Losing hair during menopause? Here’s what’s really happening

Finding strands of hair tangled on your brush or caught up in a claw clip is such a normal part of daily life that you might not notice a few more until your hair suddenly starts to feel thinner when you run your hands through it or tie it up for that afternoon jog. That’s often when the worry settles in, and when many women can’t stop noticing it. The slight receding at your temples, or that tiny bald patch at the back of your neck that seems to be growing, and perhaps you’d heard of menopause hair loss before, but never given it all that much thought.

After all, of all the menopausal symptoms we talk about, hair loss is often low on the list, but it's one of the factors that can impact us the most. Our hair is often tied to our identity and self-esteem, and losing it can have a huge impact on our confidence and mental and emotional health. So, here, let's take a look at what menopausal hair loss is, how it's different from age-related hair loss, why it happens, how to identify it, and how to promote healthy hair growth throughout your postmenopausal life.

What is menopause?

Menopause is a transitional period in a woman’s life where her ovaries stop producing estrogen, her menstrual cycle ends, and the reproductive stage of her life is over [3]. It consists of three distinct phases:

• Perimenopause, sometimes called the menopausal transition, is when your hormones begin to fluctuate, your periods become irregular, and you may experience perimenopause symptoms such as hot flashes, night sweats, disturbed sleep and mood changes
• Menopause, which is when your periods stop entirely, and
• Post-menopause, which begins a year after menopause occurs, marks the start of the rest of your life.

The average age of menopause is 51 years, but some women may experience this natural biological process earlier or later [5].

How hormonal changes affect your body and hair

During perimenopause, your hormones are ultimately in a state of flux, culminating in the relative increase in androgens and the end of ovarian estrogen production, which occurs during menopause itself. This has a big impact on your body, as estrogen has been shown to play an important role in cardiovascular health, bone health, the metabolic system, urinary system, and the vagina. As a result, when your body stops producing the same amounts of estrogen and produces more androgen, you’ll see changes to your body which can include weight gain, osteoporosis, a dry or itchy vagina and urinary incontinence [3].

What’s perhaps less known is that estrogen also plays a role in hair health, as your hair follicles are an estrogen-sensitive tissue [1]. As estrogen reduces, it can cause a gradual thinning of your hair and otherwise impact the growth of healthy new hair.

How does your hair and scalp change during menopause?

During menopause, the hormonal fluctuations can lead to significant changes to your scalp and hair, particularly in the hair shaft and hair growth cycle, which can result in deviations in hair texture and strength, as well as hair loss in women. On top of that, the permanent loss of ovarian estrogen in menopausal women can impact the function of the hair follicle itself by affecting your broader metabolism and blood flow, which limits the availability of vital nutrients and natural oils to your skin, scalp and hair [5].

Common signs of thinning and texture changes

Hair loss is a natural part of the hair growth cycle, with every person losing up to 100 hairs per day. That said, any more than that can be a sign that you’re experiencing menopausal hair changes or other hair disorders.

The first signs of this will generally be noticing more hair on your brushes and combs, on your clothing or in your bed, or clogging up your bathroom drains. You might then start to feel that your hair has gotten thinner or grown dry or brittle, and see that your part has grown wider and your hairline higher. Some postmenopausal woman may also start to notice small bald patches at the top or back of their head, frontal hairline recession, or receding hair at the temples [2].

While nobody likes to see or feel their hair thinning, this is not uncommon for postmenopausal women to experience.

The link between menopause and hair loss

While some hair shedding or hair loss can be attributed to ageing and genetic predispositions, the significant hormonal changes during menopause, and the significant decrease in estrogen levels can affect the hair follicle and interfere with the hair growth cycle.

After all, the hair growth cycle is regulated by the endocrine system, where hormones like androgen, melatonin, prolactin, melanocyte-stimulating hormone and estrogen all play a vital role in managing and maintaining hair health. As your estrogen levels drop and your androgen levels rise during and after menopause, that cycle can get disrupted, leading to hair loss in many women, particularly if they have a sensitivity to androgens.

Recent studies have found that over 50% of postmenopausal women experience some degree of hair loss [5], making it a common part of menopausal life.

The role of oestrogen and androgens in hair growth

Many hormones play a vital role in how your hair grows, but androgen and estrogen are particularly influential, and while they interact with one another, they also perform quite different functions.

When it comes to body hair, androgens can be great – they stimulate the tiny, fine hair across the body to grow, turning small hair follicles into larger, deeper ones to form longer, thicker, darker terminal hair. This is what gives you pubic hair and underarm hair, as well as facial hair, such as your eyebrows.

Unfortunately, they have the opposite effect on the scalp, shrinking hair follicles in a process known as hair follicle miniaturisation, and shortening the hair growth cycle, resulting in thinner, weaker hair and eventually hair loss.

On the other hand, estrogen has been found to be critical in not just protecting the hair follicle itself, but in promoting the active growth phase, also known as the anagen phase, and counteracting the effects of androgen on your scalp hair [6].

As a result, having less estrogen and more androgen means you don’t have as many of the protective factors supporting healthy hair growth, and more of the factors adversely impacting your hair follicles.

