In this article

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As women get into their 40s and beyond, significant hormonal changes take place, particularly during the transition from perimenopause to menopause. This period is marked by various physical and emotional changes, and one common yet often overlooked concern is hair loss. This article explores why hair loss occurs during this phase, the types of hair loss experienced, and a range of treatments and lifestyle interventions that can help mitigate its effects.

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Perimenopause is the stage preceding menopause, typically beginning in a woman’s 40s but sometimes starting earlier. This transitional period lasts an average of 4 to 8 years, culminating in menopause, which is defined as the point at which a woman has not had a menstrual cycle for 12 consecutive months. The hormonal shifts during perimenopause and menopause, primarily involving declines in estrogen and progesterone, lead to a wide range of symptoms, including hot flashes, mood swings, sleep disturbances, and hair loss.

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Before discussing how perimenopause and menopause can affect your hair, it’s important to understand the physiology of hair and how it grows. The hair growth cycle includes several key phases:

• Anagen Phase: This is the active growth phase where the hair follicle produces new hair cells, and the hair grows rapidly, typically lasting from 2 to 7 years. Around 85-90% of hairs are in the anagen phase at any given time.
• Catagen Phase: This is a transitional phase that lasts around 2 to 3 weeks, where hair growth slows down, and the hair follicle detaches from the blood supply. Only about 5% of hairs are in the catagen phase at one time.
• Telogen Phase: This is the resting phase where the hair is shed, typically lasting around three months. Approximately 10 to 15% of hairs are in the telogen phase at any given time.
• Exogen Phase: During this phase, the resting hair is shed to make way for new growth.

The duration and health of these hair growth phases can be influenced by factors like genetics, age, nutrition, and overall health.

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Hair loss during perimenopause and menopause is predominantly linked to hormonal changes, specifically the declines in estrogen and progesterone levels. These hormones play a critical role in maintaining hair growth and health. Estrogen promotes hair growth and helps keep hair in the anagen (growth) phase for extended periods, while progesterone balances the effects of androgens (male hormones), which can lead to hair thinning and loss.

During perimenopause, irregular and extended menstrual cycles are common, reflecting the changing hormone levels that can contribute to hair loss. The hormonal fluctuations during this transition can disrupt the normal hair growth cycle.

Female pattern hair loss / androgenic alopecia

The most common type of hair loss during perimenopause and menopause is androgenic alopecia, also known as female pattern hair loss (FPHL). Hormonal changes during perimenopause and menopause lead to a decrease in estrogen and progesterone production and an increase in androgen levels. This hormonal imbalance causes hair follicles to shrink, miniaturize, and produce finer, shorter hairs. The result is thinning hair and hair loss.

Specifically, the decrease in estrogen and progesterone -- and a corresponding increase in androgens like dihydrotestosterone (DHT) – can trigger FHPL.

It typically manifests as a general thinning across the top and front of the scalp, with the hairline remaining intact. Some women may also notice widening part lines or increased hair shedding.

Telogen effluvium

Another type of hair loss during perimenopause and menopause is telogen effluvium, characterized by a sudden increase in hair shedding. This condition often arises due to stress or hormonal fluctuations, causing hair to enter the telogen (resting) phase prematurely, leading to increased shedding.

Diffuse thinning

Many women experience overall thinning and shedding of hair during perimenopause and menopause rather than noticeable bald spots. This diffuse hair loss is also linked to hormonal changes.

Frontal fibrosing alopecia

Frontal fibrosing alopecia is a type of hair loss associated with perimenopause and postmenopause. It causes progressive recession of the frontal hairline.

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If you are experiencing hair loss during perimenopause or menopause and are not already being treated for a thyroid condition, your first step in evaluating your hair loss is to get a complete thyroid panel.

There are several reasons why this is an essential step in evaluating hair loss in mid-life.  

First, hair loss is a common symptom of hypothyroidism and the risk of developing hypothyroidism increases in women during perimenopause and menopause. Since the symptoms of hypothyroidism can overlap with those of menopause—such as fatigue, weight gain, mood swings, and hair loss—it’s essential to rule out thyroid dysfunction as a contributing factor.

