Perimenopause Hair Loss

Perimenopause (the transitional phase leading up to menopause) is a natural part of aging in women. During this time, hormonal fluctuations can cause a range of changes including hot flashes,  mood changes, weight gain, and, for some women, thinning hair or increased shedding.

If you’ve noticed changes in your hair during perimenopause you may be wondering: Does perimenopause cause hair loss too? 

Yes, hair loss is another thing to count among the myriad changes that can happen during perimenopause. 

But what exactly is the connection between perimenopause and hair loss? And is there anything you can do to slow it down? Or, better yet, can you prevent it from happening in the first place?

Keep reading to learn all the basics (and more) on hair loss and perimenopause.

What Is Perimenopause Hair Loss?

Perimenopause is the transitional phase leading up to menopause. It’s characterized by a gradual reduction in ovarian function, which leads to shifts in reproductive hormone levels. 

Perimenopause typically starts between ages 45 and 55 and lasts an average of four years. You’ve officially entered menopause when you’ve gone 12 consecutive months without a period. 

During perimenopause, levels of estrogen and progesterone fluctuate, affecting various systems in the body — including the hair growth cycle.

Many women notice increased hair shedding or gradual thinning during this stage due to these changes in hormone levels. Since estrogen and progesterone levels remain low after menopause, hair loss may persist beyond perimenopause.

Is hair loss a sign of perimenopause? It can be. Let’s break down what to look out for.

Symptoms of Perimenopause Hair Loss

The symptoms of perimenopause hair loss are often consistent with those of androgenetic alopecia, or female pattern hair loss. This is the most common type of hair loss in women.

If you have female pattern hair loss, you might notice:

• Thinning hair at the crown of your head or around your temples

• A widening part

• Increased hair shedding

• Reduced hair volume

Women in perimenopause may also experience a condition known as telogen effluvium. Telogen effluvium is the occurrence of excessive hair shedding that happens in response to certain physical and psychological triggers, including hormonal changes.

People with telogen effluvium typically notice diffuse hair loss, which means hair loss happens evenly throughout the head, instead of being concentrated in specific areas.

Hormonal changes, along with genetic and environmental factors, contribute to perimenopausal hair loss. We’ll explore the causes of hair loss during perimenopause in more detail below.

Female Pattern Hair Loss

During perimenopause, estrogen levels begin to drop.

Estrogen plays a role in the hair growth cycle and may protect against hair loss. As estrogen levels drop in the run-up to menopause, more hair loss may occur. 

Estradiol (a form of estrogen) extends the anagen phase of the hair cycle, which is the phase during which hair actively grows. As estrogen levels decline, androgens — male sex hormones — begin to have a greater impact on the health of your hair follicles. 

The activity of androgens shortens the anagen phase of the hair growth cycle and causes hair follicles to shrink. Over time, this leads to thinner and shorter hair than usual.

Genetics are another factor thought to play a role in female pattern hair loss. Many different genes may interact with environmental factors to contribute to hair loss.

Telogen Effluvium

Telogen effluvium can occur due to a variety of different triggers, including hormone fluctuations and stress.  

In telogen effluvium, a large number of hairs move from the anagen (growth) phase to the telogen (resting) phase of the hair growth cycle. When new hairs grow, they push out the hairs stuck in the resting stage. 

Telogen effluvium can cause up to 70 percent of hairs to enter the resting telogen phase at once. This can lead to a period of excessive shedding. Women with telogen effluvium can lose over 200 hairs each day.

Unlike female pattern hair loss, telogen effluvium is typically temporary. Hair typically grows back after six to nine months.

Both female pattern hair loss and telogen effluvium have distinct risk factors. It’s important to point out, however, that these risk factors aren’t exclusive to women in perimenopause. They can affect women of all ages.

Risk Factors for Female Pattern Hair Loss

Age is an unavoidable risk factor for hair loss. Experts estimate that 40 percent of women are impacted by female pattern hair loss by age 50. 

As mentioned earlier, genetics also play a role in hair loss. So, if a close female family member like your mother or sister had hair loss during perimenopause, you may be more likely to experience it yourself.

In fact, a 2020 study found that 69 out of 111 women (just over 62 percent) with female pattern hair loss reported a family history of the condition. The link with family history was stronger on the mother’s side.

Risk Factors for Telogen Effluvium

There are many factors that can trigger telogen effluvium. These include:

• Hormonal fluctuations 

• Psychological stress

• A severe illness, infection, or injury

• Major surgery

• Rapid weight loss 

• Low calorie intake or crash dieting

• Nutritional deficiencies, such as those in protein or iron

• Thyroid disease

• Use of certain medications

If you’re in the menopause transition and notice thinning hair, an increase in hair shedding, bald spots, or a receding hairline, make an appointment with a healthcare provider to discuss it.

