Telogen Effluvium

Why is my hair suddenly falling out in handfuls?

Telogen effluvium is sudden, diffuse hair shedding that typically starts two to four months after a shock to the body, such as illness, surgery, childbirth, crash dieting or severe stress. It looks alarming, but it is usually temporary. The follicles are resting rather than dying, and shedding generally settles as the trigger resolves.

Is this you?

• Noticeably more hair in the plughole, on your pillow, or in your brush, often two or three times what is normal for you

• Shedding all over rather than in one patch or a receding line

• A ponytail that feels thinner, or a widening parting

• It started a few months after being ill, having an operation, giving birth, losing weight fast, or a very stressful period

• Hairs come away easily when you run your fingers through

These symptoms overlap with several other conditions, including pattern hair loss, thyroid related shedding and iron deficiency, so heavy shedding on its own cannot tell you which is which.

What is happening and why

Each hair follicle cycles between growing (anagen) and resting (telogen). Normally only a small proportion of your follicles rest at any one time, which is why losing some hair daily is normal. A significant physical or emotional shock can push a large proportion of follicles into the resting phase at once. Around two to four months later, the length of the resting phase, those hairs are released together, and the shedding begins. That delay is why so many people cannot connect the shedding to its cause. By the time the hair falls, the trigger is months in the past.

It is well established that most telogen effluvium resolves on its own. Once the trigger has passed, the follicles re enter growth and density gradually recovers over several months to a year. The complication is that other conditions, and sometimes a second, compounding factor such as low iron or a thyroid issue, produce near identical shedding. Telling them apart requires examining the scalp, which is what the assessment is for.

How I assess it

The appointment begins with a careful history. I will ask what happened in the three to six months before the shedding started, and about your general health, medications, diet and cycle, because the trigger usually sits in that window, and because more than one factor is often in play.

I then examine your scalp with trichoscopy, a high magnification lens that shows what a mirror or a photo cannot. It shows me the proportion of short regrowing hairs, which is a genuinely reassuring sign, whether anything points towards a different type of hair loss, and whether the scalp itself is healthy. I take clinical photographs to give you an objective baseline, so recovery over the following months can be properly compared rather than remembered. Where blood tests would be useful, I can arrange testing, or request it through your GP.

The assessment has two jobs here: confirming this actually is telogen effluvium, and finding any compounding factor that would slow recovery if left unaddressed.

Treatment options, and why the right one depends on the cause

Well established approaches. It is well established that the core of managing telogen effluvium is identifying and resolving the trigger, and correcting any confirmed deficiency, such as low iron, through your GP. Time then does most of the work.

Emerging and adjunctive in clinic therapies. Evidence is growing that some in clinic scalp therapies can support the follicle environment during recovery. Early research suggests approaches such as growth factor mesotherapy may help some people, and results vary. Whether any of it adds value in your case depends on what is actually driving your shedding.

Self care and nutrition. Eating regularly and well, handling your hair gently, and giving recovery time all genuinely matter. Crash dieting is both a common trigger and a common reason recovery stalls. What your routine should look like is worked out at assessment, because a plan matched to the wrong cause can waste months while a compounding factor goes unaddressed.

See also: pattern hair loss. 

When to see your GP

See your GP if you have other symptoms alongside the shedding, such as exhaustion, weight change, feeling cold, heavy periods or dizziness. These can point to thyroid, iron or autoimmune causes that need medical testing and treatment. Where anything I find at assessment needs medical attention, I will refer you on and coordinate with your GP.

Getting help in Ipswich and Suffolk

I am based in Ipswich and see clients from across Suffolk, including Woodbridge, Felixstowe, Stowmarket and Bury St Edmunds, many of them people a few months after an illness or a baby, worried by how much hair is coming away. Heavy shedding usually settles, but the only way to confirm what is happening, and to catch anything compounding it, is to look at the scalp properly. That is what a consultation is for. You can book your consultation whenever you are ready.