In the years preceding menopause, a female's hormones go through fluctuations that can affect everything from her mood to her skin. According to the Mayo Clinic, these changes can occur in your 30s, but for most, they begin to happen around their 40s and early 50s. Whenever they do start, it's important to remember that the menopausal transition is totally natural and not to be feared. Those with female bodies do, however, require support to navigate this time and figure out what's happening internally (and externally). One concern for those who experience menopause is hair loss, which is associated with a decline of certain hormones.
Ahead, a gynecologist, naturopath, and dermatologist explain menopausal hair loss and offer recommendations on how to manage it.
Meet the Expert
- Kate Denniston, ND, is a licensed naturopathic doctor, trained in both conventional and alternative medicine. She specializes in helping women optimize their hormonal health and practices at Los Angeles Integrated Health.
- Lavanya Krishnan, MD, FAAD is a board-certified dermatologist specializing in medical and cosmetic dermatology and is the founder of Arya Derm in San Francisco.
- Nicole Williams, MD, FACOG, FACS is a board-certified gynecologist and founder of The Gynecology Institute of Chicago. She specializes in fibroids, minimally invasive hysterectomy, pelvic/sexual pain, heavy bleeding, menopause, and urinary incontinence.
Is Menopause Associated with Hair Loss?
Menopause is when a female's period has stopped for at least one full year. However, in the several years before the onset of menopause, also known as the perimenopausal transition, a female's hormone levels begin to slowly decrease. "Many [females] will start to experience some mild hot flashes or night sweats at her period, when hormones are at their lowest," says Williams. "Literally, the ovaries just begin to peter out and no longer produce estrogen."
As the ovarian hormones, estrogen and progesterone, start to fluctuate during perimenopause, some women can experience hair loss. "While we do not know the exact mechanism of action of the hair loss, we do know that [females] in menopause experience a progressive reduction in the density of terminal (thicker) hairs," says Williams. "We believe this is probably hormonal, because during pregnancy when hormones are elevated, many women experience an increase in hair growth which diminishes after birth."
Denniston explains menopausal hair loss as something that happens due to an imbalance of hormones. "Prior to menopause," she says, "estrogen and progesterone balance out androgens, like testosterone and the more potent androgen, dihydrotestosterone." She says estrogen and progesterone are "nourishing to the hair follicle." During perimenopause, when estrogen and progesterone decline more rapidly than testosterone, "higher levels of testosterone are left unopposed." As a result, hair loss can occur. She adds, "Hair loss is typically worse if there is increased 5-alpha-reductase activity, which is an enzyme that converts testosterone to the more potent dihydrotestosterone, also known as super testosterone." Denniston says some women have a stronger "biochemical preference for this enzymatic activity."
What to Expect
Because this process is measured over time, don't expect your hair to suddenly fall out in clumps. Instead, Krishnan says, "This type of hormonal pattern hair loss typically manifests itself as hair thinning along the part-line and thinning in the frontal region of the scalp." She goes on to say that hormonal hair thinning has a very "distinctive pattern."
How to Manage Menopausal Hair Loss with Diet, Supplements, and Lifestyle
There are several effective supplements on the market to address menopausal hair thinning and loss. Respectively, diet plays an important role in managing hormones, and should be seriously considered as women enter menopause. In particular, Denniston advocates an anti-inflammation and low-glycemic diet. "Keeping inflammation and insulin regulated is important," as underlying inflammation and insulin resistance can affect the 5-alpha-reductase pathway, she says.
Denniston also suggests a high-fiber diet to "keep blood sugar stable and to keep insulin resistance and testosterone in check." She also suggests incorporating ground raw flaxseed into your diet. "It has lignans that help modulate estrogen activity and omega-3 fatty acids to reduce inflammation."
Maca is another supplement to consider, Denniston says, to "support the hypothalamic-pituitary-ovarian axis, which can make a big difference for a woman’s symptoms during menopause." She adds, "The plant sterols in maca have a balancing effect on the endocrine system. Maca has been used for hundreds of years in Peru to help ease menopausal symptoms."
A couple other herbs that may be helpful include adaptogenic herbs like ashwagandha and holy basil. Denniston says they can "help regulate the hypothalamic-pituitary-adrenal axis and increase stress resilience." She also likes reishi mushroom and saw palmetto. These help "block the 5-alpha-reductase enzyme and the production of super testosterone, dihydrotestosterone."
Then, there's also the commercial route. "One of my favorite oral supplements is Nutrafol," says Krishnan. "I commonly recommend combining the men’s and women’s version of Nutrafol to offer an ideal combination of biotin, saw palmetto, turmeric, collagen, ashwaghanda, and a few other ingredients."
Finally, Krishnan recommends menopausal women invest in an ionic hair dryer and steer away from regular hot styling tools. "Ionic (rather than ceramic) hair dryers are recommended as they use less heat to thoroughly dry the hair," she says. "They also do not cause as much damage to the actual hair shafts, which leaves the hair shinier and more smooth for longer." Williams adds that chemical hair treatments should be avoided as should "over-processing the hair." She also recommends women nix any "extreme styling" that might pull the hair from its follicles.
How to Manage Menopausal Hair Loss with Medical Treatments
Krishnan says there are a couple of prescription medications that can be useful in managing menopausal hair loss. She recommends topical minoxidil (aka Rogaine), topical spironolactone, and topical steroids (when appropriate). "Certain in-office treatments such as PRP (platelet rich plasma) injections or Keralase therapy following laser or microneedling to the scalp can also be helpful."
Hormone therapy might be an option to consider under close medical supervision. "Estrogen supplementation can be useful for this type of hair loss but requires close monitoring by a medical professional and should only be used when not medically contraindicated," says Krishnan. "Additionally, there are prescription oral medications such as Finasteride that slow down the production of androgens such as dihydrotestosterone. These medications can be prescribed for post-menopausal women."
Williams adds that she prefers to manage all her patients on an individual basis, considering their overall health goals and desires. She imparts that "menopause is completely natural and not to be feared, and no treatment is needed." If however, a woman is experiencing symptoms that affect her life, Williams does recommend "the short-term use of some type of hormone replacement therapy (HRT)."