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Thinning hair in menopause is a common symptom. Menopause is a natural process that marks the end of menstruation for women, typically occurring between the ages of 45 to 55 years old.
During menopause, hormone levels in the body drastically change. This leads to various physical and emotional symptoms such as joint pain, mood changes, dry skin, period changes, hot flashes and hair loss. Studies have shown that up to 50% of women experience some form of hair loss during menopause.
Although, we often associate hot flashes with menopause, menopause and hair loss are common companions. According to research, around half of the menopausal women experience hair loss.
Hair loss can occur suddenly and can start during perimenopause at younger ages that most women would expect.
Changes in the estrogen and testosterone hormones typically contribute to menopausal hair loss. It can be a distressing experience for women. However, understanding the treatment options can help mitigate its effects.
The 4 Phases Of The Hair Growth Cycle
Hair grows in a cycle with three phases:
anagen (growth phase),
catagen (transitional phase),
telogen (resting phase).
The fourth phase, exogen, is the shedding of hair.
Causes Of Hair Loss During Menopause
Hormonal changes during menopause are the primary cause that women experience hair loss.
Estrogen is responsible for helping hair grow faster and stay on the head for a longer time. During menopause, estrogen levels decrease, leading to slower hair growth and shorter hair cycles.
Additionally some women are sensitive to the change in estrogen to testosterone ratio, meaning they have relatively less estrogen and more testosterone which contributes to thinning hair.
These hormonal imbalances also:
shrink of hair follicles,
make the hair finer and
reduce the total number of hair follicles.
Other Causes of Hair Loss At Menopause
Other things that can make women's hair fall out during menopause include:
Genetics
Some women naturally lose hair as they get older, following a pattern in their family.
Nutritional Issues
Iron deficiency, other nutrient deficiencies or malnutrition can cause hair thinning
Hormonal Changes
This could happen after having a baby, during menopause, or due to thyroid issues.
Health Problems
Certain chronic illnesses such as thyroid disorders or Lupus erythematosus or infections, such as a severe flu can cause hair loss.
Medicine and Treatments
Some drugs or therapies, like those for cancer, depression, or arthritis, may lead to hair loss, Intake of drugs or of hormones (oral contraceptives, hormone replacement therapies).
Stress
Very stressful events sometimes make your hair fall out months later. This can be both psychological stressors or physiological stressors such as illness.
Hairstyles
Pulling your hair tightly, like in ponytails or braids, can cause weakening of the hair and hair loss over time.
Types of Hair Loss During Menopause
Hair loss during perimenopause and menopause, could be due to these 3 common types of hair loss:
Female pattern hair loss (androgenetic alopecia)
Telogen effluvium
Frontal fibrosing alopecia
1. Female Pattern Hair Loss (Androgenetic Alopecia):
Female pattern hair loss has a distinct pattern, with a widening of the hair parting, and loss of hair at the front of the scalp and the back.
As the name androgenetic alopecia suggests, this type of hair loss is linked to hormonal imbalance of androgens such as testosterone and dihydrotestosterone (a more potent androgen).
Most women experience some degree of this type of hair loss at some time of their lie.
As estrogen levels drop during perimenopause and menopause there are relatively increased androgens so this is a common time for onset of the condition. It makes the hair follicles shrink and lose hair.
This condition runs in the families and is permanent and typically progressive if not treated.
2. Telogen effluvium
Telogen effluvium is the name for a common cause of diffuse temporary hair loss due to the excessive shedding of resting or telogen hair after some acute stress to the system such as illness, pregnancy, weight loss, dieting, stopping the oral contraceptive pill or psychological stress.
However in women aged 30-60 years, chronic telogen effluvium can occur. It is a diffuse type of hair loss for that persists for more than 6 months, with no obvious reason or stress related event.
The research suggests that chronic telogen effluvium is caused by fluctuating hormones that impacts circadian clock genes which negatively influences the hair growth cycle in women of this age (Hormones and Clocks 2016).
This type of hair loss is often reversible with appropriate treatment.
3. Frontal fibrosing alopecia
Frontal fibrosing alopecia (FFA) is a less common form of scarring hair loss that affects postmenopausal women. There is destruction of the hair follicle. It causes hairline recession and, in some cases, eyebrow loss.
The underlying cause is still unknown, but hormonal changes, cosmetics & an abnormal autoimmune response are thought to play a role.
