Hair loss is a common concern among women, and hormonal fluctuations during pregnancy and breastfeeding can exacerbate this condition. Minoxidil, a vasodilator medication commonly used to treat androgenetic alopecia, has gained attention as a potential solution for women experiencing hair loss.
This article aims to examine the use of Minoxidil in pregnancy and nursing mothers, including its effectiveness, potential issues, side effects and alternative treatment options.
Hair loss, medically known as alopecia, is a distressing condition affecting individuals worldwide. Women, in particular, may experience hair loss due to various factors such as genetics, hormonal imbalances, stress, nutritional deficiencies, and ironically even pregnancy and breastfeeding. Some of the types of hair loss that women can experience include:
The majority of the aforementioned hair loss conditions are not directly related to pregnancy but may coincide with it incidentally. The exception to this is telogen effluvium, the most common cause of diffuse hair loss in women [1], which may be triggered by pregnancy.
Whilst some women have pre-existing hair loss before pregnancy, many suffer from hair loss as a result of pregnancy. Pregnancy-induced hair loss is a common occurrence and can be caused by hormonal fluctuations during and after pregnancy. Other reasons why women may experience pregnancy-related hair loss include iron deficiency, which is very common in pregnant women, and thyroid problems [2].
Pregnancy-induced hair loss It is a type of telogen effluvium – a form of hair loss characterised by excessive shedding of hair. This occurs when there is a disruption in the hair cycle growth phase, specifically the telogen phase (the resting phase), which gives it its name. Typically, a significant number of hair follicles prematurely enter this phase which results in excessive hair shedding.
What is more, there is a fair amount of anecdotal evidence that stopping taking hormonal contraceptives can cause hair loss. If a woman has fallen pregnant soon after coming off the pill, this could be a trigger for hair loss in pregnancy. Scientifically, however, the jury is still out on the effects of the contraceptive pill on hair loss [3].
In the case of postpartum hair loss, the hormonal changes that occur in pregnancy can lead to a prolonged anagen phase, resulting in thicker hair. However, after childbirth, hormone levels rapidly decrease, causing more hair follicles to enter the telogen phase and eventually shed.
The shedding associated with telogen effluvium is generally diffuse and occurs evenly across the scalp, which is different from other types of hair loss in women. It usually becomes noticeable about two to three months after a triggering event (in this case, hormonal changes after childbirth) and can persist for several months before the hair cycle returns to normal. About six months after childbirth, many women have visible tufts of shorter hairs near their scalp, typically more noticeable at the forehead. This is due to the re-growth of the hair that was previously shed. Usually, pregnancy-induced hair loss resolves within about six months without the need for treatment.
As women strive to maintain their self-esteem and confidence, many consider treatment options to address the issue of hair loss, regardless of its cause. Minoxidil, a topical medication that promotes hair growth, has emerged as a potential solution for women experiencing hair thinning. Whilst Minoxidil use in women is generally considered safe[4], the use of Minoxidil in pregnancy raises concerns due to potential risks to the developing foetus.
Minoxidil, often under the brand name Rogaine, is a vasodilator medication originally developed for the treatment of hypertension. However, oral Minoxidil was discovered that it had the unexpected side effect of promoting hair growth. Since then, Minoxidil has been formulated as a topical solution or foam for the treatment of hair loss in both men and women[5].
When applied to the scalp, Minoxidil widens the blood vessels, increasing blood flow to hair follicles. This improved circulation is thought to stimulate hair growth and prolong the anagen (growth) phase of the hair cycle. The exact mechanism of Minoxidil’s action in promoting hair growth is not fully understood but is believed to involve the conversion of Minoxidil to its active form, minoxidil sulphate, which may stimulate cellular pathways supporting cell proliferation in the hair follicle.
