Of all the side effects of breast cancer treatment, hair loss can be one of the most difficult ones to deal with emotionally.
You may think it seems silly or vain to worry about your hair given everything else you are coping with. But it’s OK to feel bad that your hair may thin or fall out completely. Your hair is part of who you are, and losing it can make you feel a loss of control.
On the other hand, you may not feel strongly about the possible loss of your hair. You may view it as a positive sign that you are working hard to get rid of the breast cancer. Or, you may miss your hair but want to experiment with hats and head scarves. There is no right or wrong way to feel.
It can help to understand why hair loss may occur during breast cancer treatment and follow tips on how to manage it.
What are the symptoms of hair loss?
Hair loss does not cause pain. But before your hair falls out, you could feel scalp tenderness or discomfort. The process may be quick or gradual. Before you start treatment, ask your doctor what to expect.
Hair loss usually doesn’t start until after a few treatments. You may lose hair in the shower or notice clumps of hair on your pillow, comb, or brush. It may fall out in a “reverse mohawk” pattern, in which a strip of hair down the center of the head from front to back falls out while the hair on either side remains. Your eyebrows, eyelashes, pubic hair, and the hair on your arms, underarms, and legs may also fall out.
Your hair could grow back during treatment or in the months after. Most women have about an inch of hair grow back about a month after their last chemotherapy treatment. When your hair grows back, it could be a different color or texture than before. It may or may not slowly go back to what it was before your treatment.
What causes hair loss?
Many cancer treatments kill quickly dividing cells. Cancer cells divide rapidly, but so do some healthy cells, such as those found in hair. Hair follicles are among the most quickly growing cells in the body and are likely to be harmed by cancer treatments.
Not everyone loses hair during breast cancer treatment. If you’re having certain kinds of chemotherapy, you may be more likely to lose your hair because these medicines go after quickly dividing cells. Some chemotherapy medicines make all your hair fall out. Others thin or change your hair, and still others do not impact your hair at all. Whether and when hair loss happens depends on the types of chemotherapy medicines you receive. The dose and timing of your treatments may also be a factor.
Other cancer treatments can also have an effect on hair
- Hormonal therapies, such as aromatase inhibitors, tamoxifen, and oophorectomy, may cause hair thinning or loss
- Radiation treatment can cause hair loss to the treated area
Ask your providers whether the treatments you will receive could cause hair loss, and what type of hair loss you should expect. Having this information will help you prepare.
How can I manage hair loss?
Some women want to take charge by shaving their heads or cutting their hair very short, before the hair falls out. You may find it empowering to do so. Or you may prefer to wait and see.
If you wish to cover your head, you may want to explore your options ahead of time. You could choose a wig that resembles your natural hair or one that gives you a new look, or you could buy caps and brightly colored scarves.
Heat escapes from the tops of our heads. Without hair, you may find yourself feeling chilly. Buy hats to protect your scalp from the sun and to keep warm. If you don’t want to cover your head, it is perfectly fine to go bald – just remember to use sunscreen.
It would be great if there were a simple pill to prevent hair loss or a magic lotion you could rub on your scalp to keep your hair full. There isn’t such a product (though you might see some that make the claim), but research into how to minimize cancer effects, including hair loss, is ongoing.
You may have heard of "scalp cooling," a therapy that helps some people lose less or no hair during chemotherapy. In this therapy, you wear a cooled headpiece during chemotherapy sessions. By lowering the temperature of your hair follicles and scalp, the blood flow to this area is slowed and is less exposed to the chemotherapy medicines. Recent studies have found scalp cooling helps some people keep their hair. It works better with some chemotherapy medicines than with others. Read our page, Scalp Cooling to Help Prevent Hair Loss, to learn more about this therapy.
The American Cancer Society offers these tips on ways to be gentle to your hair during cancer treatment:
- Use mild shampoo
- Use soft-bristle hair brushes
- Use low heat if you use a hair dryer
- Don’t use brush rollers
- Don’t dye or perm your hair
- Use a satin pillowcase
Dealing with the emotional toll of hair loss
Women from many cultures and backgrounds find that hair loss affects the way they view their bodies and femininity. If you’re already self-conscious about your hair and the role it plays in your life and in your relationships, hair loss can make a sensitive issue even worse. Even if you’ve never felt your hair was an important part of who you are, you may be surprised by how distressed you feel about losing it.
You may also feel that, for the first time, everyone can see you’re sick.
You may find it useful to talk to a mental health professional about your feelings. Your healthcare team may be able to recommend someone who specializes in helping women with breast cancer.
In-person support groups or online communities may also bring you comfort. It can be reassuring to know you’re not alone.
You’re going through a difficult time that likely few people in your life can really understand. Seeking help as you face this challenge isn’t a sign of weakness. It’s a sign of strength.