Everyone tells you it is just part of it. If yours is still going strong a year on, that is not the normal shed, and it is something you can act on.

By Anna Cave-Bigley

There is a particular morning, somewhere in the fog of the first year, when you look down at the handful of hair in the shower drain and feel something tip from surprise into dread. Then it is the comb, then the pillow, then the thinning patch at your hairline you start arranging your parting to hide. And everyone, every single person, tells you the same thing: it is normal, it is just part of it, it will pass.

For most women, they are right. For me, it did not pass. It took over a thousand pounds of my own money and four different practitioners, all of whom said the same word, hormones, before anyone thought to run the two cheap tests that explain most of the cases that drag on. So this is the piece I wish someone had handed me: what the normal shed is, how to tell when yours has crossed into something else, and the exact words to say to get checked.

The normal shed, and why it happens

During pregnancy, your high oestrogen holds far more of your hair than usual in its growing phase. That is the famous pregnancy mane, thick and glossy, all those strands that would ordinarily have shed simply staying put. Then you give birth, oestrogen drops sharply, and all of those held hairs move into the resting and shedding phase at once. The clinical name is telogen effluvium.

It usually begins around two to four months after birth, peaks somewhere near the four to five month mark, and for most women it is winding down by six to twelve months. It can look frightening, hair coming out in fistfuls, but the follicles themselves are intact and the hair grows back. Up to a third to a half of women go through some version of it, and breastfeeding can stretch the timeline out a little. This is the version everyone means when they say it is part of it. And usually it is.

When it is not just part of it

The trouble is that "usually" is not "always," and the gap between them is where a lot of women fall through. If your shedding is still going strong past about a year, or it is dramatically more than what the women around you went through, that is the point to stop accepting "it is hormonal" and start asking questions. Dermatology guidance is clear that postpartum shedding which persists beyond the expected window warrants looking for an underlying cause, most often iron deficiency, a thyroid problem, or an underlying pattern hair loss the shed has unmasked.

Two of those travel with stubborn postpartum shedding more than anything else. Both are cheap to test. Both are treatable. And both are routinely missed, because their symptoms look exactly like ordinary new motherhood.

Iron, and the normal-versus-optimal trap

Iron is essential to the rapidly dividing cells that build a strand of hair, so when your stores run low, hair is one of the first non-essentials your body stops spending on. Pregnancy, birth, blood loss and the return of your periods all draw iron down hard, which is why studies of women with diffuse shedding repeatedly find a large share running low, in one review of more than 2,800 women, close to half had low ferritin.

Here is the trap, and it is the one I fell into. The test you want is ferritin, which measures your iron stores, and the standard lab "normal" range often starts as low as 12 to 15. So you can be told your iron is perfectly fine while sitting at a level that is nowhere near enough for your hair. Many hair specialists treat to a much higher target, commonly cited somewhere around 40 to 70. The precise number is debated, and not every study agrees, but the gap between "not anaemic" and "enough to grow hair" is real, and it is exactly the gap that gets women waved out of the surgery with a reassuring "your bloods are normal."

So ask for ferritin by name. Not "iron," not a standard blood count, ferritin specifically. And ask for your actual number, written down, not the word "normal."

Building it back, on the plate

Here is the hopeful part, and the reason prevention matters as much as testing: iron is one of the most fixable things on this whole list, and food does it beautifully. Better still, you can start refilling the tank before the shedding ever begins, in pregnancy and through the feeding months, rather than waiting for the drain to scare you.

For meat-eaters, the single most powerful food is the one our grandmothers swore by and our generation forgot: liver. Grass-fed beef liver is nature's multivitamin, and that is not a turn of phrase. A small portion delivers a dense hit of the most absorbable form of iron, heme iron, alongside B12, folate, vitamin A, copper and choline, almost exactly the spread a depleted postpartum body is asking for. It is a traditional first food for new mothers across the world for good reason. You do not need much, a portion once or twice a week, or a spoonful of pâté on toast, does more than a fistful of capsules. One caveat worth knowing: liver is so rich in vitamin A that it is the one food to ease back on in pregnancy itself. After the baby is here, it is a gift.

The reason liver and red meat punch so hard is absorption. Heme iron, the kind in meat, fish and liver, is taken up far more readily than the iron in plants: people eating animal foods absorb roughly 14 to 18 per cent of the iron they eat, against 5 to 12 per cent for plant-based eaters. That does not mean a vegetarian cannot hold her stores, it means she has to be cleverer about it.