Minoxidil has been shown to be effective in promoting hair regrowth, particularly in people with androgenetic alopecia. Studies have shown that it can increase hair count, improve hair density and lead to visible improvements in hair growth. However, the response to Minoxidil can vary among individuals, often taking several months before visible changes become noticeable.
As mentioned, many women use Minoxidil to treat their hair loss. However, as is the case with many medicines or female hair loss treatments, it is best avoided during pregnancy due to the potential side effects and risks involved.
Of course, there is little in the way of studies of conclusive evidence regarding its safety – not many women are willing to gamble with the health of their unborn baby even if their hair loss is significantly troubling them.
Let’s consider the potential issues and risks with Minoxidil use in and after pregnancy.
The main concern with Minoxidil use in pregnancy is its systemic absorption, which could potentially affect the developing foetus.
Minoxidil’s vasodilatory properties may increase blood flow to the placenta, raising concerns about possible adverse effects on foetal growth and development.
One study reports the case of a 28-year-old woman who applied Minoxidil 2% to her scalp daily due to hair loss. When she had a routine ultrasound scan 22 weeks into her pregnancy, the test showed significant heart, brain and vascular formations in the baby [6].
The heart had increased in size and had a globose shape with a distal stenosis in the aorta. The baby’s colon was also significantly longer than is typical and the ventricles in the brain were also enlarged with abundant haemorrhages. The placenta also had ischaemic areas and did not appear to be at the correct gestational age regarding villi maturation. When analysed histologically, there were signs of the abnormal formation of blood vessels and extensive damage to the nervous system [6].
Aside from this case, rare cases of hypertrichosis (excessive hair growth) have been associated with women using Minoxidil during pregnancy. This is called foetal Minoxidil syndrome[7], which usually diminishes after six months.
Animal studies have also shown the negative effects of Minoxidil in pregnancy. Studies revealed that there was increased foetal absorption of the drug when it was administered at five times the maximum recommended human dose [8]. There was no concrete evidence of teratogenicity (reproductive toxicity causing foetal abnormalities), however [9].
From the limited research and cases that exist, caution is advised when considering Minoxidil use during pregnancy.
Research has shown that over 68% of new mothers experience some degree of hair loss after giving birth [9]. For breastfeeding mothers facing the challenge of postpartum hair loss, some may consider Minoxidil as a potential treatment option.
Most women are aware that the medications they take are often transferred into their breast milk [11]. However, as limited data are available regarding the safety of Minoxidil use while breastfeeding, caution should be exercised.
There is some thought that maternal topical application of Minoxidil should pose a lower risk to older, full-term breastfed infants, but might be best avoided while breastfeeding a premature or neonatal infant [12].
One piece of research describes the case of an infant whose mother used 5% topical Minoxidil twice a day whilst breastfeeding her baby who was born four weeks prematurely [13]. At two weeks of age, the child appeared normal but had a considerable amount of black hair on the forehead by the time he or she was two months old. When the mother discontinued the treatment, the infant shed the excess hair.
Due to the limited data available on Minoxidil’s safety in pregnancy and breastfeeding, alternative treatment options for hair loss in these periods should be considered.
Non-pharmacological approaches that stimulate follicles for hair growth such as gentle hair care practices, avoiding hairstyles that put excessive strain on the hair, and ensuring a balanced diet with adequate nutrients for hair health can be beneficial.
Psychological support and counselling can also help women cope with the emotional impact of hair loss during pregnancy and breastfeeding.
Hair loss during pregnancy and breastfeeding can be distressing for women, and the use of Minoxidil as a treatment option requires careful consideration due to limited evidence on its safety during these periods.
Pregnant and nursing women experiencing hair loss should consult their healthcare provider to explore alternative treatment options and discuss the potential risks and benefits associated with Minoxidil use.
Further research is necessary to establish the safety and efficacy of Minoxidil specifically in these populations.
Prioritising the well-being of both the mother and the developing child is crucial in making informed decisions regarding hair loss treatment during pregnancy and breastfeeding.
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