It can be diagnosed by biopsy.
Treatments include:
of oral or injectable steroids
anti-inflammatory antibiotics,
anti-androgen medications such as finasteride
immune suppressants such as ciclosporin or mycophenolate.
What Are The Signs of Hair Loss At Menopause?
Here are some common symptoms of hair loss in menopause:
Thinning hair on the scalp
Bald spots on the scalp
Widening part line
Noticeable decrease in hair volume
Increased hair shedding is often noticed on pillows, shower drains, or hairbrushes.
Slower hair growth and longer time for hair to regrow after shedding
Changes in hair texture, such as becoming finer or more brittle
Can Hair Loss During Menopause Be Reversed?
A common question asked by many women is if menopausal hair loss is reversible or not.
The answer is not black and white; it's somewhat gray. Because the answer depends on the type of hair loss. Some people with a strong family history of baldness cannot regrow their hair back easily compared to others.
If the hair loss is solely because of the hormonal changes at menopause, the hair loss may be slowed or reversed by treating the hormone imbalance with hormone replacement therapy or with medications.
How to Treat Menopause Hair Loss
To help with menopause hair thinning, you can change your lifestyle, take medicines, or get professional treatments. The right treatment for you can depend on they type of hair loss and the cause. The best results may come when you combine hormonal treatments with procedures that promote healthy hair growth.
All treatments designed to encourage hair growth can take up to 6 months before the results begin to show, due to the slow growth of scalp hair.
Estradiol Hormone Therapy
There has not been much research into the impacts of estradiol hormone therapy on hairloss and menopause. One small study found that use of HRT over 6 months in women with female pattern hair loss had:
increased number of hair in the telogen - non-growth phase,
reduced frontal hair thinning and
increased the plucking strength (Estrogen Therapy and hair Growth 2023).
Minoxidil
Minoxidil is mainly used for baldness in men, but it can also work for women, including those going through menopause. A Cochrane Systematic Review published in 2012 concluded that minoxidil solution is an effective treatment for female pattern hair loss.
Anti-Androgen Medications
Your doctor may prescribe pills like finasteride or spironolactone for women's hair loss. They reduce androgens (such as testosterone)- classically thought of as male hormones.
Finasteride reduces potent testosterone so it helps the scalp hair grow but will not increase the growth of body hair.
Similarly, spironolactone can prevent further hair loss and reduce facial hair growth.
Hair Transplant
Hair transplant can be a costly but effective option for women who do not have enough hair to cover their bald spots. The procedure involves taking tiny patches of skin from the back of your head that has active hair growth and transplanting it to the front areas where you are experiencing hair loss. It is expensive.
Microneedling
This is an advanced hair treatment for menopausal hair loss. Tiny needles in the scalp to stimulate hair growth. Studies suggest that microneedling is a useful procedure to stimulate hair growth in those who do not respond to Minoxidil treatment. They also suggest that microneedling provides a better response to improve hair growth.
Laser Treatment
Photobiomodulation, or simply laser therapy, is a new favorite treatment for hair loss among trichologists.
Low-intensity light is shone on the scalp, stimulating circulation and enhancing collagen production.
This makes the scalp healthy and helps hair grow.
Laser therapy stimulates hair growth by shining low-intensity light on the scalp. Low level laser therapy reasearch suggests that laser treatment is as effective as minoxidil, and combination therapy is superior.
Hair Transplant
When nothing else works, a hair transplant is a possible treatment. It is a cosmetic surgical procedure. The doctor removes hair from one part of your body, typically the back or side of the head and implants it to the scalp.
Usually, the procedure is done under anesthesia, and it can take up to a year to see the full results.
Wigs and Head Coverings
Wigs, hairpieces, and extensions or scarves are also an option for those looking to stylishly cover their hair loss.
Natural Remedies To Prevent Hair Loss at Menopause
Prevention is better than cure. If you're at the stage of perimenopause and want to avoid hair loss, these lifestyle measures are important for general health as well as hair health. Remember though if you are losing hair and these are not helping that the sooner you get access to treatments with good evidence behind them for reducing hair loss, the better you are able to slow the process.
Manage Stress
Stress is a part of life. Unmanaged stress can contribute to hair loss? So, if you don't aready have good strategies for managing your stress, try some relaxation exercises, yoga, meditation, or deep breathing to help manage stress.