Visiting your local dermatology practice is a great place to start. Dermatologists are doctors who specialize in diagnosing and treating conditions that impact the skin, hair, and nails.

Diagnosing Perimenopause Hair Loss

Generally speaking, a healthcare professional can diagnose perimenopause hair loss by getting your medical history and examining your scalp and hair.

A medley of things can contribute to hair loss, so come to your appointment prepared to answer questions related to:

• When your hair loss started

• Whether your hair loss was sudden or occurred gradually over time

• Whether you have a family history of hair loss

• Any underlying medical conditions associated with hair loss you may have, such as PCOS (polycystic ovary syndrome) or thyroid disease

• The medications and supplements you’re currently taking

• Stressful life situations you’ve recently experienced

• Your diet and lifestyle habits

A healthcare professional may do a variety of tests while examining your scalp. A few examples of these include:

• Pull test. During a pull test, a healthcare professional will gently pull on some of your hairs. If more than 10 percent of the pulled hairs come away from your scalp, it signals active hair shedding.

• Trichogram. In this test, a healthcare professional will pluck 60 to 80 hairs from two different areas of your scalp. They’ll then look at these hairs under a microscope to see which phase of the hair growth cycle they’re in. Finding many hairs in the telogen (resting) phase of the hair cycle can point toward telogen effluvium.

• Videodermoscopy. Videodermoscopy uses a special camera that allows a healthcare professional to evaluate hairs and hair follicles. Because female pattern hair loss causes hair follicles to become smaller, finding thinner hairs on a videodermoscopy is a sign of this type of hair loss.

Several treatment options for perimenopausal hair loss are available to slow hair loss or promote hair regrowth.

It’s important to point out here that telogen effluvium is typically self-limiting, meaning it goes away on its own without treatment, as long as the inciting cause has been resolved.

In contrast, female pattern hair loss progresses over time if it’s left untreated. That means that it needs to be managed to boost new hair growth and prevent additional hair loss.

Minoxidil for Perimenopause Hair Loss

There’s a good chance your healthcare provider will recommend medication to help with your hair loss. One you may have heard of is minoxidil (generic for Rogaine^®).

Topical minoxidil is FDA-approved for treating female pattern hair loss. Its exact mechanism of action isn’t clear, but it seems to extend the anagen phase of the hair cycle, increasing hair thickness and length.

Both 2% minoxidil solution (a liquid) and 5% minoxidil foam are available for purchase over the counter. Research has found that both formulations are equally effective at addressing hair loss.

Oral minoxidil may be available via prescription, though this form of the medication isn’t FDA-approved for hair loss. Researchers have found that oral doses ranging from 0.25 to 1.25 milligrams daily are effective for female pattern hair loss.

Spironolactone or Finasteride 

Two other medications that may be prescribed by a healthcare provider are spironolactone and finasteride.

Spironolactone is a diuretic with anti-androgen properties. It’s not FDA-approved for hair loss in women, but researchers have found that it can be effective for female pattern hair loss, particularly when combined with other hair loss treatments like minoxidil.

Finasteride works by the conversion of testosterone into DHT, the process that drives male pattern hair loss. While not FDA-approved for women, it effective for female pattern hair loss.

Since perimenopause is a natural part of aging, there’s no surefire way to prevent the hair loss associated with it. What’s more, other risk factors like genetics are out of your control as well.

When it comes to perimenopausal hair loss, particularly female pattern hair loss, timely intervention and treatment is key. Early treatment can go a long way in preventing further hair loss and regrowing hair. As such, it’s important to consult with a healthcare professional when you first notice signs of hair thinning or loss. 

That said, there are some things you can do in your daily life to help promote healthy hair as you approach menopause. Not only are the tips below beneficial for hair health, but some may also help with overall well-being.

Perimenopause Hair Loss Prevention Tips

Try out these tips to help maintain healthy hair as you enter perimenopause:

• Eat a balanced diet. Nutritional deficiencies — such as being low in iron or vitamin D — can lead to hair loss. Eat a balanced diet to ensure you’re getting enough of these essential nutrients. If you have a deficiency, your provider may recommend taking a supplement.

• Reduce stress. As mentioned earlier, stress can contribute to telogen effluvium. Explore activities to help lower your stress levels, like meditation or yoga. Sometimes, simply curling up with a good book or hanging out with a friend can help.

• Quit smoking. Smoking can make existing female pattern hair loss worse. If you smoke, work with your healthcare provider on a quit plan you can stick to.

• Change your ’do. High-tension hairstyles — such as tight ponytails, braids, and locs — can lead to a type of hair loss called traction alopecia. Styling your hair differently can help prevent this.

• Cut back on heat. Things like curling irons, hair straighteners, hot oil treatments, and even using a blow dryer on the high-heat setting can damage your hair.