Hair loss: is the menopause to blame?

How to tackle thinning hair and restore hair health

• Hair can be vital to your self-esteem and confidence
• Hair shedding can be gradual or sudden
• Not all midlife hair loss is hormone related – genetics and health play a part

By the time you get to the perimenopause, you’ve been bombarded with images of women shaking out their thick, lustrous hair. What we don’t see is strands coming out, yet it’s normal to lose between 50 and 100 hairs a day.

But if you’ve started to notice you’re losing more hair than usual, it can be hard to determine the cause – and the solution.

Who is affected by hair loss?

Hair follicles start to shrink from your mid-40s, so hair becomes thinner with age. The number of hair follicles also reduces. Hair loss may start during the perimenopause or occur many years after. In a poll of nearly 6,000 women for balance founder Dr Louise Newson’s book, the Definitive Guide to the Perimenopause and Menopause, 50% of respondents noticed their hair was thinning and 39% experienced hair loss.

You’ll probably notice your hair thinning or shedding before anyone else does. You’ll be used to knowing how much hair you usually lose when brushing or showering, and how it normally feels in your fingers. You might notice you’re gradually losing more hair than usual or that your hair line is moving backwards, or the parting widening, or you might notice your scalp more, especially when your hair is wet.

Can the menopause cause hair loss?

While hair thinning and shedding are a natural part of ageing, there can be numerous factors involved. One of these is menopause.

Consultant dermatologist Dr Sajjad Rajpar says: ‘Although we don’t know how oestrogen supports hair growth, there are oestrogen receptors in the hair follicles.’ When oestrogen levels drop, it can lead to shedding.

For women who experience hair loss in menopause, Dr Rajpar says roughly two thirds will have a general loss of hair over their scalp and most of those women will also experience thinning of hair on the body. ‘We don’t know why lack of oestrogen in this group causes shedding as replenishing oestrogen with HRT doesn’t always restore hair growth.’

The other third of women who experience hair loss in menopause will have it localised to the frontal area of their scalp and may have additional hair where they don’t want it, such as the upper lip or chin. Dr Rajpar says the absence of oestrogen is allowing testosterone levels to proceed and cause a pattern-type hair loss.

RELATED: Hair loss and hormones: Dr Sajjad Rajpar

What else can cause hair loss?

There are other potential causes of hair loss and more than one of them could be responsible. They can include:

Female pattern hair loss This is often hereditary – one in three women have the genes for female pattern hair loss. In many cases genetics, rather than the menopause, can be the cause.

Telogen effluvium This is a type of temporary hair loss that can occur as a result ofsevere stress, an illness, calorie restriction, thyroid hormone imbalance or iron deficiency. The hair’s growth cycle becomes imbalanced, and hair can intensely shed.

Skin conditions ­Seborrheic dermatitis (dandruff) and scalp disorders can cause hair loss, as can alopecia areata, lupus and scarring alopecia.

Medications ­ Certain drugs can cause hair to shed such as pain killers, antidepressants and blood pressure treatments.

What treatments can I try?

Before determining a treatment plan, consult a hair loss specialist to try to determine the cause/s of your hair loss so you can tailor your plan to your needs.

Minodixil is the only medication that’s licensed for the treatment of hair loss in women – it’s only licensed for female pattern hair loss but can help other hair loss conditions. You don’t need a prescription but should discuss the pros and cons of taking it with your doctor.

Medications that may boost hair growth in women and are prescribed in hair tonics or in oral from by some healthcare practitioners include higher strengths of minoxidil, finasteride, oestradiol, progesterone, cyproterone, caffeine and tretinoin. Bespoke combinations are planned for each patient and can help target the predominant cause. It is important to note these medications are not licensed for hair loss in women and you should discuss the risks and benefits with an experienced practitioner before embarking on these treatments.

While HRT may not restore hair growth if other conditions are responsible for hair loss, it can slow down or even stop hair loss in some women. Body identical oestrogen and progesterone are preferable as these will replenish what was there anyway. Many women find testosterone has a beneficial effect on their hair, and that it helps it grow thicker.

RELATED: Testosterone: the forgotten hormone with Professor Isaac Manyonda

Many hair supplements are on the market but while the likes of zinc, biotin and iron contribute towards hair growth, supplements should only be taken if levels are low following testing, and under supervision. 

How else can I look after my hair?

Use a gentle shampoo – consider an anti-dandruff shampoo if you have any scaling – and a good quality conditioner. Avoid tight hair styles to reduce the strain on hair follicles and avoid intense hair drying or heated appliances, which can damage hair shafts and make them more prone to splitting. Also protect your scalp from the sun’s damaging ultra violet (UV) rays by wearing a hat.

Ensure you eat a balanced diet and if you’re planning to lose weight, do so very gradually – sudden drops in calorie intake can affect your hair. Managing stress can be beneficial to your hair’s health, and a hairdresser can help with volume-boosting style or suggest root sprays to conceal loss. Finally, remember that you’ll need to be patient to see an effect from any positive changes you make – typically three to six months.