During the menopause transition and following, hair follicles may shrink, causing the hair to become thinner and thinner until it eventually falls out. Hormone related changes that affect the follicle contribute to slower growing hair and make it easier for it to fall out.
As if hot flashes weren't bad enough, if you are in your mid-40s or 50s and experiencing hair loss, it could be a symptom of menopause. For women, our hair can be so much of our identity, and hair loss can bring up anxiety, insecurity, and stress. Luckily, there are several possible solutions, including natural therapies and medications, to address the root causes of menopausal hair loss.
In this article we will discuss the causes, symptoms, prevention strategies, and tips to grow thicker, fuller hair.
In this article
- Introduction to Menopause Hair Loss
- Causes of Menopause Hair Loss
- Symptoms of Hair Loss During Menopause
- Treatment Options for Menopause Hair Loss
- Natural Remedies for Menopause Hair Loss
- Prevention Tips for Menopause Hair Loss
- Diagnosis of Menopause Hair Loss
- Conclusion: Coping with Menopause Hair Loss
- Frequently Asked Questions about Menopause Hair Loss
Introduction to Menopause Hair Loss
Before we understand what causes hair loss in menopause, it’s helpful to define terms and understand what is menopause. The natural hormonal changes in menopausal women affect the whole body, including hair.
Understanding What is Menopause
The official definition of menopause is the one-year mark without a menstrual cycle. The years leading up to menopause, called perimenopause, are when hormones shift, resulting in cycles becoming irregular and symptoms like hot flashes, insomnia, headaches, and night sweats can begin.
As the shift happens from perimenopause to postmenopause, estrogen, progesterone, and testosterone will ultimately decline.
Learn all the ins and outs of perimenopause in my article When Does Perimenopause Start and How Long it Lasts.
The hormonal changes in perimenopause, especially when you near menopause, can cause perimenopause hair loss. Thinning and hair loss can continue in postmenopausal women, sometimes becoming worse.
Defining Hair Loss During Menopause
It has been found that the number of women with hair loss in their menopausal years may be as high as 50%. In one study1 of women who were an average nine years into menopause, 52.2% reported hair loss as a symptom.
The type of hair loss in menopause is defined as female pattern alopecia or hair loss2, formerly called androgenic alopecia or androgenetic alopecia, and is the most common hair loss disorder in women. Female pattern hair loss occurs when the size of hair follicles decreases, causing hair thinning and fewer hairs on the head.
Female pattern alopecia primarily affects the central scalp and can be noticed along the part line, the front hair line, and the sides of the scalp. It may also come out in clumps while showering or brushing your hair.
In addition to the hair shaft reducing in diameter, the growth phase may be affected and more hair breakage may occur.
Causes of Menopause Hair Loss
Female hair loss in menopause is multifactorial and can include the hormonal influence on hair follicles, genetics, stress, and nutrient deficiencies. Studies suggest that hormone imbalances that occur in menopause, namely the shifts in estrogen and progesterone can be to blame.
Hormonal Changes During Menopause
As estrogen and progesterone decline in late perimenopause and into the postmenopausal years, hair growth is slowed. These two hormones have a significant impact on healthy hair growth and without them, the hair can become thin, dry, and break easily.
Estrogen is an essential hormone for overall skin health3. Estrogen helps keep the skin firm, plump, and hydrated. When estrogen levels decline with menopause, it not only accelerates skin aging but affects the hair follicles and can contribute to hair loss and thinning. In addition, when the body is actively converting estrogen to testosterone during menopause, this reducing the follicle's exposure to androgens.
In some cases, the production of androgens4, including testosterone, can lead to miniaturization of the hair follicle and hair loss. When hyperandrogenism is the issue, women experience hair loss on the head and can also see hair growth on the chin or upper lip.
Progesterone is produced by the ovaries following ovulation, but as ovulation stops, the levels of progesterone decline. One role of progesterone is to block the production of excess testosterone and prevent it from being converted into its more potent form, dihydrotestosterone or DHT. When it comes to androgens, DHT is largely responsible for changes to the hair follicle that result in hair loss and thinning.
The enzyme known as 5-alpha reductase is responsible for the conversion to DHT. Saw palmetto, nettle root, and topical rosemary oil are natural DHT blockers. We'll discuss those shortly, along with medications your doctor may recommend.
Additionally, hypothyroidism (too little thyroid hormone) and hyperthyroidism (too much thyroid hormone) can both result in hair loss.The decline in estrogen and progesterone with menopause affects metabolic health. It’s common for women to gain some weight in menopause, and an increased body mass index (BMI) correlates with female pattern hair loss5. Insulin and blood sugar can play a role in hair loss.
