Hair Loss and PMOS: 5 Evidence-Based Strategies That May Help

One of the hardest things about hair loss is that it can feel like you're watching it happen in slow motion.

You notice more hair in the shower drain.

Your ponytail feels thinner.

Your parting seems wider than it used to be.

You start avoiding certain hairstyles or checking your hair in every mirror you pass.

Hair loss is one of the symptoms that many women with PMOS (formerly PCOS) tell me they find most upsetting, yet it's also one of the symptoms they often feel least supported with.

Whilst there isn't a magic cure, there are things that may help. The key is understanding what's driving the hair loss in the first place.

Why Does PMOS Cause Hair Loss?

Hair loss in PMOS is often linked to elevated androgen levels.

Androgens are hormones such as testosterone and DHEAS that are naturally present in women but may be elevated in those with PMOS.

These hormones can affect the hair follicle, causing hairs to become progressively finer, shorter and less pigmented over time. This process is known as follicular miniaturisation and is one of the main reasons women with PMOS may notice thinning around the crown, temples or parting.

The frustrating thing is that the same hormones that can contribute to unwanted hair growth on the face or body can simultaneously contribute to hair thinning on the scalp.

This is why simply focusing on hair products often doesn't address the root cause.

1. Improving Insulin Sensitivity

One of the major drivers of elevated androgen levels in PMOS is insulin resistance.

When insulin levels remain elevated, the ovaries can be stimulated to produce more testosterone.

Higher androgen levels may then contribute to symptoms such as hair loss, acne, excess facial hair and irregular periods.

This is why improving insulin sensitivity is often one of the first areas I focus on with clients.

Helpful strategies include:

• Eating regular meals

• Prioritising protein

• Increasing fibre intake

• Strength training

• Improving sleep

• Managing stress

• Increasing daily movement

• Considering myo-inositol where appropriate

  
  

Will improving insulin sensitivity reverse hair loss overnight? Unfortunately not.

Hair growth is slow, and hair follicles take time to respond to changes in the hormonal environment. However, by addressing one of the root drivers of androgen excess, you may help create more favourable conditions for healthy hair growth over time.

2. Don't Underestimate the Role of Stress

When we think about hair loss in PMOS, most people immediately focus on testosterone and insulin resistance. However, stress may also play an important role.

In some women with PMOS, chronic stress can activate the hypothalamic-pituitary-adrenal (HPA) axis – the body's main stress response system. This may increase production of adrenal androgens, particularly DHEAS. Why does this matter? Because androgens are one of the key drivers of hair thinning in PMOS.

Stress can also worsen insulin resistance, disrupt sleep and increase inflammation, creating a cycle where several of the root causes of PMOS begin reinforcing one another. One of the challenges with PMOS is that many of the underlying drivers are interconnected. Stress can worsen insulin resistance. Insulin resistance can increase androgen production. Elevated androgens can contribute to symptoms such as hair loss.

The good news is that improvements in one area often create positive knock-on effects elsewhere.

This doesn't mean reducing stress will suddenly reverse hair loss, but it is one of the reasons I encourage women to think about stress management as part of a broader strategy to support hormonal health.

3. Ask Your GP to Check Your Ferritin

This is one of the most overlooked areas when it comes to hair loss. Ferritin is a marker of your body's iron stores. Many women are told that their iron levels are "normal", but ferritin is not always included in routine blood testing unless specifically requested.

Several studies have found that women experiencing diffuse hair loss frequently have lower ferritin levels than women without hair loss. Interestingly, some researchers have suggested that ferritin levels considered adequate for preventing anaemia may not be sufficient for optimal hair growth.

Whilst there is no universally agreed target, several papers propose that ferritin levels of approximately 40–60 ng/mL may be more supportive of healthy hair growth than the traditional cut-offs used to diagnose iron deficiency anaemia.

The research isn't completely consistent. Some studies have found a strong relationship between ferritin and hair loss, whilst others have not. However, if you're experiencing hair thinning, ferritin is absolutely worth discussing with your GP.

It may be one of the simplest things to investigate, particularly if you also experience:

• Fatigue

• Breathlessness

• Dizziness

• Restless legs

• Heavy periods

  
  

4. Could Your Hair Loss Be Something Other Than PMOS?

Although elevated androgen levels are a common cause of hair thinning in women with PMOS, they aren't the only possible explanation.

Hair loss can also be linked to:

• Iron deficiency

• Low ferritin levels

• Thyroid dysfunction

• Recent illness or infection

• Significant weight loss

• Certain medications

• Nutrient deficiencies

• Postpartum hormonal changes

  
  

This is one reason why I encourage women experiencing hair loss not to assume PMOS is the sole cause. Sometimes there are multiple factors contributing at the same time.

