Losing hair during perimenopause? Here’s what’s really going on

If you've recently noticed hair loss or bald spots where before your hair felt full and healthy, you're not alone.

Hair changes during perimenopause are common and natural, and understanding them can help you take back control of your hair health.

Here's everything you need to know about female hair loss, perimenopause, and how to encourage hair growth, so you feel like your most confident self again.

How your hair and scalp change during perimenopause

During perimenopause, your hair and scalp go through noticeable changes due to shifting hormone levels:

• Hair density may feel lighter, particularly on the top of your head or around the parting
• Hair shedding may increase, especially in the fall and spring
• Hair may become finer and less voluminous
• Lower oestrogen levels reduce sebum (aka natural oils), so hair may become drier and more prone to breakage
• Melanin production slows down, so you may notice more grey strands
• Hair texture may change from straight to curly or vice versa
• Reduced sebum can make your scalp dry, flaky, and itchy
• Hormonal fluctuations may trigger mild scalp inflammation, which can contribute to hair thinning

What is perimenopausal hair loss?

Perimenopausal hair loss is exactly what it sounds like: hair loss that happens as women enter perimenopause—the stage leading up to menopause.

We'll explain in more detail what exactly causes perimenopause hair loss, but the main culprits are hormonal changes and disruptions in the hair growth cycle.

Perimenopause hair loss is gradual, and usually starts at the crown or along the centre part. The hair becomes thinner, more brittle, and may show a more visible scalp.

How it differs from other types of hair loss

A common question when it comes to perimenopausal hair loss is how to tell it apart from other types of hair loss, particularly androgenetic alopecia or telogen effluvium.

In a nutshell:

• Perimenopause hair loss is caused by hormonal fluctuations. It usually presents as diffuse thinning across the top of the scalp or along the parting, is gradual, and may come with other perimenopausal symptoms like hot flashes, mood swings, sleep issues, and irregular periods.
• Androgenetic alopecia, or female pattern hair loss, results from genetic sensitivity to androgens [1]. It's also gradual and progressive; it often starts at the top of the head and commonly causes a widening centre part.
• Telogen effluvium is more sudden and acute, triggered by a specific event like childbirth, surgery, or severe stress [2]. It presents as even shedding all over the scalp, and usually, hair regrows once the trigger is resolved.

What causes hair loss during perimenopause?

Hair loss during perimenopause happens when fluctuating hormones interfere with the hair’s natural growth and renewal process, often with lifestyle factors and genetics influencing the severity and pattern of thinning, too [7].

Hormonal fluctuations

During perimenopause, your oestrogen and progesterone levels start to drop, which can lead to a bunch of physical and emotional changes.

Looking at hair health specifically, there are 4 main ways hormonal fluctuations can affect growth and retention:

• Disruption of the growth cycle. Both oestrogen and progesterone play a role in how fast your hair grows and how long it stays on your head. Fluctuations can disrupt the hair follicle's internal clock and leave it stuck in the shedding phase for longer than usual [3].
• Increases androgens. During perimenopause, as oestrogen drops, male hormones like testosterone increase [4]. This can shrink your hair follicles, leading to thinner, shorter strands that are more likely to shed, and contribute to the shortened growth cycle we touched on before.
• Reduced nutrient supply. Oestrogen helps dilate your blood vessels, making it easier for oxygen and nutrients to reach your follicles. Lower oestrogen levels mean the nutrient supply can get disrupted.
• Slower regeneration and repair. Hormonal changes can slow down cell turnover and collagen production in the scalp, which weakens the environment needed for healthy hair growth.

Stress and lifestyle factors

Cortisol levels often rise during perimenopause—once again due to the declining oestrogen. This can make you feel more stressed than usual and, in extreme cases, lead to ongoing or chronic stress.

So how does this connect to hair loss, you may ask?

Well, it all comes down to those hair cycle disruptions. When stress levels stay high for long periods, more follicles may be prematurely pushed into a resting phase [5].

