What Causes Hair Loss During Menopause?

Menopause is a natural phase in a woman’s life that marks the end of her reproductive years. This phase typically occurs between the ages of 45 and 55.

While menopause brings several physiological changes, one of the most distressing for many women is hair loss. This article explores the causes of hair loss during menopause, delving into the hormonal changes, potential health issues, and practical solutions to manage and treat this condition.

What is Menopause?

Menopause is the permanent cessation of a woman’s periods (also known as menses) and when reproductive function is lost due to complete depletion of the ovarian follicle (egg) supply. Perimenopause is the transition state that precedes menopause, which is characterised by wide hormonal fluctuations and irregular menstrual patterns with women having at least 1 menstrual cycle every 3 months¹. Menopause can also happen due to medical reasons such as surgery that involves removing the ovaries (oophorectomy) or the uterus (hysterectomy), cancer treatments like chemotherapy, or a genetic reason².

Common Symptoms of Menopause

Hot Flashes: These are sudden feelings of warmth, typically lasting several minutes, starting with a flushing sensation that spreads across the upper body. This symptom is caused by a rapid rise in body temperature, and these episodes can persist for an average of 4 to 5 years.
Bone Mineral Loss: Due to reduced oestrogen levels, menopause can lead to detectable bone mineral loss, increasing the risk of osteoporosis and fractures.
Vaginal Dryness: Due to reduced oestrogen levels, the vaginal tissues can become drier and thinner, leading to discomfort and irritation.
Urinary Symptoms: Menopause may cause urinary incontinence and increase susceptibility to urinary tract infections.
Mood Changes: Many women experience significant mood changes during menopause, including increased episodes of depression and anxiety.
Decreased Libido: A reduction in sexual desire is also a common symptom, often linked to hormonal changes and vaginal dryness².

Managing Menopause Symptoms

Menopause is a natural phase in a woman’s life, not a sickness that requires treatment, but rather a transition that can be managed to alleviate uncomfortable symptoms. Each treatment plan should be personalised, considering individual health needs and symptom severity.

Hormone replacement therapy: Often prescribed to alleviate common menopausal symptoms such as hot flashes, night sweats, and vaginal dryness by supplementing the body with oestrogen and progesterone. However, HRT is not suitable for everyone, and it’s essential to discuss the benefits and risks with a professional healthcare provider.
Lifestyle modifications: Maintaining a balanced diet rich in calcium and vitamin D, regular physical activity to improve mood and bone health, and stress management techniques like yoga or meditation to help cope with emotional symptoms.
Medications: Selective serotonin reuptake inhibitors (SSRIs) or gabapentin can be used to manage hot flashes and mood swings in women who cannot take HRT³.

The Role of Hormones in Menopausal Hair Loss

Hormonal changes are the primary drivers of hair loss during menopause. As women age, the production of oestrogen and progesterone—hormones that support hair growth—declines. These hormones help keep hair in its growth phase (anagen phase) for longer periods, promoting healthy and thick hair. However, with the onset of menopause, the reduction in oestrogen and progesterone leads to shorter hair growth cycles, making hair thinner and more prone to shedding .

At the same time, levels of androgens, such as testosterone, may remain relatively stable or even increase in relation to the declining oestrogen. Androgens can cause hair follicles to shrink, leading to thinner hair strands and eventually, hair loss. This condition is known as androgenic alopecia, or female pattern hair loss, and it often manifests as diffuse hair thinning and loss. This is a different distribution when compared to hair loss across the crown and temples in men⁴.

Other Contributing Factors to Hair Loss During Menopause

While hormonal changes play a significant role, other factors can contribute to hair loss during menopause:

Stress: The physical and emotional stress associated with menopause, including symptoms like hot flashes, sleep disturbances, and mood swings, can trigger a condition known as telogen effluvium. This condition causes a significant number of hair follicles to enter the resting phase simultaneously, leading to diffuse hair shedding across the scalp.
Nutritional Deficiencies: During menopause, the body’s ability to absorb and utilise nutrients efficiently can decline. Deficiencies in essential vitamins and minerals, such as iron, vitamin D, and biotin, can weaken hair and exacerbate hair loss. Ensuring a balanced diet rich in these nutrients is vital for maintaining hair health⁵.
Thyroid Imbalances: Thyroid disorders, which are more common during menopause, can also lead to hair loss. Hypothyroidism (underactive thyroid) can slow down metabolism and disrupt the hair growth cycle, leading to thinning hair .
Medical Conditions and Medications: Certain medical conditions, such as autoimmune diseases or scalp infections, and the medications used to treat them, can also contribute to hair loss during menopause. It’s important to consult with a healthcare provider to determine if any underlying health issues are affecting your hair.

