Sabrina Khan

Age: 28 years old female

Examiner

Station List
Doctor
Patient
Full Case

Marking Scheme

Data Gathering and Diagnosis

  • Take a detailed history of the hair loss—clarify whether it is thinning or shedding. Thinning often starts at the parting line, sides, or crown of the scalp and presents gradually with finer, more brittle strands, as seen in conditions like PCOS or androgenetic alopecia. In contrast, shedding tends to be sudden, more diffuse, and often linked to recent stress or nutritional deficiencies like iron deficiency or telogen effluvium.
  • Ask if there are any bald patches, visible scarring, redness, or rashes on the scalp. 
  • Enquire about the patient’s usual hair care routine and if they have made any recent changes in hair products or styling methods, such as tight hairstyles or heat treatments.
  • Ask about any family history of hair loss. 
  • Enquire about use of medications known to affect hair growth such as antidepressants, carbimazole, or chemotherapy, as well as any recent dieting or nutritional concerns that might contribute to hair loss.
  • Take a menstrual history and specifically ask if her periods are heavy. Recognise that heavy periods can lead to iron-deficiency anaemia. If so, ask about symptoms of anaemia, such as dizziness, light-headedness, tiredness, palpitations, chest pain, or shortness of breath.
  • Rule out other contributing causes such as PCOS or hypothyroidism by asking about acne, excessive hair growth on the body (hirsutism), recent weight changes, or skin changes. 
  • Explore the emotional and functional impact of the hair loss—whether it has affected her confidence, daily life, or performance at work.
  • Ask if she has experienced any recent stress or life changes. 
  • Ask if there is any chance, she could be pregnant or if she has recently given birth, as postnatal telogen effluvium is a common and self-limiting cause of hair shedding.
  • Makes a diagnosis of Hair loss probably caused by heavy menstrual blood loss 

Example of explanation to patient​

Sabrina, based on what you’ve told me about your heavy periods and hair loss, it’s possible that the hair loss is linked to iron deficiency anaemia. When your iron levels are low—often due to blood loss—it can lead to a condition called telogen effluvium, where your hair enters a resting phase and starts to shed more than usual.

This type of hair loss is quite common and usually temporary. To confirm this, we’ll need to see you in person so we can examine you properly and run some blood tests. If it turns out to be iron deficiency, we can start treatment with iron tablets and also look at ways to better manage your periods. Once the iron levels are corrected and your body has time to recover, the hair loss typically settles, and your hair starts to grow back

You mentioned that you’d like to be referred to dermatology and possibly start some medication to help with your hair loss. I think that’s a reasonable request, and I completely understand your concerns. Would it be okay if we start by checking your blood tests first? It’s quite possible that your hair loss is linked to iron deficiency, which may be due to the heavy bleeding from your periods. If we find that iron deficiency is the cause and treat it, the hair loss may stop, and your hair could begin to grow back naturally. 

Management  

  • Arrange a set of blood tests to investigate possible causes of hair loss and heavy periods: including ferritin, full blood count (FBC), thyroid function tests, vitamin B12, folate, vitamin D, liver function tests (LFTs), urea and electrolytes (U+Es), and coagulation profile (to assess for bleeding tendencies).
  • Offer a face-to-face appointment to examine the scalp and hair—this will include a hair pull test to help determine the pattern and type of hair loss and to check blood pressure and pulse to ensure haemodynamic stability
  • Also advise that during the face-to face consultation, you will perform an abdominal and speculum examination to assess for any pelvic causes of heavy menstrual bleeding. This may guide whether a pelvic ultrasound is required.
  • Acknowledge the patient’s concerns and interest in dermatology referral or medication: “You mentioned wanting something to help with your hair loss or to be referred to a dermatologist. That’s completely understandable. With your permission, I suggest we first wait for the blood test results. If iron deficiency is found, treating it may help reduce hair shedding and support regrowth—so that might be all that’s needed.”
  • Discuss temporary options for hair appearance if distressing—such as the use of hairpieces, styling adjustments, or cosmetic products.
  • To manage heavy menstrual bleeding in the short term, consider starting Tranexamic acid, Mefenamic acid, or Norethisterone while awaiting full assessment and results—after checking for contraindications.
  • Provide safety netting for signs of worsening anaemia (e.g., palpitations, fainting, or shortness of breath), and advise to seek medical attention if any of these occur.
  • Book a follow-up appointment in 1 week to review blood test results and agree on a tailored treatment plan going forward.

Learning point from this station: ​

Hair loss in women can be multifactorial and requires a holistic approach. It’s important to distinguish between hair thinning (as seen in hormonal causes like PCOS or androgenetic alopecia) and hair shedding (commonly from stress, iron deficiency, or post-partum telogen effluvium). Always assess for reversible causes, including iron deficiency due to heavy periods, thyroid dysfunction, and nutritional deficiencies.

This station also highlights the importance of sensitive communication—patients may be distressed about hair loss and may request immediate solutions or referrals. Taking time to explain the value of blood tests before prescribing or referring helps set realistic expectations and encourages a more collaborative and evidence-based management plan.

Additionally, don’t overlook the psychosocial impact of hair loss—it can affect confidence, social interaction, and quality of life, especially in younger or working women. A supportive, empathetic consultation goes a long way.