Women's hair loss is something that's often not discussed openly, but for those going through it, it affects much more than just their physical appearance.
Leading scalp micropigmentation artist and founder of Cheltenham's HeadStrong Clinic, Russ Nicholson, breaks the silence around women's hair loss – and shares how SMP can help.
Is hair loss as common for women as it is for men?
Honestly, it's far more common than most people realise. We're so used to seeing men lose their hair that it feels 'normal', but the truth is that around 40 to 50 per cent of women experience some degree of hair loss or thinning by the age of 50, and among women who've been through the menopause, more than half notice a change in their hair. So this isn't a small or unusual thing — a lot of women are quietly living with it.
Where it differs is in the pattern. Men tend to lose hair in a very recognisable way — the hairline recedes, the crown thins, and it can progress towards baldness. Women very rarely follow that route. For women it's usually more diffuse — an overall thinning across the top of the scalp.
The signs are subtler: the parting starts to look wider, the ponytail feels thinner than it used to, or you catch the light on your scalp in a photo and notice more skin showing through than before. It tends to concentrate around the crown and the top, and it usually doesn't go all the way to complete baldness.
The difficult part is that because it's so gradual, and often hidden under the rest of the hair, other people frequently don't notice it at all — but the woman living with it notices every single day. And that's really the heart of it. For a lot of women, hair is tied up with identity, with femininity, with feeling like themselves. So even a change that looks small from the outside can feel enormous on the inside.
What are some of the underlying reasons behind women's hair loss?
There's rarely just one cause, and that's part of what makes women's hair loss so complex. Genetics play a big role — female pattern hair loss is hereditary, just as it is in men, and while it can start any time after puberty, it usually becomes more noticeable with age.
Hormones are probably the biggest driver I see. As women approach and go through the menopause, oestrogen levels fall, and that makes the hair follicles more sensitive to other hormones, so the hair can become finer and shed more. And it doesn't always wait for the menopause itself — perimenopause can begin five to ten years earlier, so many women start noticing changes in their forties without quite knowing why.
Then there are life events and health factors. Pregnancy and the months afterwards are classic triggers — a lot of new mums experience quite dramatic shedding a few months after giving birth. Stress, illness, thyroid problems, and low iron can all cause hair to thin.
Significant or rapid weight changes are another one — and that's become very topical with the rise of GLP-1 weight-loss medications like Ozempic and Mounjaro. What tends to happen there isn't the drug attacking the hair directly, it's that rapid weight loss and a drop in nutrition put the body under stress and push more hairs into a resting, shedding phase. Encouragingly, that kind of shedding is usually temporary and settles once nutrition and weight stabilise, but it can be very frightening while it's happening.
And of course illness — cancer treatment in particular. Chemotherapy can cause hair loss, and when the hair grows back it often returns with a different texture or colour, and many women simply aren't shown how to care for it or style it. That's an area very close to my heart, and part of why I do the work I do supporting people through those moments.
If someone is worried about their hair thinning, what's the first step to take?
My honest advice is: don't panic, and don't rush straight to a 'fix' before you understand what's actually going on. The first step should be getting to the root of it — I'd always encourage someone to see their GP or a trichologist first. Some causes of hair loss are very treatable, and even reversible — a thyroid issue, low iron, a stressful period, postpartum shedding — and a simple set of blood tests can reveal a great deal. It would be a shame to spend time and money treating the symptom when the cause is something that can be put right.
Alongside that, the foundations really matter, and they're the same foundations as general health: good nutrition — enough protein and iron in particular — managing stress where you can, decent sleep, and looking after your scalp, because healthy hair grows from a healthy scalp. There are some genuinely good supplements and treatments on the market now, far more than there used to be, but I'd always want someone to build on solid ground first rather than chase quick fixes.
I'm always upfront with clients about this: scalp micropigmentation doesn't grow hair, and it doesn't treat the underlying cause. So the sensible order is — understand what's happening, support your body and your hair health, and then, if the thinning has settled and you'd still like to create the look of more density, that's where something like SMP comes in.
How can SMP help women experiencing hair loss or thinning?
