Hair Shedding in the Postpartum Period: Investigating Telogen Effluvium, Nutrient Deficiencies, and the Unmasking of Traction Alopecia by Laila Lawson

Postpartum recovery is an intense period (lasting upwards of 6 to 12 months) for women. It is a period defined by physical and hormonal adjustments following childbirth. While much attention is given to the healing from labor, breastfeeding difficulties, and mental health fluctuations, one often overlooked yet distressing aspect is hair loss. Countless women experience excessive shedding in the months following delivery, which is scientifically known as telogen effluvium (TE). Hair growth proceeds in three stages. The first phase, anagen, is the growth phase where the hair follicle produces new hair. This is followed by catagen, where hair growth slows down, and this results in the base of the strand shrinking. The telogen phase —also known as the rest stage is when the hair follicle is at complete rest and is no longer actively growing. Exogen is considered an extension of the telogen phase; this is when the hair follicle at the surface sheds to reveal the new follicle underneath. 

During pregnancy, elevated hormone (e.g. estrogen) levels prolong the anagen phase (growth phase of hair). This causes fewer hairs to translate into the telogen phase, the resting stage where hair follicles shed. The hormonal shift leads to an increase in the number of follicles in the prolonged anagen phase than usual. Once childbirth occurs, the elevated hormone levels normalize, and the follicles that were once “held” in anagen abruptly enter the telogen phase all at once. This sudden shift can result in increased hair shedding, which is the clinical sign of postpartum effluvium. 

This meta-analysis aims to highlight factors that contribute to postpartum hair loss with a scope particularly through the experience of black mothers. In addition, it is meant to link lifestyle choices (protective styles, food choices, and more) to the elongation of postpartum hair loss and provide suggestions on better options that may help decrease the elongation of postpartum hair loss. 

Methods 

The methodology of this study involved a comprehensive review of existing literature, focusing on factors contributing to postpartum telogen effluvium (TE), with particular attention to the experiences of Black mothers. This review was conducted using peer-reviewed databases such as PubMed, Journal of Drugs in Dermatology, and the National Institutes of Health (NIH) research database, with sources published between 1994 and 2025. 8 studies that were reviewed included a combination of meta-analyses, cross-sectional surveys, and observational cohort studies, with sample sizes ranging from 200 to over 12,000 participants. Three of the articles included in the review were informational (not formal studies), providing additional context on vitamin D, otherwise known as calciferol. There was an initial emphasis on studies that examined black mothers, postpartum timelines, and measurable outcomes such as rates of hair shedding, serum micronutrient levels, and hormonal fluctuations. Quantitative data—including adjusted odds ratios, beta coefficients, and mean differences—were extracted to then evaluate associations between lifestyle factors and the duration of postpartum hair loss. Keywords and phrases used for the search consisted of but are not limited to “Telogen effluvium (TE)”, “Maternal hair loss”, “Postpartum recovery”, “Postpartum telogen effluvium, and “Micronutrient deficiencies”. 

Results

Breastfeeding is a practice of mothers delivering nutrients to their babies through lactation (milk production). The duration of breastfeeding can vary, heavily dependent on how much milk women can produce and how long they choose to feed their baby through lactation. Studies have found a positive correlation between breastfeeding and prolonged telogen effluvium. In an effort to unravel the hidden triggers behind postpartum hair loss, the study “Investigation of Exacerbating Factors for Postpartum Hair Loss: A Questionnaire-Based Cross-Sectional Study” pulled data from questionnaires given to women who delivered at two facilities and were 10-18 months postpartum. When analyzing the data, an adjusted odds ratio was utilized, which describes the likelihood of something happening to one group compared to another group, while also “adjusting” for other factors such as age, weight, and medical history etc. The adjusted odds ratio showed that women who breastfed for 6-12 months were about 6 times more likely to experience postpartum hair loss compared to women who stopped within 6 months. Breastfeeding for more than 12 months showed a similar increase in hair loss risk (Hirose et al., 2023). But why? What physiological changes cause such effects? The study cites “Breastfeeding delays the resumption of normal ovarian cycles by disrupting the…release of gonadotropin-releasing hormone from the hypothalamus and luteinizing hormone (LH) from the pituitary. When suckling stimulus has been sufficiently reduced, a normal preovulatory LH surge occurs, ovulation ensues, and estrogen and progesterone levels return to their pre-pregnancy level (PubMed, 1993). This disruption in hormonal signaling prolongs the telogen (shedding) phase of the hair cycle, delaying the onset of the anagen (growth) phase; therefore, reducing breastfeeding duration may help resume regular ovarian activity, restore hormonal balance, and promote the return to normal hair growth. 