Stay Active
Exercising regularly is generally good for your health. It improves cardiac health, reduces stress, and keeps your hair happy.
Eat Well and Stay Hydrated
Healthy hair needs good nutrients. If you take a balanced diet with lots of vitamins and minerals, it will not only benefit your hair but your overall body as well.
Use Gentle Hair Care Products
Many hair products contain harsh chemicals and colors. Such products can damage your hair, especially when prone to hair loss. Wash and style your hair with more gentle hair products.
Hair Styling
Although women prefer high ponytails or tight buns, such hairstyles can pull on your hair, causing them to break. Additionally limiting heat related procedures like blow dryers and straighteners will also help.
Psychological Impact of hair loss in menopause
The psychological impact of hair loss in menopause is often underestimated. It can cause significant distress and negatively affect self-esteem, body image, and overall quality of life.
Women experiencing hair loss may feel less attractive and struggle with feelings of anxiety or depression.
It is essential to address the emotional impact of hair loss by seeking support from loved ones or professionals, practicing self-care and self-compassion, and exploring different treatment options.
Frequently Asked Questions About Thinning Hair During Menopause
Does Estrogen Help Hair Growth?
Estrogen can help hair growth in women, as it promotes the production of keratin, a protein that makes up the structure of hair. However, during menopause when estrogen levels drop, hair loss may occur.
This is because estrogen also helps to keep hairs in their growth phase for longer periods of time. When there is less estrogen present, hairs may enter the resting phase and fall out sooner.
Are There Any Natural Remedies For Hair Loss At Menopause?
There are some natural remedies that may help prevent or reduce hair loss during menopause.
These include managing stress, exercising regularly, eating a balanced diet with plenty of vitamins and minerals, staying hydrated, and using gentle hair products. However, it is important to recognise that hormones are powerful chemicals in tiny doses and may need to be added back or evened out to support optimal hair growth.
Can Estrogen Replacement Cause Hair Loss?
Estrogen replacement therapy (ERT) may cause temporary hair loss in some women. This is because ERT can alter hormone levels and disrupt the hair growth cycle.
However, in the long term, estrogen may actually help promote hair growth. It is important for women considering ERT to discuss any potential side effects with their healthcare provider. Additonally you may see changes in hair shedding if you reduce your estrogen dose or increase your testosterone dose.
Do Supplements Help Reduce Menopausal Hair Loss?
A recent study demonstrated that used, alongside pharmaceutical therapy, a suplement with collagen, taurine, cysteine, methionine, iron, and selenium was helpful in reducing hair loss.
THE TAKEWAYS: MENOPAUSE AND HAIR LOSS
While it is natural for hair to fall out with age, menopause can accelerate hair loss.
Hormonal changes, certain medications, and damaging haircare can contribute to thinning hair in perimenopause and menopause.
If you want healthy hair as you age, take care of your hair and overall health and get the medical support you need.
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Download our Free Menothrive Guide, to feel in control and love your life during peri and menopause.
Book an appointment with Dr Deborah Brunt at Otepoti Integrative Health.
REFERENCES
Chaikittisilpa, Sukanya MD, MSc; Rattanasirisin, Nattiya MD; Panchaprateep, Ratchathorn MD, PhD; Orprayoon, Nalina MD; Phutrakul, Phanuphong PhD; Suwan, Ammarin MD; Jaisamrarn, Unnop MD, MHS. (April 2022). Prevalence of female pattern hair loss in postmenopausal women: a cross-sectional study. Menopause. 29(4):p 415-420.
Fabbrocini, G., Cantelli, M., Masarà, A., Annunziata, M. C., Marasca, C., & Cacciapuoti, S. (2018). Female pattern hair loss: A clinical, pathophysiologic, and therapeutic review. International journal of women's dermatology, 4(4), 203–211.
Dhurat, R., Sukesh, M., Avhad, G., Dandale, A., Pal, A., & Pund, P. (2013). A randomized evaluator blinded study of the effect of microneedling in androgenetic alopecia: a pilot study. International journal of trichology, 5(1), 6–11.
Liu, K. H., Liu, D., Chen, Y. T., & Chin, S. Y. (2019). Comparative effectiveness of low-level laser therapy for adult androgenic alopecia: a system review and meta-analysis of randomized controlled trials. Lasers in medical science, 34(6), 1063–1069.
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