Role of Genetics in Hair Loss
If your mother had female pattern hair loss, will you have it too? Possibly. There is evidence of a genetic predisposition for women with androgen-related hair loss6. Even normal androgen levels can interact with follicular cells, and women share some common genes involved in androgenetic alopecia or hair loss.
Hair loss is multifactorial, which means even if there are some genetic markers, your lifestyle may still play a significant role in preventing and treating hair loss.
Impact of Stress and Anxiety on Hair
Research confirms the connection7 between stress and changes in the hair follicle. Stress hormones and neurotransmitters in the brain affect the hair follicle in terms of inflammation, the microbiome, and mitochondrial function. This connection is part of the brain-hair follicle axis.
In times of extreme stress or significant emotional stress, acute hair loss known as telogen effluvium can result in rapid shedding—sometimes even losing hair in clumps. This is a non-scaring, temporary condition in which the hair almost always grows back.
Addressing stress levels is an important piece of preventing and treating hair loss. We'll discuss some therapies to help address this component later.
The Connection between Nutritional Deficiencies and Hair Health
There are key nutrient deficiencies that have been shown to contribute, if not cause, hair loss. Iron deficiency or nutritional deficiencies in vitamin D, B28, B12, and biotin have all been associated with hair loss.
When you stop menstruating, iron deficiency anemia may be overlooked. But there are many factors that can contribute to iron deficiency, including heavy periods that may have been present years leading up to menopause. It's important to have testing to understand if this is a contributing factor for you.
Important nutrients for health include:
Nutrition plays a significant role in hair follicle and shaft health. Deficiencies in micronutrients9 contribute to hair loss and poor hair health.
- Vitamin B2
- Vitamin B3
- Vitamin B5
- Biotin
- Vitamin B12
- Vitamin C
- Vitamin A
- Vitamin E
- Vitamin K
- Zinc
- Iron
- Copper
- Selenium
- Essential fatty acids
- Vitamin D10
Symptoms of Hair Loss During Menopause
Menopausal hair loss is different from shedding; we all shed hair daily. When shedding first shifts to hair loss, such as in late perimenopause, it may be gradual and occur over several years. Symptoms can include thinning, increased hair fall, and a change in texture.
Thinning Hair on the Scalp
Thinning hair may occur on the top, front, and sides of the scalp. You may notice more scalp showing where your hair parts and your hair density decreases.
More Hair Fall Than Usual
We all shed some hair daily, but excess hair loss can show up as increasing hair fall. You may notice more hair in the brush after brushing, in the shower drain, on your clothing, and on your pillowcase. Your ponytail may be smaller.
Change in Hair Texture
In addition, a symptom of menopausal hair loss may be a thinning of the hair as it grows from a smaller follicle. You may notice a coarser texture as the hair turns grey or white.
For some women, they may experience brittle hair, dryness, frizz, or increased waviness or curl. Women with curly hair may notice their hair changes in texture and is less curly than it was in the past.
Treatment Options for Menopause Hair Loss
Next, let’s look at some treatment strategies to support menopausal hair loss. Identifying the problem early is helpful to prevent future loss, as that might be more effective than trying to regrow hair once it’s gone.
Hormone Replacement Therapy (HRT)
Hormone replacement therapy (HRT) or menopause hormone therapy involves taking progesterone, estrogen, and sometimes testosterone to replenish declining hormones in menopause. Many prescription options are available from your healthcare provider, including bioidentical (body-identical) options, which some women prefer.
HRT supports several perimenopausal and menopausal symptoms, including skin (and hair) health11. While hormone treatments can bring symptom relief and in some cases, slow or reverse hair loss, it is important to remember that certain hormones may contribute to hair loss.
Testosterone is absolutely essential to women's health, but if your body has a preference for converting it to DHT, you may experience more hair loss. This is why it's important to monitor the loss of hair you're experiencing before and after starting treatment. Additionally, using natural or prescription agents that reduce DHT production can be beneficial in some cases. Your doctor should be able to guide you in the best medical treatment options for you.
Read more about HRT and the health risks of low hormones here.
Topical Treatments for Hair Regrowth
The most common topical treatment for hair regrowth is minoxidil. Rogaine is a popular brand name of minoxidil. This topical solution is effective in both men and women, and it works by opening potassium channels to stimulate hair growth12.
Finasteride or Propecia and Ketoconazole are also topical hair loss treatment options. I’ll discuss medication options in more detail below.
