Why Are You Losing Your Hair in Menopause?
When it comes to menopause, hot flashes are the hallmark symptom. But other symptoms can crop up, like irregular bleeding, trouble sleeping, mood changes, and memory problems. Among the lesser-discussed issues of menopause is hair loss, which many women also experience in midlife.
Normal Shedding vs. Hair Loss
On average, most women shed between 50 to 100 hairs each day as others grow in. This is considered a normal cycle.
So, what’s the difference between shedding and hair loss? If you’re losing more than 125 hairs a day—or if more hair is falling out than the hair that grows in to replace it—it’s considered to be hair loss, or alopecia. And over 50% of all women will experience some type of noticeable hair loss in their lifetimes.
There are three different types of nonscarring hair loss that can occur in women:
- Female-pattern hair loss, where the hair thins out, typically on the top portion of the head, known as the crown, and the sides of the forehead, called temple scalp.
- Telogen effluvium, or the gradual onset of hair shedding or falling out a few months after a specific trigger, such as stress, illness, medications, etc., usually occurring one to six months after the trigger.
- Anagen effluvium, or sudden, immediate hair loss that’s related to certain medications like chemotherapy, which stops the growth of hair follicles abruptly.
The most common type of hair loss experienced with menopause is female-pattern hair loss, explains Mache Seibel, M.D., a board-certified ob-gyn.
Why Do Women Lose Hair During Menopause?
“Hair naturally goes through three phases: It spends most of its time growing, but it also has the phase of resting, and then it has a phase of falling out,” Seibel says. “No matter who you are, your hair is always going through these phases.” He adds that “in menopause, these phases can sometimes get out of whack with each other,” where more hair spends time falling out than growing, triggering noticeable hair loss.
This is likely related to the imbalance of hormones in the body during menopause, notes Sara Kurian Lamb, M.D., a board-certified dermatologist at Johns Hopkins Medicine, in Baltimore. “The drop in levels of estrogen and progesterone during menopause increase the effects of androgens [male hormones], and this balance shift accelerates female-pattern hair loss,” she explains.
Other systemic factors can lead to stress-related hair loss in women, as well, making it appear that female-pattern alopecia is accelerating. For example, a psychological or physical stressor, such as a divorce or surgery, can trigger this kind of hair loss. It’s temporary and may resolve after a stressful time.
Common causes of hair loss in women may be thyroid abnormalities, low iron, low vitamin D, weight loss, surgeries, illnesses, hospitalizations, new medications, breakups or divorces, etc. It’s important to identify the triggers of telogen effluvium so that it can be corrected if possible.
Most dermatologists will do a standard blood test panel to check for systemic causes of hair loss at the first visit, including a complete blood count (CBC), a complete metabolic panel (CMP), a thyroid-stimulating hormone (TSH) level, a ferritin test, an iron panel, an antinuclear antibody test, and more.
“Then, there's another whole set of hair loss that can be from dermatologic issues,” Seibel says. “Autoimmune diseases, inflammatory diseases, … diabetes, and hypertension are also factors that can contribute to hair loss in some people.”
Thus, a dermatologist who’s a hair specialist may do a better job of asking the right questions and teasing out the condition(s) that may be affecting your hair loss. Treating the root cause of the hair loss is crucial to getting better results.
Signs of Menopause-Related Hair Loss
“A lot of women, when they hit menopause, will talk about how they’ve noticed that there's more hair on the sink; it’s clogging up the drain; it’s coming out on their brushes,” Seibel says.
That includes Lynette Sheppard, creator and moderator of the Menopause Goddess website and blog, who started to notice hair loss within the first year she entered perimenopause. “When I would comb it, it would just come out in droves,” she says.
Although the hairline typically doesn’t recede like it would in men, you may notice that the area where you part your hair is getting a bit wider, adds Seibel. You may even be able to see your scalp through your hair in some places.
“Typically, it's most prominent at the crown and temples, and the diameter of the hairs get smaller,” adds Lamb. So when you put your hair up, you may notice that your ponytail is not as thick as it used to be.
The Emotional Aspects of Hair Loss in Women
When women experience hair loss, it often takes a toll on their self-image and emotional well‑being.
“While many changes happen in our appearance with aging, hair loss, I would say, is the one that tends to bother women the most,” Lamb says.
Hair loss is a well-known concept for men. “They may not like it, but men know it’s normal,” Seibel says. “For women, who spend vast amounts of money on a good hairdresser and want to look attractive and feel good about themselves, it's a very big deal.”
Katie Taylor, the CEO and founder of the Latte Lounge, an online platform for midlife women, can attest to that. She first started to notice hair loss around her 50th birthday. “I felt very self-conscious,” she says.
Lynette had a similar reaction. “I used to tell my husband, ‘I'm going to have to buy wigs. I'm going to need to wear hats all the time. I'm going to go bald,’” she says. “I really was much more panicked about [the hair loss] than anything else. It’s quite horrifying.”
