Hair loss during menopause: why your hair thins

Hair loss during menopause happens because the protective influence of oestrogen falls away, leaving your follicles more sensitive to androgens. Research in postmenopausal women finds female pattern hair loss in more than half. The pattern differs from the shedding you see with iron deficiency.

That difference is the most useful thing to know. It decides whether you look at your hormones, your iron, or both.

And it decides what to expect from treatment.

What does menopausal hair loss look like?

In female pattern hair loss your hair thins gradually across the crown and parting, while the hairline at your forehead usually stays intact. You rarely lose clumps. You notice your ponytail feels thinner and your parting looks wider.

Hair loss from iron deficiency or after childbirth is diffuse across your whole scalp, often several months after the trigger. Then you see more hair in the shower drain than a widening parting.

The two can run together. In perimenopause periods often get heavier, draining your iron stores while your hormones are already shifting.

That is exactly the combination we see most often.

What role do your hormones play?

Oestrogen appears to extend the growth phase of your hair. When it falls, that phase shortens and more follicles move into rest earlier. At the same time the balance between oestrogen and androgens changes, so sensitive follicles start producing finer hair.

A review of female pattern hair loss stresses that androgens are not the whole story. Many women with this pattern show no sign at all of excess male hormones.

That matters before you have hormones tested. A normal oestradiol value does not rule this pattern out.

So I am cautious about the idea that a hormone panel explains your hair loss. It can rule something out. It rarely proves anything.

Imagine two women aged 52. Both see their parting widening, and both have a ferritin of 22 micrograms per litre.

The first loses hair at her crown. Her hairline is intact. The second finds clumps everywhere, including at the sides, since a strict diet last year.

Same value, different pattern.

For the first, female pattern hair loss fits. For the second, the diffuse picture points back to that trigger a year ago. The pattern tells you more here than the number does.

Which blood values are worth checking?

The values that most often yield something in hair loss are ferritin, haemoglobin and thyroid function. Those three can cause or worsen hair loss, and all three can be addressed. That puts them first, including during menopause.

Your ferritin reflects your iron stores. It can be low while your haemoglobin still looks fine, and that quiet deficit is often missed in hair loss.

For your thyroid it is TSH and sometimes free T4. Both an underactive and an overactive thyroid can thin your hair.

Thuisarts and the Dutch NHG guidelines describe this route as the usual first step for hair loss in women. We follow it.

To cover those values in one go, they sit in the broader menopause blood test. The general route at any age is in hair loss in women.

What can you do about it?

Starting early helps more than waiting, because treatment for this pattern mostly aims to slow further loss. Full regrowth is uncommon. Minoxidil is most often named as the first step in dermatology, and that is a conversation with your GP.

It also helps to remove what makes it worse. Strict dieting, low ferritin and tight hairstyles all contribute.

What we often see women do is try supplements for months before having their ferritin measured. That is the wrong order.

Measure first, then choose.

Does this belong with your other symptoms?

Usually yes. Hair loss often surfaces in the same period as hot flashes, sleep problems and drier skin. Viewed separately it looks like coincidence, when a shared explanation sits underneath.

The timeline and the rest of the picture are in our overview of hot flashes.

If fatigue is in the mix, tiredness during menopause is the logical next step, because it shares the iron explanation with this article.

References

• Singal A, Sonthalia S, Verma P. Female pattern hair loss. Indian Journal of Dermatology, Venereology and Leprology, 2013. PMID 23974580.
• Thuisarts.nl, hair loss in women.
• NHG guidelines, Dutch College of General Practitioners.

Lunara Health provides blood testing and explanation, not diagnosis. Your results are reviewed by a BIG-registered doctor. Always involve your GP if you have symptoms, and do not use this article to treat yourself.