Menopause and hair loss: Yes it happens, this is what can help

It’s no secret that hair changes as you age. Please see: Spotting that first glint of silver strands in the mirror after decades of being fully brunette. But did you know that hair change can also be brought on by the menopause transition? Around half of women experience menopause-related hair changes due to hormones and other factors. And it may sound superficial, but appearance changes can be upsetting — especially if you don’t know what to do about it. 

Knowing what to expect with your hair during menopause can help you feel more empowered and confident. Here’s why menopause can cause hair loss, how it happens, treatment and styling options, and more on what to expect with menopause hair loss.

During menopause, hormonal fluctuations can cause changes in the hair follicle. This can lead to:

• Hair thinning

• Loss of volume

• Changes in texture

These effects are associated with the decrease in estrogen levels that comes with menopause. The exact cause behind the changes is complex, but it may be linked to genetic predispositions, sensitivity to male hormones (called androgens), and changes in the hair growth cycle.

Not all women experience hair loss or changes during menopause — only about half do. And for the 50% that do, the extent of the changes can vary drastically from person to person. Some people may find they encounter hair loss, and others may experience thinning hair in menopause or a widening of their part.

The hair growth cycle and menopause

Hair growth takes place in three stages: anagen (growth), catagen (involution), and telogen (rest). Anagen is the phase where hair growth is active, so hair shafts are generated, and the follicle reaches its maximum length and volume. Hormones can significantly impact this phase, and the hair follicle is estrogen sensitive, so during the menopause transition, when hormone levels fluctuate, you can see menopause hair changes. 

Estrogen decreases and androgen levels increase (including testosterone), which both can have a direct impact on your follicles. These fluctuations can result in changes to the hair shaft and cycle, including decreased density and thickness and difference in texture. For instance, while androgens help to control the hair cycle, overstimulation of the hair follicles by androgens during menopause can lead to shorter growth periods, as well as shorter and thinner strands. New hair growth is also delayed, and the combined effect can result in thinning hair or hair loss in menopause.

Estrogen deficiency during menopause can also contribute to hair loss, as estrogen is thought to promote hair growth. A decrease in estrogen may affect the metabolic and vascular functioning of your hair follicles, leading to menopausal hair loss.

If you notice a change in your hair density, it's important not to simply self-diagnose. Speak to your clinician about possible causes, especially if you notice any sudden hair loss or patchy and scarring patterns.

The short answer is yes, but it isn’t fully to blame. In the U.S., the average age of reaching menopause, or going 12 months without a period, is 52 years old. And hormonal changes can start in your 40s during perimenopause. But various other factors can overlap at this life stage, which may contribute to ‘menopause’ hair changes.

Factors beyond hormones to keep on the radar

A decline in estrogen levels associated with menopause is not always the cause of hair loss. Other factors can come into play that can affect your hair health. For example:

• Age: The hair follicles on your scalp can naturally shrink as you age. 

• Diet: Nutritional deficiencies could have an impact on your hair health. Specific vitamins that contribute to healthy hair include vitamin A, B₂ B_3, B_7, B_9, B_12, C, D, E, and iron.

• Physical factors: Telogen effluvium is a form of hair loss that can affect people after metabolic stress (which can be brought on by rapid weight loss), hormonal changes beyond what you experience in menopause, or medication. 

• Genetic factors or family history: Hereditary-patterned baldness is the most common cause of hair loss. In women, it’s most noticeable after menopause.

• Certain medications: Some medications, including selective serotonin reuptake inhibitors (SSRIs), may cause hair loss as a side effect. This is referred to as drug-induced alopecia. 

• Illnesses and conditions: Various illnesses and conditions may contribute to hair changes — for example, thyroid hormones regulate multiple cellular activities, including different phases of the hair growth cycle. A decrease in thyroid hormones due to a thyroid condition can cause hair loss.

If you’re noticing a change in your hair texture or seeing way more hair go down the drain when you shower, you may be wondering if the menopause transition is to blame. And it can be hard to know the answer to that question. Hair changes to color and texture are common with aging. And metabolic changes brought on by weight gain and muscle loss can also have an impact on the quality of your hair. 

A clinician will be able to help you figure out what’s going on. To help them determine the cause of your hair changes, keep a simple symptom log and take photos to track any changes.

What to expect at an appointment 

If hair loss during menopause is causing you distress and impacting your quality of life, it’s important to seek guidance from a medical professional. You should also reach out if you notice any unusual hair loss, or any of the following:

• Very rapid change in hair

• Scalp inflammation or bleeding

• New hair growth on your face alongside scalp thinning

At your menopause appointment, your clinician will reviewyour medical history and any current medications you take. They’ll complete an examination and discuss your treatment options for hair loss during menopause. If they suggest any treatments, make sure to ask about the risks and benefits — as well as a realistic timeline of when you may expect an improvement.

Medication is the most common form of treatment for hair loss in women, but there are other non-medication options available, from addressing vitamin deficiencies to low-level laser treatments.