The good news? There are ways to treat and manage it, which can in turn help boost your self-esteem.
Treating Hair Loss in Women
Hair loss is usually a symptom of something else that’s going on in your body—whether it’s menopause, extreme stress, or an underlying condition. So, the best course of action is to determine what’s causing the hair loss in order to find the right treatment.
“Seeing a dermatologist to identify your specific cause and type of hair loss and coming up with a treatment approach based on that is key,” advises Lamb.
It can also be helpful to find a dermatologist who specializes in hair loss. “I went to a dermatologist, and he basically didn't know anything about menopause or perimenopause, so he just decided that I must have had some stress, and that it would all grow back and it'd be fine,” Lynette says.
Seibel advises seeing a dermatologist who might take a small biopsy of your scalp, if necessary, and send it to a specialist known as a dermatopathologist to help confirm or rule out various diagnoses.
Biopsies are usually done in the setting of scarring alopecia, a type of hair loss where there’s a scar in the place of where hair used to be. When there’s a scar, it’s nearly impossible for hair to grow through the tissue, and thus it tends to be a permanent type of hair loss.
The most common causes of scarring alopecia are discoid lupus erythematosus, lichen planopilaris, traction alopecia, or trauma/injury. Understanding the causes of scarring alopecia with a biopsy is helpful to guide better treatment for the patient.
Only one drug is currently approved by the FDA for hair loss specific to menopause—a topical treatment called minoxidil that’s applied to the scalp to stimulate hair growth. However, the FDA has approved laser products that can also be used to help female-pattern alopecia.
Your dermatologist may also recommend other treatments to help with hair loss depending on the underlying cause.
How to Manage Your Hair Loss
In the meantime, there are strategies you can adopt to help keep hair loss during menopause and perimenopause to a minimum and style it in ways that help boost your self-confidence. Start with these tips:
- Find a hairstylist who has experience with thinning hair. When Lynette’s hair loss first started bothering her, her stylist brushed it off and told her it would be fine. “So, I went to another hairdresser who actually had struggled with thin hair her whole life,” she says. The new stylist was able to make some recommendations that helped, like trying a layered haircut.
- Get highlights. “[My stylist also] put highlights in my hair to kind of swell the hair follicle so it looked thicker,” says Lynette.
- Limit exposure to chemicals. That includes things like bleach, relaxers, or perms, explains Lamb, as they can be damaging to your hair.
- Stick with loose styles. “Limit hairstyles that put a lot of tension on the hairs,” Lamb says. That includes tight braids, ponytails, and buns. “That can cause hair loss—it can pull it out at the root,” adds Seibel. This causes traction alopecia, a type of hair loss that leads to scarring at the roots, creating permanent damage where the hair may not grow back. If a hairdo hurts, it’s too tight.
- Ditch hot tools. Skip out on styling your hair with curling irons or straighteners, advises Seibel. “[Hot tools] are very harmful to the hair,” he says, explaining that they can cause hair breakage by making thin hair more fragile.
- Swap out hair products. “I started using a shampoo and cream rinse that were specifically formulated for thinning hair,” Lynette says.
- Cover it up. “I use color powders and sprays to cover up the areas that are showing more scalp,” Katie says. You can also experiment with accessories like hats.
- Try supplements. Although there isn’t much research to support the use of vitamins and supplements for hair loss, according to Seibel, some people take ferritin, biotin, vitamin B6, or vitamin D. “You need some vitamin A for hair growth to happen,” he adds, “but high doses can actually be detrimental to the hair.” Biotin supplements can affect certain blood tests, so if you’ve been taking them for your hair, tell your doctor before getting your blood drawn.
- Consider a whole new look. At one point, Katie was looking at hair extensions but decided against it because “the hair loss was predominantly at the front, which would’ve pulled the hair out and made it even worse.” Some even turn to wigs, adds Lamb.
- Focus on an overall healthy lifestyle. “I make sure my diet is optimized, my stress levels are as low as they can [be], and that I’m exercising and getting lots of fresh air,” Katie says. And if you smoke cigarettes, take steps to quit.
- Give it time. “It takes about three months before women will be able to see that something really happened that impacts them in a favorable way,” Seibel says. And rest assured—most menopause-related hair loss slows down over time. “It’s a rough ride for a while,” adds Lynette, “but it does actually stabilize.” If something doesn’t feel right, consult a medical professional so that they can make sure there’s not an underlying condition triggering hair loss in addition to female-pattern alopecia.
If you’re concerned about any hair loss you’re experiencing with menopause, talk to your doctor. “If you consider all the things that can happen in menopause, hair loss is extremely important, but it gets put on the shelf of things that don't get talked about,” Seibel says. “They may be able to actually help you … or direct you to someone who can.”
Seeking treatment early, before the hair loss progresses to scarring, is key, Lamb says. “Some hair loss and thinning is inevitable with aging, but with the right treatment plan, you can work to preserve your hair for as long as possible.”
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