After a few months, this can result in noticeable shedding, often when washing or brushing your hair.

As for the lifestyle factors, certain habits can negatively impact hair health over time. For instance:

• A poor diet means your follicles may not receive the key nutrients they need to grow stronger, thicker hair
• Inadequate sleep (a common challenge among perimenopausal women) is a form of physical stress that further disrupts the growth cycle
• Smoking impacts your blood flow, so oxygen and nutrients can't reach your scalp as efficiently as they should [6]

Genetics

Although hormones are the main culprit behind perimenopause hair loss, genes can also play a role.

People with a genetic predisposition for hair loss can be more prone to follicle miniaturisation and start to see thinning earlier or more prominently as oestrogen and progesterone levels shift.

How long does perimenopausal hair shedding last?

Every woman experiences perimenopause—and all the symptoms it comes with—differently. So, there isn't one set answer to how long perimenopausal hair loss lasts.

Some women may only notice shedding for a few months, while others can go through cycles of thinning and regrowth over several years.

If you're concerned about the amount or pattern of shedding, it's always best to speak to a healthcare professional, who can identify the cause behind it and help you address it.

How to manage hair loss during perimenopause

Starting to notice thinning hair can take a toll on your self-esteem. And during a life stage like perimenopause, when emotions are often already heightened, that's the last thing you need.

The good news? There are ways to support and stimulate hair growth, from simple habits you can add to your daily routine to medical treatments that target underlying causes:

Lifestyle tips

Small changes to your daily habits can make a real difference in slowing down perimenopausal hair loss:

• Focus on nutrition. Eat a balanced diet rich in protein, iron, zinc, biotin, essential fatty acids, and vitamin D. This will help avoid nutritional deficiencies that could otherwise accelerate hair loss. You could also speak to your doctors about supplements, if you're struggling to get enough through food alone or if your blood tests reveal a deficiency.
• Manage your stress levels. We already know how cortisol can affect your growth cycle. If you find that your stress levels tend to run high, explore calming strategies like meditation, yoga, or journaling.
• Exercise regularly. That's right, exercising can help promote hair growth. It supports hormonal balance and increases blood flow to the scalp, delivering oxygen to nourish healthy hair follicles.

Hair and scalp care

Taking care of your scalp and hair can help reduce breakage and support healthy growth.

• Be gentle. Avoid things like tight hairstyles, chemical hair treatments, and excessive heat, all of which can make your hair weaker and pull on your follicles
• Moisturise and nourish with the right hair products. Go for lightweight formulas that hydrate your scalp and combat brittleness without weighing your hair down
• Massage your scalp. Not only can it reduce stress levels, but it also stimulates blood flow to the scalp, which encourages hair regrowth. Two birds, one stone

Medical hair loss treatments

If you're experiencing significant hair loss and changing habits isn't delivering the results you were hoping for, there are other ways to treat hair loss that require the guidance of a doctor:

• Hair transplants. This is a surgical treatment where healthy hair follicles are moved from a donor area to thinning areas
• Red light therapy. This is a type of low-light laser treatment that increases blood flow to the follicles and reduces scalp inflammation
• Hormone replacement therapy (HRT). HRT is designed to address menopausal symptoms by restoring the lower levels of oestrogen and progesterone. In some cases, it can have a positive impact on hair loss

Can you prevent perimenopausal hair loss?

Unfortunately, it's hard to prevent perimenopausal hair loss entirely.

However, adopting healthy lifestyle habits, making sure you're eating well, and using gentle hair care practices from early on can help slow thinning and reduce the overall impact of hair loss over time.

When to speak to your doctor about hair loss

Hair loss is typically not a reason for concern.

That said, there are some signs that hair loss may warrant getting a professional opinion:

• Significant increases in shedding
• Very visible thinning
• Sudden and dramatic hair loss
• Patchy loss
• Accompanying symptoms like fatigue, weight fluctuations, stress, or changes in mood

In the event of any of these, a professional can help identify underlying causes and offer advice on how to best manage your hair health.

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