Medically reviewed by Katelyn Hagerty, FNP
Written by Our Editorial Team
Last updated 6/3/2021
The beginning of menopause is a chaotic time for many women. The psychological implications of entering a new life stage would be enough to overwhelm most people, and coupled with the physiological symptoms? Well, it can be downright unbearable.
Most of us are familiar with menopause though the media’s often questionable portrayal of hot flashes and equally hot tempers, but the symptoms go far beyond the occasional sweat outbreaks.
Google perimenopause symptoms and you’ll see a wide array of things allegedly linked to the onset of menopause, including mentions of hair loss.
They’ve got to be kidding, right? It’s not enough to deal with everything else, but now we’ve got to worry about our hair?
There’s good news and bad news. The good news is that perimenopause doesn’t mean you’re going to start shedding your gorgeous locks.
But there are some increased risks of hair loss correlated with the onset of menopause.
Before we get into that, let’s take a quick look at what perimenopause is, and what you need to know about it.
Perimenopause is the transition point where menopause begins. It’s the point at which women will begin to notice hormonal changes.
The specific period isn’t well defined, as women can encounter it at different ages. For the average woman, that number is 47, with the stages lasting into a woman’s 50s.
But those numbers vary substantially, and there’s a bit of bad news for women who think they may be getting out of the way early: early onset of perimenopause can actually signal more serious symptoms to come.
Speaking of symptoms, let’s address some of the most common ones.
Most people are familiar with a few well-known symptoms of menopause, but there are a substantial number of less talked about (and more ambiguous) effects of the end of a woman’s reproductive years.
Changes and symptoms of perimenopause include hot flashes, which will typically last between one and two years, but can potentially last for the rest of a woman’s life.
Other symptoms of perimenopause include poor sleep, which is sometimes a result both of perimenopause and the aging process more generally.
The perimenopause period is also a time with increased likelihood of mental disorders like depression and anxiety — and can increase in severity as the transition continues.
And then there are the sexual symptoms: vaginal dryness and dyspareunia occur in roughly one third of the population. These conditions, however, don’t often go away without treatment.
And then there’s the hair loss question.
This is probably a good time to explain the basics of androgenic alopecia, also commonly referred to as male pattern baldness or female pattern hair loss.
Androgenic alopecia is caused by hormonal fluctuations. Men can also experience androgenic alopecia as early as their twenties — and while women can as well, it’s much more common after menopause.
There are key differences between how men and women experience it. Typically, women will see thinning across the whole of their head, rather than in certain locations like men. That means no receding hairline or bald spot on the crown.
And then there’s the hair question.
Perimenopause is not, in specific terms, a condition that can cause hair loss. It’s not a stated symptom of the condition.
But, that being said, there’s some bad news.
Hormonal changes have been shown in some cases to exacerbate conditions like female pattern alopecia, also known as androgenic alopecia.
The condition can worsen during perimenopause, especially if its effects were already showing before the onset of perimenopause.
The hormones that typically cause female pattern hair loss are called androgens, but interestingly enough, not all women show an increase in circulating androgen levels.
This suggests that a more complicated mechanism may be involved.
What we do know is that perimenopause can cause a decrease in the duration of the anagen phase of hair growth — one of hair’s three life cycle phases.
Typically 90 percent of your hair should be in the anagen phase at one time, but when this number is reduced, so is your hair count.
Because estrogen is thought to influence hair growth, it’s believed that the reduction in ovarian estrogen levels may be the cause of androgenic alopecia in women.
Treatment for perimenopause is varied, and because each woman’s unique list of symptoms can vary in intensity and frequency, it’s difficult to make one single treatment list.
The most important principle in treating symptoms is to provide maximal relief, which means understanding what is typical, and what is atypical, or more severe.
Hormone therapy is often employed. Unlike birth control, menopausal hormone therapy is considered low dose.
For instance, a woman being treated for menopause will use about a quarter of the equivalent estrogen of an oral contraceptive.
SSRIs may be prescribed for mood-related symptoms including depression. SSRIs may also positively impact the symptoms of hot flashes.
But studies have shown that botanical and nonpharmacologic remedies aren't very effective — omega-3 fatty acids and yoga included.
Androgenic alopecia is difficult to treat, and realistically, the damage can’t always be reversed if it has gone too far.
That’s why it’s best to consult a healthcare professional the moment you see signs of hair loss.
Let’s start with some lifestyle changes, like reducing processed foods and increasing vitamin intake.
Some key vitamins — particularly vitamin A, vitamin D and biotin (like the stuff found in our Biotin Gummy Multivitamins) — can help reduce hair loss.
Medications are trickier for women than men. Oral medications like finasteride reduce the effects of a hormone called DHT, and studies show finasteride is effective in men.
But for women, the efficacy of finasteride is unclear — and there are serious risks for pregnant women, like causing a fetus to develop ambiguous genitalia.
Women who aren’t pregnant may experience sexual dysfunction, and some cancer risks.
Instead of finasteride, women should consider antiandrogens like spironolactone or cyproterone acetate.
On the topical front, minoxidil might be an effective treatment for you. Minoxidil increases blood flow to hair follicles, which has been shown to increase hair (albeit in male test subjects) by 18 percent.
We should also point out that proper hair care makes all the difference. Some shampoos can include ingredients that might help fight DHT, like saw palmetto.
Alternative options are available. Wigs, hair extensions, transplants and other solutions may be the right option for you, depending on your unique circumstances, and how effective other treatments are or aren’t.
That last point we made about effective treatments? Well, it leads us to our most important piece of advice, which is to consult a healthcare professional first.
Healthcare professionals have the proper training to recognize what is and isn’t normal in your symptoms.
We suspect you’ll have already talked to someone as perimenopause symptoms begin to set in, and this person will be a great asset in helping you diagnose and address any hair loss issues that might come along for the unpleasant ride.
Point being: don’t delay treatment, because delays might only lead to more irreparable damage. In many cases, once hair has been gone for a while, it is less likely to ever come back.
If you’re seeking more answers, or just want to read on, check out our Guide to Hair Loss for more treatments.