Endometriosis is a chronic condition where tissue similar to the lining of the uterus (endometrium) grows outside the uterine cavity, often on the ovaries, fallopian tubes, and pelvic lining. This misplaced tissue responds to the monthly hormonal cycle, leading to inflammation, scar tissue formation, and often severe pain. While hair loss is not a defining symptom, many patients report noticeable changes in hair density and texture. This systemic impact is often tied to the body’s overall response to chronic illness and the medications used for management.
The Endometriosis and Hair Loss Connection
Endometriosis is not a direct cause of hair loss, as the ectopic tissue does not physically damage hair follicles. Instead, the link is indirect, driven by systemic factors associated with chronic inflammation and hormonal fluctuation. This internal environment disrupts the delicate hair growth cycle, triggering shedding as a response to physiological stress or imbalance.
The most frequent pattern observed is telogen effluvium, which is diffuse, temporary hair loss across the scalp. This occurs when a higher percentage of hair follicles prematurely shift from the growing phase (anagen) into the resting and shedding phase (telogen). This type of shedding is generally reversible once the underlying systemic trigger is identified and resolved.
Hormonal Influence on Hair Cycles
The primary mechanism contributing to hair changes is the profound hormonal imbalance often seen in endometriosis. Estrogen and progesterone regulate hair growth, helping to keep follicles in the active anagen phase for longer periods. Endometriosis is frequently characterized by estrogen dominance or significant fluctuations in these sex hormones, which destabilize the normal growth cycle.
This unstable hormonal environment can also affect the balance of androgens, which are naturally present in women. An increase in circulating androgens or an alteration in their regulation can lead to female pattern hair loss, or androgenetic alopecia. This presents as a progressive miniaturization of hair follicles, resulting in visibly reduced density at the crown and part line.
The chronic pain and inflammation associated with endometriosis place a significant stress burden on the body. Prolonged exposure to high levels of the stress hormone cortisol can independently push hair follicles into the resting phase. The disturbance of Sex Hormone Binding Globulin (SHBG), a protein that controls the amount of free hormones in circulation, can amplify the negative impact of fluctuating hormones on the hair follicle.
Treatment-Related Causes of Hair Changes
A distinct and often more common source of hair changes is the side effects of medical interventions used to manage endometriosis. Many pharmaceutical treatments intentionally alter the hormonal environment to slow the growth of endometrial tissue. These rapid hormonal shifts, while beneficial for the disease, can lead to temporary hair shedding.
Gonadotropin-releasing hormone (GnRH) agonists and antagonists, for example, create a temporary, medically-induced menopause by suppressing estrogen production. This profound hypoestrogenic state can mimic the hormonal shock of natural menopause, triggering significant telogen effluvium. The sudden drop in estrogen signals the hair cycle to enter the shedding phase.
Similarly, older treatments like Danazol, a synthetic androgen, are explicitly linked to hair changes. Because Danazol has masculinizing effects, it can promote scalp hair thinning while sometimes causing unwanted hair growth elsewhere. Even high-dose progestins and certain types of hormonal birth control, commonly used to manage symptoms, can have an androgenic profile that contributes to scalp hair loss in susceptible individuals.
Managing Hair Changes
For individuals experiencing hair loss alongside endometriosis, the first step involves a comprehensive medical evaluation to identify the underlying trigger. It is important to rule out co-occurring nutritional deficiencies, which are common in chronic conditions. Heavy menstrual bleeding, a frequent symptom of endometriosis, can deplete the body’s iron stores, leading to low ferritin levels associated with hair loss.
Imbalances in thyroid hormones and low Vitamin D levels are also frequently observed in individuals with chronic inflammation and must be tested for and corrected. Addressing these deficiencies through targeted supplementation can often reverse the hair shedding, especially in cases of telogen effluvium.
Managing the chronic stress and inflammation associated with the condition is also a helpful strategy. Techniques that reduce systemic stress, such as mindfulness or gentle exercise, can help lower cortisol levels and minimize the negative impact on the hair growth cycle. In most cases, hair loss triggered by hormonal shifts or stress is temporary, and hair density often recovers once the underlying disease activity or hormonal regimen stabilizes.