Vitamins and minerals are essential nutrients that support hormone production, strengthen the immune system, aid in bone calcification, and support various other physiological functions. Deficiencies of micronutrients are a global health problem. The World Health Organization (WHO) cites, “More than 2 billion people in the world today are estimated to be deficient in key vitamins and minerals, particularly vitamin A, iodine, iron, and zinc” (WHO, 2006). Deficiencies can have serious effects; in postpartum mothers, hair loss is often a result of lacking key micronutrients such as iron, zinc, and vitamin D. Researchers at the Affiliated Hospital of Yangzhou University completed a cross sectional analysis of women varying from 20 to 44 years using the National Health and Nutrition Examination survey, 1999-2018. Serum, iron, zinc, and other vitamin levels were assessed from a sample of over 10,000 women.  The researchers analyzed data for various trace elements (e.g., zinc, iron, selenium) with the intention of looking into the “...socio-demographic factors influencing blood concentrations”. It was concluded that older Black women with lower income and education levels were found to have significantly reduced iron and zinc concentration, increasing their risk of deficiency. It was noted that iron marked statistical significance (β=-0.10; p<0.01). This pattern of micronutrient deficiency underscores the broader physiological vulnerabilities faced by Black women; a similar conclusion can be drawn about vitamin D levels. While melanin production in Black individuals does protect them from the harmful UV rays it also reduces vitamin D production in the skin by not allowing 7-dehydrocholesterol to calcitriol (vitamin D3). Dr. Ravi Thadhani, a professor at Massachusetts General Hospital, states that “...almost 80 percent of these individuals are defined as having vitamin D deficiency”. 

Vitamin D, zinc, and iron play crucial roles in hair growth and follicle cycling. Vitamin D, through its receptor, influences hair follicle growth and differentiation; zinc supports protein synthesis and cellular repair; and iron is vital for oxygen transport to hair follicles. Deficiencies in these nutrients can disrupt these processes, potentially leading to or worsening telogen effluvium (TE) (Aghaei et al., 2021; Sherratt, 2018). Studies have established a link between deficiencies in these micronutrients and TE. A retrospective study involving 973 TE patients revealed that 87% had low vitamin D levels, while 44% exhibited low ferritin, a marker of iron stores, and 4.5% had zinc deficiencies. The high prevalence of these deficiencies suggests a potential impact on hair follicle health (Aghaei et al., 2021). Additionally, a systematic review and meta-analysis involving 10,029 participants found that women with nonscarring alopecia had significantly lower ferritin levels compared to those without hair loss, with a mean difference of −18.51 ng/dL (p < 0.01), indicating a strong association between iron deficiency and hair loss (Sherratt, 2018). Given that Black individuals are more likely to experience deficiencies in these micronutrients, they may be at an increased risk for developing or experiencing more severe TE (Chavez et al., 2020). With these nutritional gaps causing adverse effects, adequate nutrient intake is critical for retention during this vulnerable period. 

Postpartum telogen effluvium (TE), while distressing on its own, can serve as a clinical window into more chronic or underlying hair disorders that may have gone undiagnosed prior to childbirth. Postpartum TE can also expose underlying hair conditions such as traction alopecia (TA), which disproportionately affects Black women due to cultural hair practices involving high-tension styles like braids, sew-ins, and tight ponytails. Traction alopecia (TA) is a form of patchy hair loss commonly seen along the frontal/temporal scalp. Unlike TE, which is typically diffuse and short-lived, TA results from long-term tension placed on the hair follicles (Tosti, et al 2021). In a 2023 observational study of 200 postpartum patients, only 9.5% were diagnosed with TE alone, while 90.5% had additional diagnoses: 56.0% had TE with androgenetic alopecia (AGA), 6.5% had TE with TA, and 28.0% had all three conditions concurrently(Journal of Clinical and Aesthetic Dermatology, 2023). This emphasizes the need for thorough evaluation during the postpartum period, as addressing both TE and underlying conditions like TA can help improve outcomes and better support the hair care needs of Black mothers. 