Also, during perimenopause and menopause, women experience significant hormonal changes, particularly with estrogen and progesterone levels. In addition to leading to hair loss, these fluctuations can adversely affect thyroid function.

Finally, the primary cause of hypothyroidism in the U.S. is Hashimoto’s thyroiditis, an autoimmune disease. Women are more likely to develop autoimmune diseases during menopause due to changes in immune function. And autoimmune diseases – specifically Hashimoto’s thyroiditis – can trigger hair loss, slow hair growth, and overall hair thinning.

Given the overlap of symptoms, proper diagnosis is critical to effective treatment. If hair loss is solely attributed to hormonal changes during menopause, other causes, like thyroid disorders, might be overlooked. Testing thyroid function ensures a comprehensive approach to treatment.

If thyroid dysfunction is detected, appropriate treatment with thyroid hormone replacement medication can significantly improve symptoms – including hair loss – and overall health outcomes.

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If hair loss is extensive or concerning, consider having an evaluation with a physician or a dermatologist. An evaluation for hair loss during perimenopause and menopause involves a thorough examination to determine the cause and develop an appropriate treatment plan. Here’s what such an evaluation typically entails.

Medical history and lifestyle assessment: The first step in evaluating hair loss is obtaining a detailed medical history. The doctor will inquire about the patient’s age, menopausal status, family history of hair loss, and previous medical conditions or treatments. Medications, such as hormone therapy, thyroid medications, or chemotherapy, are also discussed, as they can impact hair health.

Lifestyle factors are also examined, including diet, stress levels, sleep patterns, and hair care routines. A balanced diet and a low-stress lifestyle can influence hair health; certain hair care practices may contribute to hair loss.

Physical examination:  A thorough physical examination of the scalp and hair is conducted. The doctor looks for patterns of hair loss, scalp conditions like redness or scaling, and signs of breakage or damage. They might use a dermatoscope to examine the hair follicles and scalp closely during this exam.

Blood tests: Given the significant hormonal changes during perimenopause and menopause, blood tests are often necessary to check hormone levels, including estrogen, progesterone, and testosterone. Apart from thyroid function – discussed earlier -- other factors that might contribute to hair loss, such as iron levels and vitamin deficiencies. These should be assessed through blood tests.

Additional tests: In some cases, doctors might conduct more specific tests. A “pull test” assesses the amount of hair shedding by gently pulling on strands to see how many come out. A scalp biopsy, though less common, might be used to examine hair follicles at a microscopic level to identify autoimmune or other underlying conditions.

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Medications or supplements may sometimes be recommended to help with hair loss. Here are some of the most common treatments.

Minoxidil: Minoxidil (Rogaine) is the only FDA-approved medication for treating hair loss in women. Minoxidil prolongs the anagen phase and enlarges hair follicles, leading to thicker hair. It is typically applied to the scalp once or twice daily and effectively treats female pattern hair loss. Minoxidil is available over the counter without a prescription and comes in 2% and 5% strengths. It can take months – up to a year –  to see results. Keep in mind that with minoxidil, the effects are only maintained while you’re taking the medication, and any new hair growth will be lost if the treatment is stopped.

Finasteride: The medication finasteride (Propecia) inhibits the conversion of testosterone to dihydrotestosterone (DHT), which can help slow hair loss and promote hair regrowth. Finasteride can be prescribed for hair loss in perimenopausal and menopausal women, especially if other treatments like minoxidil have not been effective. Some studies have shown that finasteride can increase hair density and reduce hair shedding in pre-menopausal and post-menopausal women.

Note: the FDA does not approve finasteride for use in women because it can cause birth defects. Any woman of childbearing age who can become pregnant should not take Propecia due to this risk.

Spironolactone: Spironolactone is an oral medication that can help reduce androgen levels, thus preventing their impact on hair follicles. It is often used off-label for treating hair loss in women and is particularly useful for those with androgenic alopecia.

Hormone replacement therapy: While most doctors wouldn’t typically recommend hormone replacement therapy (HRT) solely for treating hair loss, it can help address the underlying hormonal imbalances changes that contribute to perimenopausal and menopausal hair loss. HRT may be an option if other treatments are not effective.