Identifying Menopausal Hair Loss

Menopausal hair loss typically presents as diffuse thinning across the scalp, particularly at the crown and part line. Unlike male pattern baldness, women are less likely to experience complete baldness but may notice a gradual reduction in hair density. Hair loss stages in women are classified by the Ludwig scale. It’s crucial to differentiate menopausal hair loss from other types of hair loss, such as those caused by medical conditions or nutritional deficiencies, as the treatment approach may differ⁴.

Managing Hair Loss During Menopause

While hair loss during menopause can be challenging, there are several strategies that can help manage and mitigate its effects⁴:

Hormone Replacement Therapy (HRT): HRT can help stabilise hormone levels by supplementing oestrogen and progesterone, potentially slowing down hair loss. However, HRT is not suitable for everyone and should be discussed with a healthcare provider to weigh the benefits and risks.
Topical Treatments: Minoxidil (Rogaine) is a widely used topical treatment that, when used regularly, can stimulate hair growth and slow down hair loss. It works by increasing blood flow to the hair follicles, prolonging the growth phase of the hair cycle⁶.
Nutritional Support: A diet rich in vitamins and minerals that support hair health, such as iron, vitamin D, zinc, and biotin, is essential. In some cases, supplements may be necessary to address deficiencies.
Stress Management: Techniques such as yoga, meditation, and regular physical activity can help manage stress levels, which in turn can reduce the impact of stress-induced hair loss.
Hair Care Practices: Gentle hair care practices, such as avoiding harsh chemical treatments and limiting the use of heat styling tools, can help minimise hair breakage and protect thinning hair. Traction alopecia is a type of hair loss that occurs as a result of a continuous pulling force on the roots of the hair. This pulling force usually comes from wearing your hair in tight braids, bun, or ponytails.
Consider Hair Transplantation: For women experiencing significant hair loss, hair transplantation can be an effective solution. This procedure involves transplanting healthy hair follicles from other parts of the scalp to thinning areas, providing long-lasting and natural-looking results⁷. At The Treatment Rooms London, our experienced surgeons specialise in hair restoration procedures. We offer personalised consultations to assess your specific needs and recommend the most suitable treatment plan.

When to Seek Professional Help

If you notice significant hair thinning or shedding during menopause, it’s important to consult with a healthcare provider or a dermatologist who specialises in hair loss. They can conduct a thorough evaluation to determine the underlying cause and recommend appropriate treatment options. Early intervention can help slow down hair loss and improve hair regrowth outcomes.

Conclusion

Hair loss during menopause is a common and often distressing experience for many women. Understanding the hormonal changes and other factors that contribute to this condition is crucial for finding effective treatment options. By addressing hormonal imbalances, managing stress, and adopting healthy hair care practices, women can take proactive steps to maintain their hair health during this transitional phase. For those seeking more advanced treatments, options such as hormone replacement therapy, topical treatments, and hair transplantation offer promising solutions to manage and even reverse hair loss.

References

Santoro, N., Roeca, C., Peters, B. A., Neal-Perry, G. (2021) ‘The Menopause Transition: Signs, Symptoms, and Management Options’, The Journal of Clinical Endocrinology & Metabolism, 106(1), pp. 1–15. Available at: https://doi.org/10.1210/clinem/dgaa764
NHS. Menopause Overview. Available from: https://www.nhs.uk/conditions/menopause/
Zouboulis, C. C., Blume-Peytavi, U., Kosmadaki, M., Roó, E., Vexiau-Robert, D., Kerob, D., & Goldstein, S. R. (2022) ‘Skin, hair and beyond: the impact of menopause’ Climacteric, 25(5), pp. 434–442. Available at: https://doi.org/10.1080/13697137.2022.2050206
Rinaldi F, Trink A, Mondadori G, Giuliani G, Pinto D. (2023) ‘The Menopausal Transition: Is the Hair Follicle Going through Menopause?’ Biomedicines, 11(11), pp. 3041. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10669803/
Rajput, R. (2022) ‘Influence of nutrition, food supplements and lifestyle in hair disorders’, Indian Dermatology Online Journal, 13(6), 721. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9650738/
Suchonwanit, P., Thammarucha, S., and Leerunyakul, K. (2019) ‘Minoxidil and its use in hair disorders: a review’, Drug design, development and therapy, 13, pp.2777–2786. Available at: https://doi.org/10.2147/DDDT.S214907
International Society of Hair Restoration Surgery. “Hair Transplantation for Women.” Available from: https://ishrs.org/hair-transplantation-for-women/