If you are plant-based, three habits do most of the work. Eat your iron with vitamin C, a squeeze of lemon over the lentils, peppers through the bean stew, citrus next to the greens, because vitamin C sharply increases how much plant iron you take up. Keep tea and coffee away from your iron meals by an hour or so on either side, because the tannins in both block it hard. And lean on the real sources: lentils, beans, tofu, tempeh, pumpkin seeds, dark leafy greens and fortified grains, with a cast-iron pan adding a little more. If your ferritin stays stubbornly low despite all of that, a supplement is a conversation with your doctor, not a personal failing.

Thyroid, the other one nobody checks

The year after birth is also when thyroid problems most commonly surface for the first time. Postpartum thyroiditis affects somewhere around one in twelve to one in twenty women in the year after delivery, and both an underactive and an overactive thyroid cause diffuse shedding. The cruelty of it is that the other symptoms, bone-deep fatigue, low mood, feeling cold, brain fog, are precisely the things everyone, including you, will put down to having a new baby. Thyroid dysfunction is a well-recognised and treatable driver of this kind of hair loss, and it hides in plain sight.

The screen is a TSH, often alongside a free T4, and thyroid antibodies if postpartum thyroiditis is suspected. Ask for it by name too.

How to get the tests

This is the part I most want you to take. Walk in with the specific words ready: "I would like my ferritin and my TSH checked, and I would like to know the actual numbers." If you are told your hair loss is "just hormonal" without a single blood test, that is not a diagnosis, it is a guess, and you are entitled to ask what was measured and what it came back as.

If your iron or your thyroid is the problem, correcting it brings the hair back, over months rather than days, but it comes back. And if both come back clear, then "it is hormonal and it will settle" has earned the right to be said, and you get to stop worrying with evidence behind you. Either way you win, which is the whole point of asking.

It cost me a small fortune and the better part of a year to learn that the two tests that mattered were the two nobody ordered. You should not have to spend what I spent to be taken seriously. Two tests. Their names are ferritin and TSH. Say them out loud at your next appointment.

If you want the wider map of rebuilding a depleted body through the first months, the kind nobody hands you on the way out of hospital, the first chapter of our book, The First 100 Days Postpartum, is free.

Anna x

The science, sourced

• What postpartum telogen effluvium is, why it happens, and its triggers including thyroid disease and iron deficiency: Telogen Effluvium, StatPearls (NCBI Bookshelf)

• When postpartum shedding warrants investigation: Treating Telogen Effluvium, clinical dermatology overview

• Low ferritin in women with diffuse hair loss: Retrospective Review of 2851 Female Patients With Telogen Effluvium

• Ferritin, hair loss, and the normal-versus-optimal threshold debate: Serum Ferritin Levels, A Clinical Guide in Patients With Hair Loss

• Iron in food, heme versus non-heme absorption, and how to boost it: Dietary Iron, StatPearls (NCBI Bookshelf)

DISCLAIMER

The SABI blog and articles are not meant to instruct or advise on medical or health conditions, but to inform. The information and opinions presented here do not substitute professional medical advice or consultations with healthcare professionals for your unique situation.

ABOUT ANNA

Anna is a Co-founder and CEO of The SABI and has spent the past 13 years working in or for governments, senior businessmen and politicians around the world. Living in Bogota, Colombia, she recently renovated one of Colombia's oldest and most iconic coffee estates, developing a unique taste and travel experience. She lives with her husband and three boys Lorenzo, Alfie and Salvador who are responsible for the beautiful journey that inspired her to pursue The Sabi.

HORMONAL & PROUD

The SABI was created to help women through the hardest moments of pregnancy, childbirth, postpartum and every stage that follows. We want to change the story around our hormones, from one of taboo, embarrassment and loneliness to one of awareness, and even pride.

More than a wellness brand, The SABI is a line of rituals, supportive tools and functional herbal remedies, tested by hundreds of years of traditional medicine and now backed by modern science. It was conceived by women who have lived the joys and the deeper costs of bringing a child into the world, of a heavy or difficult period, of miscarriage and trouble conceiving.

Consider this an invitation to know your body and its cycles, to learn to work with them at any stage of life, and to know that support exists. Look for the right sources, know there is help, and know that you are not on your own.