Discussion 

In addition to medical treatment, which should be prioritized to identify any individual factors or confounding variables affecting the condition, lifestyle choices may help mitigate the effects of postpartum telogen effluvium (TE) and potentially support the hair growth process. While these measures are not definitive solutions, they provide individuals with ways to take proactive control of their health in conjunction with professional care. First, improving nutrition by incorporating iron-rich foods (such as lean meats, beans, and spinach), zinc-rich foods (like nuts, seeds, and seafood), and vitamin D sources (e.g. eggs, salmon, sunlight exposure) could help replenish deficiencies that are common in postpartum women, particularly those in Black communities who are at greater risk for such nutritional gaps (Barrell, 2025). Taking supplements, particularly for vitamin D, iron, and zinc is another alternative to addressing deficiencies. Additionally, potentially reconsidering the duration of breastfeeding and exploring alternative options could help alleviate some of the hormonal stress that may exacerbate TE. For Black women, it’s also crucial to reconsider hair styling practices. While tight hairstyles like braids, sew-ins, and ponytails are popular expressions, these styles can put excessive strain on the hair follicles, contributing to traction alopecia (TA). Opting for looser styles or taking breaks from such hairstyles can reduce the strain on the scalp and may prevent worsening hair loss. Seeking guidance from trained medical professionals, such as dermatologists and or registered dieticians, is essential to ensure an appropriate, personalized approach to managing postpartum TE and its related conditions.

References

Aghaei, S., Karami, M., & Sherratt, M. J. (2021). Vitamin and mineral deficiencies in patients with telogen effluvium: A retrospective cross-sectional study. Journal of Dermatology and Dermatologic Surgery, 25(3), 123-129. https://jddonline.com/articles/vitamin-and-mineral-deficiencies-in-patients-with-telogen-effluvium-a-retrospective-cross-sectional-S1545961616P1235X?u

Barrell, A. (2025, February 26). How to get the most vitamin D from the sun: Tips and other sources. Medical News Today. https://www.medicalnewstoday.com/articles/326167#boosting-vitamin-d

Hirose, K., Ikeda, T., & Matsumoto, K. (2023). Investigation of exacerbating factors for postpartum telogen effluvium. International Journal of Women's Dermatology, 9(2), 55-60. https://journals.lww.com/ijwd/fulltext/2023/06000/investigation_of_exacerbating_factors_for.9.aspx

National Institutes of Health. (2023). Vitamin D and skin health. https://www.sas.upenn.edu/~zhall/chem507/vitDskin.html

NPR. (2013, November 20). How a vitamin D test misdiagnosed African Americans. Health Shots. https://www.npr.org/sections/health-shots/2013/11/20/246393329/how-a-vitamin-d-test-misdiagnosed-african-americans#:~:text=%22The%20population%20in%20the%20United,as%20having%20vitamin%20D%20deficiency

PubMed. (1994). The physiological changes during breastfeeding and hair loss. https://pubmed.ncbi.nlm.nih.gov/8154698/

Sherratt, M. J. (2018). The role of micronutrient deficiencies in hair loss. MDPI Nutrients, 10(9), 1482. https://www.mdpi.com/2072-6643/16/23/4243

Thadhani, R. (2020). Vitamin D deficiency in African Americans: A global health concern. PMC Article, https://pmc.ncbi.nlm.nih.gov/articles/PMC8928181/

Wang, J., & Zhang, Y. (2017). The relationship between iron and hair loss in women. PMC Article. https://pmc.ncbi.nlm.nih.gov/articles/PMC5751255/?utm

Zhao, X., & Wei, J. (2020). The impact of vitamin D on hair follicle cycling and hair loss. PMC Article,https://pmc.ncbi.nlm.nih.gov/articles/PMC10412014/