Navigating Hair Loss During Perimenopause and Menopause
Hair loss during perimenopause and menopause is a deeply personal and often distressing experience for many women.
Hair is our crown, our security blanket, and so often, it is linked to how we identify with ourselves.
Here’s the thing:
Hair loss in women is common.
50% of women in perimenopause and menopause will experience some degree of hair loss.
Hair loss is often multifactorial, and reversing the process takes time and patience.
There are effective and evidence-based treatments that work!
Let’s explore further.
What Causes Hair Loss During Menopause?
Hormonal Factors
Estrogen Decline:
Why It Matters: Estrogen supports the anagen (growth) phase of the hair cycle. During perimenopause and menopause, estrogen levels drop, shortening the growth phase and causing hair follicles to enter the telogen (shedding) phase prematurely.
Effect: This results in increased hair shedding and thinning, particularly across the crown and part line.
Androgen Imbalance:
Why It Matters: As estrogen and progesterone decline, androgen hormones like testosterone can become relatively more dominant. The enzyme 5-alpha-reductase converts testosterone into dihydrotestosterone (DHT), which miniaturizes hair follicles.
Effect: This leads to a condition called female pattern hair loss, previously called androgenic alopecia, characterized by thinning on the top and sides of the scalp while preserving the hairline.
Thyroid Hormones:
Why It Matters: Hypothyroidism, common in midlife women, can exacerbate hair thinning by slowing hair follicle metabolism.
Effect: Hair becomes brittle, sparse, and more prone to shedding.
Other Contributing Factors
Stress and Cortisol:
Chronic stress elevates cortisol levels, which can disrupt the hair growth cycle and lead to a condition called telogen effluvium, where more hair follicles shift to the shedding phase.
Hair Care
Traction Alopecia:
Why It Happens: Repeated tension from tight hairstyles, like braids, ponytails, or buns, damages hair follicles over time.
Effect: Permanent follicle damage can occur if tension persists, leading to localized hair loss.
Chemical Damage:
Relaxers and Perms: These treatments break down hair’s natural structure, making it weaker and more prone to breakage.
Bleaching and Coloring: Harsh chemicals strip hair of moisture and protein, causing brittleness and shedding.
Heat Damage:
Styling Tools: Frequent use of flat irons, curling wands, and blow dryers at high temperatures weakens the hair shaft, leading to breakage.
Repeated Exposure: Prolonged heat styling disrupts the cuticle layer, making hair more susceptible to environmental damage.
Improper Product Use:
Harsh Shampoos: Sulfates and parabens can strip the scalp of natural oils, leading to dryness and hair fragility.
Heavy Product Buildup: Overuse of styling products like gels and sprays can clog follicles, impairing hair growth.
Neglecting Scalp Health:
Why It Matters: A healthy scalp is the foundation for hair growth. Ignoring scalp issues like dandruff, psoriasis, or seborrheic dermatitis can lead to hair thinning.
Nutritional Deficiencies:
Iron Deficiency: Essential for oxygen transport to hair follicles; low levels can stunt hair growth.
Vitamin D: Regulates hair follicle cycling, and deficiencies are linked to increased hair shedding.
Protein Deficiency: Hair is primarily made of keratin, a protein, making adequate dietary protein critical.
Scalp Health:
Conditions like seborrheic dermatitis or buildup of hair products can block follicles, impairing growth.
Autoimmune Conditions
Alopecia Areata:
Why It Matters: This autoimmune condition causes the immune system to attack hair follicles, leading to sudden and patchy hair loss on the scalp and other areas.
Lupus:
Why It Matters: Lupus is an autoimmune disease that can trigger inflammation of the scalp, scarring, and permanent hair loss if left untreated.
Hashimoto's Thyroiditis:
Why It Matters: This autoimmune thyroid condition is a leading cause of hypothyroidism, which slows hair growth and can cause widespread thinning.
Effective Treatments and Why They Work
1. Topical Treatments
Minoxidil (Rogaine):
How It Works: Minoxidil widens blood vessels, improving blood flow to hair follicles and prolonging the growth phase.
Use: Applied directly to the scalp (2% or 5% formulations), it is effective for androgenic alopecia.
Expected Results: Consistent use may result in visible regrowth within 6 months.
Has to be applied TWICE DAILY
Caution with pets as minoxidil topically is toxic to animals.
2. Nutritional Support
Iron: Supplement if ferritin levels are below 40 ng/mL.
Vitamin D: Supplement if levels are below 50 ng/mL.
Omega-3 Fatty Acids: Combat inflammation and promote a healthy scalp environment.
Zinc: Important for hair follicle repair and growth.
3. Platelet-Rich Plasma (PRP) Therapy
How It Works: Platelets from your own blood are injected into the scalp, releasing growth factors that stimulate follicle activity.
Results: Patients often see increased density and reduced shedding after 3-4 sessions.
Best with used in conjunction with other methods for hair regrowth.
4. Low-Level Laser Therapy (LLLT)
How It Works: Devices like laser combs and helmets emit light that stimulates follicular cells, increasing energy production and growth.
Results: Regular use can slow hair loss and, in some cases, promote regrowth.
MUST USE EXACTLY AS DIRECTED BY MANUFACTURER
DAILY USE FOR 1-2 YEARS
5. Hormone Therapy
How It Works: Restores declining estrogen levels and may support the hair growth cycle.
Results: Data to support menopausal hormone therapy (MHT) use solely for hair regrowth is poor, however, anecdotally, many women report experiencing an improvement in their hair loss once they initiate MHT.
6. Oral Minoxidil
How It Works:
Oral minoxidil is a systemic vasodilator that improves blood flow to the scalp, stimulating hair follicles and prolonging the anagen phase.
It also decreases follicular miniaturization caused by androgen activity, making it effective for hair loss and hair thinning.
Dosage: Low-dose oral minoxidil (commonly 0.25–2.5 mg daily) is prescribed by a healthcare provider.
Why It’s Effective:
Oral minoxidil may be a more convenient and tolerable option than topical formulations, especially for individuals who experience irritation with scalp applications.
7. Anti-Androgens
Spironolactone: Blocks androgen receptors to reduce DHT’s (testosterone metabolite) impact on follicles.
Works to protect the hair follicle and preserve growth.
Finasteride (off-label): Reduces DHT production by inhibiting 5-alpha-reductase.
Lifestyle Modifications to Support Hair Health
Stress Management:
Techniques like yoga, meditation, and deep breathing can lower cortisol levels, which may positively impact the hair cycle.
Dietary Adjustments:
Increase intake of leafy greens, lean proteins, nuts, and seeds to provide essential nutrients for hair growth.
Avoid Heat and Chemicals:
Minimize the use of high-heat styling tools and chemical treatments that weaken hair strands.
Scalp Care:
Use gentle shampoos free of sulfates and parabens.
Regularly exfoliate the scalp to prevent follicular blockage.
When to See a Specialist
If you’re experiencing severe hair loss or have noticed changes in texture and density over a short period, consult a dermatologist.
They can:
Perform a scalp biopsy to confirm diagnosis, rule out other dermatologic conditions and recommend more specialized treatments.
The Takeaway
Hair loss during perimenopause and menopause is complex but manageable. By understanding the hormonal shifts that impact hair health and implementing targeted treatments and lifestyle changes, you can take control of your hair health. Early intervention, professional guidance, and consistency with treatments are key to minimizing hair loss and promoting regrowth.