First‑line treatment

Topical minoxidil is a common treatment to help with menopause hair changes—and there are various generic products available both by prescription and over-the-counter. Minoxidil, taken orally or applied topically, may stimulate hair growth. One study highlighted that after 24 weeks of treatment, total hair density increased by 12% in women taking the medication orally, and 7.2% in women applying it topically. Only topical minoxidil is FDA-approved for the treatment of female-pattern hair loss.

It’s important to remember that minoxidil is not a miracle overnight treatment, and it doesn’t work for everyone. It also cannot restore the full density of lost hair. While the medication is safe, it can have side effects. These include alcohol-related skin irritation and hypertrichosis (extreme hair growth in other places), especially when taken orally as opposed to topically. Speak to your clinician if you want to try minoxidil and seek their advice on how to apply it.

Anti‑androgen medications

In some cases, your clinician may discuss prescription medications that reduce the androgen’s effects on hair follicles. Anti-androgens, like spironolactone, might be recommended if you don’t respond to minoxidil, but it’s important to speak to your clinician about the benefits and risks of taking any medications. They also come with potential side effects, including fatigue, dizziness, loss of appetite, thirst, weight gain, and loss of libido.

Other treatments

Low iron may be causing your hair loss, so if you have a deficiency your clinician may recommend a supplement. 

There are also procedures that may help, like laser therapy or platelet-rich plasma (PRP) injections. Laser therapy involves using low-level lasers to stimulate hair follicles, which may promote hair growth. With PRP, platelet-rich plasma cells are injected into your scalp to help with regeneration and growth. 

The role of menopausal hormone therapy for hair

Hormone replacement therapy (HRT) is a menopause treatment used to help provide relief from vasomotor and other menopause symptoms, like hot flashes and vaginal dryness. While one study has found that Hormone Replacement Therapy (HRT) may improve the appearance of the front hairline, research is limited and it’s not prescribed to treat hair loss.

In addition to medications and treatments, there are also some changes you can make to your hair care routine that could help with hair thinning during menopause. For example, lightweight volumizing shampoos could help with the appearance of hair thickness and sulphate-free shampoos are gentler and less drying, which may also benefit your hair.

Generally, try to keep your hair as healthy as possible. This could include deep conditioning to aid its general texture and avoiding heat and chemicals as well as protect your scalp from the sun by wearing a hat.

How to prevent hair loss in menopause: day‑to‑day habits

Following a consistent, gentle routine can help with menopause hair changes. This extends to how you style it. Try to avoid heat as much as you can and take care when wearing your hair up. Slicked-back, tight styles can pull on your hairline and may contribute to thinning.

Opting for volumizing haircuts and testing out different parting styles may also help you feel more confident when facing hair loss or thinning in menopause. You could also experiment with camouflage powders if there’s a spot you’re especially self-conscious about.

Eating a balanced diet, staying hydrated and minimizing stress can help with your hair health, too. A well-balanced diet can provide vital nutrients and directly contribute to hair growth and maintenance. You may also want to consider supplements like biotin, zinc, iron and Vitamin D — as some deficiencies can lead to hair loss. Talk with your clinician before starting any supplement.

During perimenopause, your hormone levels fluctuate widely. As estrogen production decreases, you may find your hair fibers are thinner and less dense — contributing to perimenopausal hair loss.

After menopause, estrogen levels are incredibly low. This end of ovarian estrogen production can cause alterations in hair growth, which is why many people can experience hair loss after menopause.

The imbalance of estrogen and androgen production may also lead to growth of hair on your face.

Setting realistic expectations about regrowth

When dealing with hair regrowth after menopause, your goal may be to slow down the loss or improve coverage, rather than full regrowth. Along your journey, you may find that cosmetic strategies and styling techniques can help boost your confidence with menopause and hair loss. And remember that results from any treatment typically take time, so try to be patient. Speak to your clinician if you have any concerns.

It may be hard to know where to start when speaking to your clinician about your menopause symptoms and hair loss. Try to define your top concerns and tell them if you’re currently taking any medication. Arriving at your appointment with a symptom log or photo journal can also help you advocate for yourself and provide more context. 

It may be helpful to monitor things like:

• The amount your hair is shedding

• Hair density at your crown and part

• Any scalp discomfort

• Your personal satisfaction and overall confidence in your appearance

Discuss both cosmetic and medical treatment options, and ask to create a treatment plan together based on your medical history and personal preference. It could also be helpful to arrange a check-in appointment in three to six months to see how your treatments are working (adjust this timeline based on conversations with your healthcare provider).

Remember to revisit your clinician if any new symptoms appear, so you can establish a new care plan.

Hair changes around menopause are common — happen to over 50% of women. This is partly due to hormonal changes as well as age-related changes to hair follicles. While hormone replacement therapy is not FDA-approved to treat hair loss during menopause, there are other treatment options that can help minimize hair loss and even help regrow some lost hair. Talk with a clinician to create a plan that aligns with your goals and is appropriate based on your medical history.