Picking out pregnancy-safe skincare can seem complicated. I have an entire page on pregnancy beauty, dedicated to which skincare ingredients to avoid during pregnancy, breastfeeding, or IVF.
Today, it’s about the use of topical minoxidil during pregnancy. Minoxidil, popularly known as Rogaine, is the only FDA-approved medication for hair loss in females, and many find it to be the only effective treatment for them. But can you use Rogaine while pregnant or if you are planning to get pregnant? What about the oral formulation? Is oral minoxidil safe for pregnancy?
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What is minoxidil?
Minoxidil was originally developed for severe hypertension in the 1970s as an oral medication. Hypertrichosis (excessive hair growth) was observed as a side effect, which was channeled in 1987 to a topical formulation known as ‘Rogaine’ for the treatment of baldness.
It is available in oral and topical formulations for the management of hair loss.
It increases blood flow to the hair follicles and prolongs the growth phase of hair, resulting in thicker, denser hair.
Topical minoxidil is more widely used than the oral form for hair loss because it is available over the counter and easy to use.
Oral minoxidil, in low doses, is also used for hair loss, but it is not FDA-approved. Its use for hair loss in the USA is considered ‘off-label’ and requires a prescription.
It may be an alternative for those who find a pill more convenient than regular scalp application, those who use a hairpiece or keratin fibers to conceal hair loss, or those with allergic reactions to topical formulations.
Can you use oral minoxidil while pregnant?
* Oral minoxidil for hair loss is not FDA-approved.
The use of oral minoxidil while pregnant has been linked with severe and debilitating malformations in the fetus.
There are multiple case reports regarding fetal anomalies with oral minoxidil when it was used for the treatment of severe hypertension in pregnant women.
Kaler et al. reported a case of a baby with excessive hair growth, abnormal facial features, anomalies of the hand, abdomen wall, and the testis born to a woman on a multi-drug regimen that included minoxidil for severe hypertension.
Rosa et al. reported two infants with excessive hair born to minoxidil-treated, hypertensive mothers. One of them had multiple congenital anomalies of the heart and did not survive.
In both the above instances, the malformations were reported with mothers using minoxidil for hypertension. However, the dosage used for hair loss is lower than that used to treat hypertension. There are no scientific experiments, for obvious reasons, on the effect of minoxidil in the pregnant human population; case reports like these urge to err on the side of caution, and therefore, the advice is to avoid minoxidil during pregnancy or when trying to conceive.
Furthermore, oral minoxidil falls in FDA Category C, which means that either studies in animals have revealed adverse effects on the fetus, or there are no controlled studies in women, or studies in women and animals are not available. The drug should be given only if the potential benefit justifies the potential risk to the fetus.
(I have a separate post on FDA drug categories that I will link here:
FDA Pregnancy Categories – Understanding Drug Safety in Pregnancy and Nursing)
Can you use topical minoxidil while pregnant?
Topical minoxidil is available over the counter and needs no prescription.
The application of minoxidil is not thought of as a therapeutic procedure and does not undergo the same level of scrutiny and pondering by expectant mothers. Furthermore, many hair ‘tonics’ or hair fall control serums may contain it, and the user can miss this ingredient on the bottle.
On long-term scalp usage, it has been shown to lower blood pressure and increase the heart rate, suggesting that even when used as a topical solution, it reaches a concentration high enough in the blood to affect other body systems (Leenen et al., 1988)
Furthermore, there have been case reports of fetal malformation, like lower limb malformations and anomalies of the heart and brain, with topical minoxidil.
These instances, though, were reported with regular and long-term usage (4 years and 1 year, respectively).
Currently, we do not have any data on how short-term use could affect the growing fetus. However, in view of the fact that it is absorbed into the bloodstream on topical application, combined with cases reported in the literature, topical Minoxidil is not recommended if you are pregnant or trying to conceive.
Takeaway
Minoxidil, an effective remedy for hair fall, is used as an oral or topical formulation for hair fall in women. However, it is not recommended for use while pregnant or while planning a pregnancy due to case reports of fetal congenital anomalies. Note that oral minoxidil is not FDA-approved for the treatment of hair loss.
Trivia
Source: The New York Times
Dr. Kahn was born in Trier, Germany, on May 11, 1934, to a Jewish family who fled Nazi Germany in 1938 and settled in the United States. At the University of Colorado’s medical school in Denver, where he was a professor, his study on patients with excessive hair growth on minoxidil started him on a journey that led to the invention of Rogaine in 1986- the topical formulation of minoxidil that revolutionized the hair loss industry and continues to hold strong.
Ironically, he could not benefit from his own invention as he was allergic to the chemical.