The simplest way I explain it is that SMP reduces the contrast between your scalp and your hair. When hair thins, the reason it looks thin is that the paler scalp starts showing through the darker hair, and your eye reads that contrast as sparse. What SMP does is place tiny, precise deposits of pigment into the scalp, in between your existing hairs, so the scalp no longer stands out. Suddenly the hair you do have looks fuller and denser, because those gaps aren't catching the light anymore.
For women, this is a very different discipline to the work I do with men. With a lot of male clients we're creating the look of a closely shaved head. With women, it's almost always about adding density underneath and through existing hair — you keep your length, nothing is shaved, and the goal is that no one can tell anything has been done at all.
We focus on the areas where thinning shows most — the parting, the crown, the top of the scalp — and blend it so it's completely undetectable, even close up. It's subtle, meticulous work, and when it's done well the result isn't 'you've had something done', it's simply that you look like you again.
Can you have SMP if you colour or dye your hair? And does SMP work on grey hair?
Yes to both. Because the pigment goes into your scalp and not into the hair itself, colouring or dyeing your hair doesn't affect your SMP at all — you can carry on colouring exactly as you always have. When we plan the treatment, we simply match the pigment tone to the colour you usually wear your hair, so it sits naturally with your look.
And SMP absolutely works with grey hair. There's a real artistry to it: the pigments we use sit on a monochromatic scale, and we dilute them to reach exactly the right tone — the more we dilute, the softer and greyer the shade becomes. So whether someone is salt-and-pepper or fully silver, we can match it.
It all comes down to the colour matching, which is one of the reasons this really isn't a treatment to hand to just anyone — the skill is in getting that tone spot on so it disappears into your natural hair.
If you have SMP and your hair starts to go grey afterwards, what will it look like?
This is a really common — and very sensible — question, and the reassuring answer is that SMP is designed to be adjusted as you age. A couple of things work in our favour. First, the pigment naturally softens and lightens over time. SMP typically lasts around four to six years before it needs refreshing — and that gradual lightening often keeps pace quite nicely with hair that's slowly greying.
Second, it's completely adaptable. If your hair greys and you'd like the SMP to stay perfectly blended, we simply use lighter, more diluted tones at your next top-up to match your new colour. Some people actually choose to let their treatment fade a little more between sessions, so it settles into a softer, more age-appropriate tone by itself.
And in the rare case someone wants to change things more dramatically, there's always the option of gentle laser softening. You're never stuck with a look that no longer suits you — it evolves with you.
What about thinning eyebrows? Is there an SMP equivalent for this?
There is — and it's something we do a lot of. Brows thin for many of the same reasons scalp hair does: age, hormones, years of over-plucking, and again after illness or chemotherapy.
At the clinic we offer what we call Hyper-Realism brows. The principle is similar to SMP, in that we're depositing pigment to recreate the look of hair, but the technique is different — instead of the tiny dots we use on the scalp, brows are built with fine, hair-like strokes that follow the natural direction of brow growth.
Done well, it's incredibly natural — it gives back shape and definition without ever looking drawn-on or harsh. For someone who's lost brow density, it can make a real difference to how balanced and 'themselves' their whole face feels.
For many women, hair loss is a sensitive subject. What would you say to encourage someone to book a consultation?
You're not alone, and there is absolutely no judgement here. I know how much courage it can take simply to talk about it, because I've been on the other side of it myself — I lost my hair in my twenties, and I understand exactly how much it can chip away at your confidence, and how isolating it can feel even when the people around you say 'it's not a big deal.'
It is a big deal, if it's a big deal to you. That's reason enough.
A consultation with me is just a conversation. There's no pressure, no hard sell, and genuinely no obligation to book a thing. Sometimes people come in and the right advice is to go and see their GP first, or to try something else entirely, and I'll happily tell them that — because my job is to help you feel like yourself again, not to sell you a treatment.
So many of my clients say afterwards, 'I wish I'd done this years ago' — and almost always, the hardest part was picking up the phone. If your hair is something that's quietly weighing on you, come and have a chat. You've nothing to lose by starting the conversation, and quite possibly a lot of confidence to gain.
To book a consultation with Russ, visit headstrongclinic.co.uk/book-online.