Types of hair loss during menopause

When we talk about hair loss, it can be easy to assume we’re talking about one thing, but there are actually three different types of hair loss postmenopausal women may experience:

• Female pattern hair loss, also known as androgenetic alopecia
• Telogen effluvium; and
• Frontal fibrosing alopecia

Female pattern hair loss

The most common cause of hair loss in women, female pattern hair loss, is a progressive miniaturisation of hair follicles that leads to thinning hair and shedding. It generally affects the central, front, and parietal regions of the scalp and operates similarly to male androgenic alopecia, although the role of androgens in female pattern hair loss has not been as clearly identified. One study of post-menopausal women showed 52% had experienced some degree of female pattern hair loss [1].

Telogen effluvium

Another common cause of menopause hair loss, telogen effluvium, is a type of nonscarring alopecia where women experience excessive hair loss as a result of a sudden change. This is generally limited to a period of a few months, although it can be a chronic condition too. Telogen effluvium can also sometimes involve some pain or a burning sensation across the scalp, which makes it unique to female pattern hair loss [1].

Frontal fibrosing alopecia

Far less common than female pattern hair loss and telogen effluvium, this is a form of alopecia which involves a receding frontal hairline and sometimes a loss of body hair, including eyebrow hair, armpit hair, public hair and limb hair. Unlike female pattern hair loss and telogen effluvium, frontal fibrosing alopecia has been found to almost exclusively affect post-menopausal women, and causes inflammation around the hair follicle, which causes the stem cell to die and leaves a permanent scar, resulting in permanent hair loss [1].

How to identify menopausal hair loss

Identifying menopause hair loss is ultimately about keeping an eye on your hair health and, in particular, noticing where your hair might be thinning, receding or changing in texture. In particular, if you find your hair part is widening, your hairline receding at the front or on top, or if you have dry or brittle hair, or if you experience any pain or burning on your scalp, it is time to speak to your doctor.

How to manage hair loss during menopause

Luckily, there are many ways not just to manage hair loss in menopause, but to promote hair growth and reverse the process. These range from simple lifestyle changes you can make to hair loss treatments specifically designed to stop hair shedding and stimulate hair growth where it's possible.

Nutrition, scalp care, and lifestyle changes

Like every other part of your body, your hair needs certain nutrients, care and support in order to be healthy, and understanding that can be the difference between minor and significant hair loss.

In particular, a balanced and healthy diet is one of the key ways to support your hair health. Many studies have found that B vitamins are especially vital in stimulating hair follicles and improving overall hair health. Foods rich in B vitamins include rice, fish such as trout and tuna, black beans, oats, yoghurt, milk, beef, almonds, cheese and eggs [2], so ensuring you get lots of that, or take a multivitamin rich in B vitamins, can be a great way to promote hair growth.

Taking care of your hair and scalp by keeping them clean has also been found to play a key role in overall hair health and hair growth. What this looks like can be different for everyone, especially factoring in hair type, race and ethnicity, living and working environment, medical conditions, and socioeconomic situation, but using gentle products free from parabens, sulfates and phthalates, all of which can irritate the scalp, is a good place to start.  

Otherwise, being gentle with your hair and avoiding brushes and fine-tooth combs, protecting your hair from heat by limiting hot styling tools such as hair dryers and curling irons, and wearing soft hair ties and hats that don’t pull or rub can help to reduce the risk of hair loss and keep your hair smooth and healthy [4].

Treatment options that may help with hair loss in women

If you’re eating well and looking after your hair and still experiencing significant hair shedding, you may need the support of a medical hair loss treatment. While the results can vary depending on your health and overall genetics, many of these have been shown to slow down hair loss, help to regrow hair and support many women to look and feel their best. Some of these treatment options include:

• Minoxidil. This non-prescription medication can be applied as a topical treatment to the scalp or taken orally, and has been proven to stimulate hair growth.
• Laser treatment. Relatively new to the hair loss treatment scene, these laser therapies create microchannels in the scalp designed to improve the absorption of a synthetic growth serum, which is applied afterwards, stimulating hair follicles for hair regrowth.
• Surgical treatments. Hair transplants have been popular since their invention in the 1950s, and are proven to have success in relocating healthy hair follicles to other parts of the scalp. That said, these surgeries have generally been found to be more effective in treating smaller areas of balding rather than overall hair loss.
• Platelet-rich plasma. Using injections or microneedling, this therapy introduces platelet-rich plasma into the scalp, utilising its growth properties to stimulate hair growth [2].

You may also have heard of hormone replacement therapy as a potential option, but while this form of therapy is often prescribed for successfully managing menopausal symptoms, studies have yet to find that it supports hair regrowth or stops hair loss specifically [5].

Other factors that can contribute to hair loss

While menopause can play a role in hair loss, it’s not the only factor in menopausal women losing their hair. In fact, studies have shown that nutrition, activity level, stress, smoking status, socioeconomic situation, weight, cultural beliefs, race, environment, and health can all impact hair health and lead to hair loss [5].

Does menopausal hair loss grow back?

Whether or not you can get back the hair you've lost and restore hair growth ultimately depends on what type of menopause hair loss you have and the impact it’s had on your hair follicles. The best way to know is to speak to a dermatologist specialising in hair loss to identify what type you’re experiencing, and work with them on a treatment plan specific to your body.

What to expect and when to seek help

Over 50% of women experience some degree of menopause hair loss, so you should expect to see some degree of hair thinning or changes to your hair texture in this chapter of your life. If you feel you are shedding more than you’re comfortable with, seeing your hairline recede, or experiencing any scalp pain, you should speak to your GP or dermatologist.

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