adverse-event information for certain products. However, adverse-event reports and observed associations do not establish the frequency of contraceptive-induced androgenetic alopecia or prove that an IUD caused a particular woman’s hair loss. Progressive thinning after insertion deserves appropriate evaluation rather than an assumption that systemic hormonal effects are impossible.
Copper IUDs do not release contraceptive hormones and may be worth discussing for women who wish to avoid hormonal contraception. However, copper IUDs can increase menstrual bleeding in some users, and heavy bleeding may contribute to iron deficiency, which itself can affect hair growth. The choice between hormonal and nonhormonal contraception should therefore account for the individual’s complete medical circumstances.
Hormone Injections
Injectable contraception, including depot medroxyprogesterone acetate, commonly known by the brand name Depo-Provera, delivers a long-acting progestin to prevent pregnancy. Depending on the formulation, injections are administered into muscle or beneath the skin at scheduled intervals.
Hair loss has been reported with injectable progestin contraception. As with other hormonal methods, it is important to distinguish increased shedding associated with changes in the hair growth cycle from progressive follicular miniaturization. The mechanism and likelihood of hair loss may vary, and an individual reaction cannot be predicted with certainty.
One important consideration is that the effects of an injection cannot be immediately reversed after administration. Women who believe they are experiencing a medication-related adverse effect should discuss the timing of their symptoms and future contraceptive options with their prescribing clinician before receiving subsequent doses.
Vaginal Ring
Hormonal vaginal rings are flexible devices placed inside the vagina to release contraceptive hormones over a prescribed period. Combined vaginal rings, including NuvaRing and its generic equivalents, release estrogen and a progestin. Other vaginal ring formulations may contain different hormones.
Although the hormones are delivered vaginally, they enter the circulation and produce systemic effects. The route of administration does not eliminate the possibility of hormone-related changes in hair growth, nor does it establish that a vaginal ring carries a greater or lower risk of hair loss than an oral contraceptive.
Women who experience shedding or thinning while using a hormonal vaginal ring, or after discontinuing one, should have their symptoms evaluated in the context of the timing of hormonal changes and any underlying susceptibility to androgenetic alopecia.
Skin Patch
The hormonal contraceptive patch delivers estrogen and a progestin through the skin. Products in this category include formulations containing different progestins and estrogen doses, which can produce differences in systemic hormone exposure.
Like combined oral contraceptives and vaginal rings, contraceptive patches alter the hormonal environment and may affect hair growth in susceptible individuals. However, there is insufficient evidence to establish that a particular patch is consistently more or less likely to cause progressive female pattern hair loss than other contraceptive methods.
The fact that contraceptive hormones are absorbed through the skin rather than taken orally does not eliminate their systemic effects. Persistent shedding, a widening central part or continuing reductions in scalp density should be evaluated rather than automatically attributed to a temporary adjustment to contraception.
What to Do if Hair Loss Begins After Starting or Stopping Birth Control
Hair loss that begins after starting, switching or discontinuing hormonal contraception should not automatically be dismissed as temporary. Although some women experience a self-limited episode of telogen effluvium, others may have previously unrecognized female pattern hair loss or more than one hair loss condition at the same time.
Hormone-related telogen effluvium may become apparent several months after a contraceptive is started, changed or discontinued. The timing of shedding can provide an important clue, but it does not establish whether the contraceptive caused the hair loss or whether an underlying condition is also present.
An appropriate evaluation should consider when the contraceptive was started or changed, the timing and duration of shedding, family history, scalp findings and other possible contributors. Women who suspect a contraceptive is contributing to their hair loss should bring the exact product name, the date it was started or changed, and any available photographs showing the progression of thinning to their medical evaluation.
Examination with trichoscopy, which uses magnification to assess the scalp and individual hairs, can help identify variations in hair shaft diameter and other signs of follicular miniaturization that may indicate androgenetic alopecia. Laboratory testing may be appropriate when symptoms or medical history suggest iron deficiency, thyroid disease or another underlying condition.
Discontinuing hormonal contraception does not guarantee that hair loss will stop or that previously lost density will return. Temporary shedding may resolve as the hair growth cycle stabilizes, but established androgenetic alopecia can continue to progress independently. Women should not stop or change contraception without discussing pregnancy prevention, medical suitability and alternative options with their prescribing healthcare professional.
Early identification of progressive hair loss matters. Delaying diagnosis while assuming that persistent thinning will eventually correct itself may result in lost opportunities to preserve existing hair.
The AHLA Perspective
The American Hair Loss Association believes the potential relationship between hormonal contraception and early-onset female pattern hair loss has received far less scientific and clinical attention than it deserves. For more than two decades, the AHLA has heard from substantial numbers of younger women who associate the beginning or worsening of their hair loss with starting, switching or discontinuing hormonal contraceptives. These recurring experiences form an important part of the association’s longstanding consumer advocacy, even though they cannot establish population-wide risk or prove that contraception caused an individual case.
One of the AHLA’s central concerns is that women reporting hair loss after a hormonal change may be reassured that they are experiencing temporary shedding without receiving a thorough assessment for androgenetic alopecia. While hormonal changes can trigger telogen effluvium, persistent shedding and progressive thinning should prompt careful examination for follicular miniaturization. This distinction is particularly important for younger women, in whom early recognition may influence long-term treatment outcomes.
The AHLA also believes women deserve meaningful information about the hormonal properties of contraceptives before treatment begins. Different progestins have different androgenic effects, but no contraceptive should be marketed or recommended as universally safe for hair simply because it has a low androgen index or antiandrogenic properties. Hair-related concerns must be considered alongside the established benefits, contraindications and overall medical safety of each contraceptive method.
More independent research is needed to determine whether particular hormonal formulations contribute to the onset or acceleration of androgenetic alopecia in genetically susceptible women, which patients may be at greater risk and how temporary contraceptive-related shedding can best be distinguished from progressive hair loss.
The AHLA’s position is that women should not be forced to choose between reliable contraception and having their concerns about hair loss taken seriously. They deserve informed discussions with their healthcare professionals, accurate diagnoses and access to appropriate treatment options. Protecting women’s reproductive health and recognizing the potentially devastating emotional impact of hair loss are complementary responsibilities, not competing priorities.