A thorough assessment and appropriate blood tests can often help identify whether something else is playing a role.

5. Minoxidil: The Treatment Many Women Don't Realise They Can Use

When most people think of minoxidil, they think of products marketed towards men.

However, minoxidil is also one of the most well-researched treatments available for women experiencing pattern hair loss.

In fact, topical minoxidil is currently the only FDA-approved treatment for female pattern hair loss.

Research suggests that around 40–60% of women experience noticeable improvements in hair density or reduced shedding when using minoxidil consistently. One of the biggest challenges with minoxidil is expectations.

Many women try it for a few weeks, don't see a difference and stop. Unfortunately, hair doesn't work that way. Most studies suggest that meaningful improvements typically require at least 3–6 months of consistent use before changes become visible.

Some women also experience increased shedding during the first few weeks. Whilst this can feel alarming, it can be a normal part of the process as older hairs are shed before new growth begins.

If you're considering minoxidil, it's worth discussing it with your GP, pharmacist, dermatologist or hair-loss specialist to determine whether it's appropriate for you.

What About Supplements?

I know it's tempting to search for the perfect hair supplement.

Trust me, I understand.

But unfortunately, there isn't currently strong evidence that any one supplement consistently reverses PMOS-related hair loss.

Before spending money on expensive hair supplements, I would focus on:

• Optimising iron status

• Ensuring adequate protein intake

• Improving insulin sensitivity

• Supporting stress management

• Correcting any nutrient deficiencies identified through testing

  
  

These foundations are often far more impactful than the latest "miracle" supplement being advertised online.

The Bottom Line

Hair loss can feel devastating. I've worked with many women who tell me it affects their confidence more than almost any other PMOS symptom. And I completely understand why.

Unlike improvements in energy or cravings, which may be noticeable within weeks, hair growth is slow. It often takes months before changes become visible. That can feel incredibly frustrating.

But that doesn't mean there's nothing you can do.

If you're struggling with hair loss, start by focusing on the areas that are within your control:

✓ Improve insulin sensitivity

✓ Manage stress and support your HPA axis

✓ Ask your GP to check your ferritin levels

✓ Consider whether minoxidil may be appropriate

✓ Rule out other potential causes such as thyroid dysfunction

Hair loss is rarely about one single thing. More often, it's about improving the overall environment in which your hair follicles are trying to grow.

And whilst progress may be slow, many women do see improvements when they take a consistent, evidence-based approach.

Struggling with Hair Loss and PMOS?

For some women, insulin resistance is playing a role. For others, elevated androgen levels, low ferritin, stress, nutrient deficiencies or thyroid dysfunction may be contributing. Understanding what's driving your symptoms is often the first step towards improving them.

If you'd like support identifying the potential root causes of your hair loss and creating a personalised plan, you can book an Initial Assessment & Roadmap where we'll review your symptoms, blood tests, lifestyle and goals in detail.

Book an Initial Assessment & Roadmap to get started.

References

Bregy, A. and Trüeb, R. (2008) 'No Association between Serum Ferritin Levels >10 μg/l and Hair Loss Activity in Women', Dermatology, 217, pp. 1–6.

Lin, C.S., Chan, L.Y., Wang, J.H. and Chang, C.H. (2023) 'Diagnosis and treatment of female alopecia: Focusing on the iron deficiency-related alopecia', Tzu Chi Medical Journal, 35, pp. 322–328.

Lucky, A.W. et al. (2004) 'A randomized, placebo-controlled trial of 5% and 2% topical minoxidil solutions in the treatment of female pattern hair loss', Journal of the American Academy of Dermatology, 50(4), pp. 541–553.

Raichur, S., Pandit, A. and Malleshappa, A. (2017) 'Correlation of serum ferritin levels in female patients with chronic diffuse hair loss: A cross-sectional study', Indian Journal of Health Sciences and Biomedical Research, 10, pp. 190–195.

Suchonwanit, P., Thammarucha, S. and Leerunyakul, K. (2019) 'Minoxidil and its use in hair disorders: a review', Drug Design, Development and Therapy, 13, pp. 2777–2786.

Tamer, F., Yuksel, M.E. and Karabağ, Y. (2020) 'Serum ferritin and vitamin D levels should be evaluated in patients with diffuse hair loss prior to treatment', Advances in Dermatology and Allergology, 37, pp. 407–411.

Van Zuuren, E.J. and Fedorowicz, Z. (2017) 'Interventions for female pattern hair loss', JAMA Dermatology, 153(4), pp. 329–330.