“I obsessed about losing [all my hair] and was often depressed and crying,” said a woman named “Mary” on the Women’s Hair Loss Project website.

Shortly after she turned 40, this patient noticed small bald patches on the sides and back of her head. She covered these patches with the rest of her hair — but she spent time each day checking for new patches in the mirror.

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Only a few years later, her hair loss began to progress rapidly and by January she had more bald patches than areas with hair. She grew tired of “scooping up hair from the floor every day,” “examining [her] head to check the bald areas,” and weeping over the loss. After she decided to shave her head completely, her eyebrows and eyelashes also fell out.

For many women, the hardest part about hair loss is that it remains an unspoken secret. Male-pattern baldness is a well-publicized issue, but “women actually make up 40 percent of American hair loss sufferers,” according to the American Hair Loss Association.

“If you have persistent, excessive hair loss that lasts for over three to six months, you may have an underlying condition that could require treatment.”

As difficult as it might be for a man to lose his hair, the emotional trauma a woman suffers from losing her hair is compounded by social expectations and a lack of openness about the subject. Organizations such as the Women’s Hair Loss Project (WHLP) aim to provide women with a community of others in similar circumstances so that they can overcome some of the stigma.

“It’s normal to lose 60 to 100 hairs a day,” said Dr. Tsippora Shainhouse, a board-certified dermatologist in Beverly Hills, California, and a clinical instructor at the University of Southern California. If you’re losing more than that, it could be triggered by a traumatic event — childbirth, significant weight loss, crash dieting, going off birth control — but it should resolve after about nine months. If hair loss persists, it could mean a more serious disorder.

“If you have discrete patches of hair loss, you may have an autoimmune, inflammatory condition called Alopecia Areata, which can be treated,” Shainhouse told LifeZette. “If you have persistent, excessive hair loss that lasts for over three to six months, you may have an underlying condition that could require treatment, such as an iron deficiency, low Vitamin D levels, or thyroid disease.”

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Vitamin deficiencies are more common than some might think, said Dr. Arielle Levitan, co-founder of Vous Vitamin in Highland Park, Illinois. “Many women do not realize they are lacking in iron and vitamin D. Years of getting periods, having babies, and nursing deplete our total body iron stores. This may not show up on routine blood testing,” Levitan noted.

Low sun exposure also leads to low vitamin D levels; a diet lacking in Biotin can also contribute to hair loss. Taking a calibrated multivitamin or adding more nuts and legumes to one’s diet can help with this.

Excessive hair treatments, heat styling, and abrasive buns and ponytails can also exacerbate the problem. “Eat healthfully with adequate protein, exercise, and go easy on hair treatments,” said Dr. Sonam Yadav, a cosmetic dermatologist and medical director at Juverne Clinic in New Delhi, India. “If the tap water is hard where you live, rinse [your] hair with drinking water instead. And watch for medical issues such as anemia and [polycystic ovarian sydrome].”

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Many women cope with their hair loss by simply wearing wigs. Others get prescriptions to decrease testosterone levels, begin taking birth control pills to increase estrogen, or try numerous products (such as Rogaine) that increase scalp circulation and reduce inflammation.

“I’ll be 38 years old in two months and this affliction stole over a decade of my life,” said one anonymous woman on the WHLP website.

She compares wearing a wig to “removing the shackles of hair loss and taking back my life.”

For many women afflicted by hair loss, the pain proves truly traumatic. Thankfully, physicians now have a better understanding of the underlying causes and can often help women offset this condition.