Iron supplements: If iron deficiency is contributing to hair loss, some experts recommend taking iron supplements to help slow or stop the shedding. However, iron supplements should only be taken if a blood test confirms an iron deficiency.

Biotin: Biotin is a B vitamin that is crucial to hair growth. Many women find that biotin supplements or biotin-infused hair care products improve hair strength and thickness.

Saw palmetto: Saw palmetto is a natural extract with anti-androgenic properties, potentially helping to reduce hair loss caused by increased androgen levels. It is commonly used in supplements designed to support hair growth.

Zinc: Deficiencies in zinc can contribute to hair loss. Supplementing with this mineral can help maintain healthy hair and reduce shedding.

Home hair growth devices:  There are home devices that can help treat hair loss. Specifically, red light therapy devices like the iRestore Essential Laser Hair Growth System and Celluma RESTORE use red light or low-level laser light to stimulate hair follicles and promote hair growth. Studies have shown these types of devices can increase hair density and thickness in people with androgenic alopecia.

Other devices like the HairMax LaserComb use laser light to treat hair loss. Clinical studies have demonstrated the effectiveness of these comb-like devices in increasing hair count and improving hair thickness compared to placebo treatments.

Lifestyle changes

In addition to prescription and natural treatments and hair loss devices, several lifestyle changes can help manage hair loss during perimenopause and menopause:

Stress reduction: Chronic stress can exacerbate hair loss by causing hormonal imbalances and triggering telogen effluvium. Practicing stress-reduction techniques like yoga, meditation, or mindfulness can help manage stress levels and promote hair health. Adequate sleep is also critical for stress management, so aim for 7-9 hours of quality sleep each night.

Balanced diet: A diet rich in vitamins, minerals, and antioxidants supports hair growth. Focus on an anti-inflammatory diet that includes a variety of fruits, vegetables, lean proteins, and healthy fats to provide essential nutrients for hair health. Experts also recommend that perimenopausal and menopausal women aim for 60-70 grams of protein daily to help slow hair loss during this transition. This breaks down to about 20 grams of protein per meal.

Stay hydrated: Proper hydration is vital to overall health and can impact hair health as well. Dehydration can lead to dry, brittle hair and increased breakage. Aim to drink at least 8 glasses of water a day to keep your hair and scalp hydrated.

Regular exercise: Exercise can help reduce stress and promote hormonal balance, contributing to overall hair health. Exercise also improves blood circulation, including to the scalp, promoting hair growth. Aim for at least 30 minutes of moderate exercise most days of the week.

Scalp massage: Regular scalp massage can improve blood circulation to the scalp, promoting hair growth. It can also help reduce stress and increase relaxation.

Hair care practices: Avoiding harsh hair treatments, such as excessive heat styling and chemical processing, can help maintain hair health. Opt for gentle hair care products and minimize the use of heat tools.

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Hair loss during perimenopause and menopause is a common issue, but it can be managed with a combination of prescription treatments, natural supplements, and lifestyle interventions. By understanding the underlying causes of hair loss and exploring various treatment options, women can take proactive steps to support their hair health during this transitional period. If hair loss becomes a significant concern, it is essential to consult with a healthcare professional or dermatologist to determine the most appropriate treatment plan.

Because thyroid disease is more common in women during perimenopause and menopause, ensuring that you have a proper thyroid diagnosis and treatment is also an important consideration when dealing with hair loss. Optimal thyroid treatment may sometimes help slow or stop excessive hair loss during this hormonal transition.

You can monitor thyroid function easily with the Paloma Health at-home thyroid test kit. The kit provides a comprehensive assessment of thyroid function by measuring four key biomarkers: TSH, free T4, free T3, and TPO antibodies. This gives a more complete picture of thyroid health compared to tests that only measure TSH.

Paloma’s expert practitioners can help analyze your test results and provide personalized recommendations and thyroid care, as well as HRT treatment for perimenopause and menopause. As a Paloma member, you’ll have access to doctors, nutritionists, health coaches, and care managers, and virtual appointments make your hormonal healthcare convenient.

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