Nutritional Supplements and Diet Adjustments
Because the skin and hair follicles require so much nutrition, a nutrient-dense, balanced diet is the foundation of hair health. In addition to the micronutrients listed above, it’s also important to eat enough quality macronutrients – protein13, carbohydrates, and fat. This set up of recipes can serve as a good starting place for anyone wanting to make diet changes to improve hair health.
Best Foods for Hair Growth
- Eggs
- Fatty fish
- Sweet potatoes
- Berries
- Spinach, chard, and other leafy greens
- Oysters
- Meat
- Peppers
- Pumpkin seeds
- Liver
- Nutritional yeast
- Avocados
Supplements can help fill nutrition gaps by providing key nutrients for hair growth. A quality multivitamin, like Women’s Twice Daily by Dr. Brighten provides valuable micronutrient support through this stage of life.
Additionally, supplementing with saw palmetto, which addresses hormones related to hair loss, and DIM, which can help with testosterone, can also be an effective way to support hair regrowth.
Hair Transplant Surgery
Hair transplant surgery, known as grafting, involves removing hair from the back of the head and implanting it into bald or thinning areas on the head. After surgery, it can take some time for the new hair to establish and to see benefits.
But in many cases of hormonal hair loss, there is a diffuse pattern of thinning and loss that may not make someone an ideal candidate for hair transplantation. It's important to discuss with your doctor the best treatment options for your case.
Natural Remedies for Menopause Hair Loss
There are at home and natural remedies for hair loss that you can try immediately or in conjunction with the recommendations of your provider.
Essential Oils for Hair Growth
Rosemary essential oil14 is effective as minoxidil in a study comparing the two interventions in people who used the treatments for 6 months. Rosemary oil may have less side effects, such as the scalp itching associated with topical medications.
It's recommended that rosemary oil be mixed in a carrier oil before apply to the scalp. With my patients, I often recommend placing a few drops on the scalp and then following it up with a scalp massage to increase blood flow just before a shower. The mixture can be left on the scalp for about 10 minutes and then shampooed out.
Lavender oil has comparative benefits to minoxidil in an animal model as well.
Herbal Remedies in Managing Hair Loss
When you understand the root cause of hair loss, many herbal options support menopause symptoms and hair health. Herbs and phytonutrients15, including turmeric, red clover, pumpkin, mulberry, quercitin, saw palmetto, and may be options for improving hair thickness and texture.
Saw palmetto may support hair health by inhibiting the 5-alpha reductase enzyme16 that turns testosterone into the more potent androgen dihydrotestosterone (DHT), thus decreasing the irreversible androgenic effects on hair follicles. Saw Palmetto Plus by Dr. Brighten is expertly formulated for women to support androgenic balance.
Lifestyle Changes for Healthy Hair
In addition to nutrition and herbal supplements, your lifestyle profoundly affects your overall health, including hair health.
Poor sleep is associated with an increased risk of hair loss17 (alopecia), and improving sleep is foundational for hair health and every aspect of health. Sleep can be tricky through the menopausal transition because of fluctuating hormones and you may need extra support. Read 10 Best Sleep Supplements for more.
Above, I discussed the impact of stress on hair as well. Managing stress is another foundational lifestyle aspect to consider for improving hair health. Read Reduce Your Stress Today for Better Hormones for actionable ideas.
Prevention Tips for Menopause Hair Loss
While there are many treatment options for hair loss, prevention is the most ideal strategy. If you are in your 40s or 50s and haven’t noticed signs of hair loss or have noticed minimal ones, now is the time to put prevention strategies in place.
Adopting a Hair-Healthy Diet
We've already discussed the importance of good nutrition for treating menopausal hair loss, and the same strategies can be used for prevention.
One study suggests18 a protein-rich diet that includes complex carbs, along with the vitamins and minerals required for healthy hair. The suggested minimum amount of dietary protein is 0.9 grams per kg of body weight daily. In some cases, more protein may be required in the diet.
Additionally, eating foods rich in vitamin C, B vitamins, vitamin A, and vitamin D is necessary for healthy hair. Minerals like zinc, iron, copper, selenium, silicon, magnesium, and calcium influence healthy hair growth and are essential as part of a hair regrowth strategy. In addition to diet, taking a daily multivitamin with highly absorbable forms of minerals can also be a supportive strategy for increasing hair density.
Reducing Stress and Anxiety
Managing stress and anxiety is a strategy to help prevent the changes in hair health driven by chronic stress. I share some of my best tips and information about addressing the root causes of stress and anxiety in the article The HPA Axis and Healing Anxiety.
