Shedding after stress, illness or birth

What telogen effluvium is

Every hair on your head grows in a cycle. It grows for years, changes for a few weeks, then rests for a few months before it falls and a new hair takes its place. Normally only a small share of hairs rest at once, so the daily loss goes unnoticed. The hair cycle, explained covers this in more detail.

Telogen is the medical name for the resting phase, and effluvium means an outflow. So telogen effluvium is an outflow of resting hairs. A shock to the body makes many growing hairs switch to rest at the same time. A few months later, they reach the end of that rest together and fall.^1,2

Doctors have described several ways this can happen. Growing hairs can be released into rest early, or the growing phase can be cut short.³ The result looks the same: shedding all over the scalp, not in patches.

You may find hair in the shower drain, on your pillow, or in your hand when you run your fingers through it. Your ponytail may feel thinner. This can be frightening. But it is not the same as going bald. In telogen effluvium the follicles are still there, and new hairs are already growing behind the ones that fall.

Common triggers

The reviews we rely on name these common triggers:

Illness with fever, such as a bad flu or another infection.^1,2
Giving birth. Shedding after childbirth has its own name: postpartum telogen effluvium.^1,2
Surgery or heavy blood loss.^1,2
Crash diets and other sudden, severe cuts in what you eat.¹
Hard emotional stress, such as grief, a break-up or a very difficult period at work.¹
Long-term illness, including thyroid problems.^1,2
Some medicines.^3,2 If you think a medicine might be the cause, do not stop it on your own. Ask the doctor who prescribed it.
Low iron. Iron deficiency is often named, although its exact role is debated.^1,2

Because of the delay, people often do not link the shedding to its cause. When you look for a trigger, think back 2 to 4 months, not 2 to 4 weeks. Sometimes there is more than one trigger, and sometimes none is found.

When it starts and how long it lasts

Shedding usually starts about 2 to 4 months after the trigger.^1,2 The delay is the resting phase. The hairs stopped growing at the time of the shock, but they stay in the follicle for a while before they fall.

Fig. 1 A typical course: shedding usually starts 2 to 4 months after the trigger, and regrowth follows.1 square = 1 month

Doctors split telogen effluvium into two kinds by how long it lasts. These are definitions, not forecasts:

Acute telogen effluvium lasts less than 6 months.^1,2
Chronic telogen effluvium lasts more than 6 months.^1,2

When the trigger is found and removed, acute telogen effluvium settles by itself.² If the trigger is still there, such as an iron or thyroid problem that has not been treated, the shedding can go on.

Regrowth is quieter than the shedding, so it is easy to miss. New hairs start short. For a while you may see short, fine hairs standing up along your hairline and parting. That is a good sign. It takes many months for these hairs to grow long enough to add visible fullness.

The shedding itself usually fades rather than stopping on one day. Over a few weeks you find fewer hairs in the drain and on the pillow, until it is back to what you were used to before.

After giving birth

Many people notice their hair feels fuller during pregnancy. A few months after the birth, a large group of hairs moves into rest and then falls, often in handfuls.

Postpartum shedding usually starts 2 to 4 months after birth and is usually followed by full recovery.¹ If it goes on for much longer, or you also feel very tired, low or cold, ask a doctor to check for other causes, such as low iron or a thyroid problem.²

Shedding or pattern hair loss?

The two can look alike at first, but they work in different ways:

	Telogen effluvium	Pattern hair loss
How it starts	Fairly suddenly, months after a trigger	Slowly, over years
Where	All over the scalp	Temples and crown, or a wider parting
What you notice	Much more hair falling out	Hair that covers less, thinner strands
Usual course	Settles once the trigger is gone	Keeps going without treatment

Many of the hairs you find will have a small pale bulb at the root. That is the normal end of a resting hair. It does not mean the follicle has been pulled out.

The two can also happen together. A bout of shedding can make you notice pattern thinning that had already started. If your hair does not return to how it was, or it thins mainly on top, read Pattern hair loss, explained and talk to a doctor.

What helps

There is no quick fix, and that is mostly good news. In acute telogen effluvium, the cycle resets by itself once the trigger has passed.²

Give it time. The hairs that fall are being replaced. Recovery is slow to see, because new hair grows at the normal pace.
Find and treat the cause. If a doctor finds low iron, a thyroid problem or another illness, treating it is the real treatment. Take iron only if a blood test shows you need it.
Eat enough. If you have been dieting hard, return to regular, balanced meals. This removes one possible trigger.
Be gentle with your hair. Wash and brush as normal. This only collects hairs that were already loose; it does not cause more loss. While your hair feels fragile, avoid very tight hairstyles and harsh chemical treatments.
Look after yourself. If stress or a hard event was the trigger, support for that helps you, whatever it does for your hair.

Be careful with supplements, serums and clinics that promise to stop shedding fast. Acute shedding usually stops by itself once the cause is gone, so almost any product can seem to work. We cannot point you to a product that reliably speeds up recovery.

For shedding that goes on for longer, doctors sometimes try other treatments, such as minoxidil. Telogen effluvium is one of the conditions in which oral minoxidil has been studied, but the research is limited, and larger trials are still needed.⁴

A practical tip: take a photo of your parting or hairline every month, in the same light. It is easier to see recovery in photos months apart than in the mirror each day.

When to get checked

Most shedding after a clear trigger needs no treatment beyond time. But shedding can also be the first sign of something that needs attention, and only a doctor can tell you which it is.

A doctor will usually ask about the months before the shedding started, look at your scalp, and may order blood tests, for example for iron and thyroid levels.

It helps to prepare a few notes before the visit:

When you first noticed the shedding, and whether it is getting better or worse.
Anything that happened 2 to 4 months before that: an illness, a birth, an operation, a big change in diet, or a hard time.
Any medicines or supplements you started, stopped or changed.
Your photos, if you have taken some.