Sabrina Khan
Age: 28 years old female
Full Case
Patient’s Data
Patient’s name: Sabrina Khan
Age: 28 years old female
Past medical history
- Nil
Drug history/repeat template
- Nil
Recent Notes/consultation
- No recent consultation
Patient booked routine consultation to discuss issues
Patient's Story (Role player’s brief)
Patient’s Story
You are Sabrina Khan, and you are 28 years old. You have noticed that you have started losing your hair for the last 2-3 months. They keep easily shedding away especially while you are in shower/combing your hair and you find some hair on the pillow when you wake up. The hair loss is all over the scalp. It is not yet apparent, but you are worried and want to stop it before it becomes apparent
No areas of scarring in your scalp. No patches
No family history of hair loss.
You have not changed hair products or used any new hair product
No recent stress.
If asked—say that you have noticed, you get tired easily and you have noticed it started around 2-3 months at same time you noticed hair loss
SAY NO TO ANY OTHER QUESTIONS ASKED
ONLY SAY THIS IF ASKED –your periods are quite heavy, and they have been heavy for over the last 6 months. You are currently on your period, and it is heavy, and you bled for 7 days. Your cycle is normally 28 days. You saw your period first at age 12. You do not bleed in between periods. You are not on any contraceptives- your partner uses condoms
Social History: You live with your partner, and you have been with him for 7 years. No other sexual partner. You do not smoke. You drink alcohol occasionally
Ideas—Not sure what maybe causing it
Concerns—You are losing your hair, and it is affecting your confidence as a model
Expectations- you will want something to prevent hair loss or be referred to hair specialist to ensure you do not lose your hair.
Accept anything offered
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
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.