Proper Hair Care Routine
Your hair care routine can prevent damage and excess shedding. Gentle hair care is necessary when experiencing hair loss. Avoid friction, stress, and chemicals on the scalp. I encourage people to discuss with their hair stylist ways to reduce excess hair loss.
You may want to reduce or avoid:
- Hair dye
- Hair dryers (especially on high heat)
- Hair straightening or curling
- Tight ponytails
- Over-washing
Talk to Your Doctor about Medications
Your doctor may have options to help prevent menopausal hair loss or stop it in its tracks. We already discussed the primary topical medication, minoxidil19.
Topical Ketoconazole also known as Nizoral is an antifungal that may reduce follicular inflammation by reducing problematic microorganisms on the scalp.
Finasteride can be used topically to inhibit 5-alpha reductase activity, preventing the conversion of testosterone to DHT.
Oral medication options for female pattern hair loss include:
- Finasteride20 (Propecia)
- Spironolactone
Diagnosis of Menopause Hair Loss
Diagnosis involves differentiating female pattern hair loss related to the hormonal changes of menopause from other types or causes of hair loss, such as autoimmune alopecia, thyroid imbalances, medication side effects, anemia, or nutrient deficiencies.
Consultation and Medical History
Understanding your family history, the onset of hair loss, and other symptoms that may accompany it is an important step in determining the best treatment approach. Keeping track of your hair loss pattern and things that make it better or worse can help you get the guidance you need from your provider.
Hormone Level Tests
Hormone testing helps assess the hormone patterns that may be driving hair loss. Hormone tests to consider include:
- Testosterone
- Androstenedione
- Dihydrotestosterone (DHT)
- Dehydroepiandrosterone (DHEA)
- Follicle-stimulating hormone (FSH)
- Luteinizing hormone (LH)
- Prolactin
- Estradiol (estrogen)
- Progesterone
- Cortisol
It's important to note that estrogen and progesterone aren't often tested in menopause or post menopause because with the cessation of your period, we expect these hormones to be low. Not all of these tests may be necessary in your case, which is why meeting with an experienced practitioner can help in determining the best lab tests.
Lab Tests for Hair Loss
In addition to hormones, your doctor may order a complete blood count (CBC) and a ferritin to evaluate your iron levels. Vitamin D testing is important to determine if supplementation is warranted. Additional mineral and nutrient testing may be order to understand if nutrient deficiencies are contributing to your hair loss.
Scalp Examination and Hair Pull Test
Your doctor should also physically examine your scalp, either directly or with dermatoscopy (a microscope used to view the epidermis), and may perform a hair pull test.
A hair pull test21 may help to estimate the severity of hair loss. To perform a pull test, your doctor will bundle about 50 hairs and firmly pull them. Then, the hair strands that are removed are counted. If you lose more than 10% of the hair, the test is positive for active hair loss.
Conclusion: Coping with Menopause Hair Loss
There’s no doubt that hair loss can be challenging. Your anger, frustration, embarrassment, and other emotions are all valid. Along with treatment strategies, it’s also vital to take care of your emotional well-being as your body changes with menopause.
Emotional Support and Self-Care
Find ways to feel supported by connecting with others going through the same changes or someone to lend an empathetic ear. Don’t neglect your self-care strategies, and continue attending to both the needs of your body and mind.
Understanding and Accepting the Changes
Understanding and addressing the root cause of your menopause hair loss is one step in managing the emotional component associated with this. Consider shifting the focus from your physical appearance to how your body feels, your strength, and your health.
Seeking Professional Help
Working with a counselor or therapist in menopause is an excellent way to find support, learn body acceptance, and address your psychological well-being during this life phase.
Frequently Asked Questions about Menopause Hair Loss
Let’s recap what we learned today with some of the FAQs I get about hair loss in menopause.
When Does Hair Loss Begin During Menopause?
Female pattern hair loss may begin before the official onset of menopause, one year after the final period. It may begin in late perimenopause as estrogen and progesterone levels decline.
Does Everyone Experience Hair Loss During Menopause?
Not everyone will experience hair loss in perimenopause or menopause, but it may affect over 50% of women.
Can Hair Regrow After Menopause Hair Loss?
Yes, it’s possible to prevent further hair loss and regrow some hair using various conventional and naturopathic approaches. You can use many of the treatment strategies discussed in this article concurrently.
While menopause hair loss can be daunting, understanding its root causes and available holistic remedies ensures you can confidently navigate this phase.
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