No matter what colour or texture it has as it grows from your scalp, hair is a loaded issue for women (and people of all genders). We associate its thickness and length with youth, beauty and fertility — and if you’ve ever carried a pregnancy, you may have noticed that your mane grew particularly voluminous and lustrous around the time your organs were most compressed (though it’s worth noting that this is often followed by a period of hair loss postpartum).
We associate thinning hair, on the other hand, with old age and sickness. It evokes thoughts of our mortality.
So it’s no surprise that a loaded hairbrush, extra strands in your fingers when you take out your ponytail, or the sight of your own scalp in a spot that your hair used to cover causes you alarm, or even shame.
It’s not an uncommon experience, however, for women in their 40s. Thinning hair generally doesn’t indicate an urgent medical problem, but it’s something to discuss with your doctor because it can have various causes. Some of these are treatable, as is the symptom of thinning hair itself.
Here’s what to know.
What is perimenopause?
Menopause, or the cessation of menses, means that you have stopped getting your period. It is officially diagnosed after you have gone at least 12 months without a menstrual cycle, and usually occurs during a woman’s 40s or 50s. According to the Mayo Clinic, the average age at which women in the U.S. experience menopause is 51.
Perimenopause refers to the time period — months or years — preceding menopause.
“It basically is a time when they’re losing their oestrogen and testosterone slowly, but not quite there. It’s a time of transition before you actually completely lose your cycle,” Dr. Monica Williams, a family medicine physician who practices functional medicine, told HuffPost.
Symptoms, she noted, vary in intensity and may come on slowly or suddenly. Because you’re still having your period, it can be tricky to put together the pieces of what’s going on.
During perimenopause, women may experience a range of symptoms related to the hormonal shift that their body is undergoing. These go beyond the classic hot flashes, and can include:
- Irregular periods
- Vaginal dryness
- Chills
- Night sweats
- Difficulty sleeping
- Changes in mood
- Weight gain
- Dry skin
- Loss of breast fullness
- And ... thinning hair
Frustratingly, perimenopause can only be confirmed in hindsight, once you’ve gone that year without a period and are officially menopausal. Because the range of normal hormone levels is so wide, it is difficult to diagnose perimenopause based on bloodwork.
Like the hormonally-driven states of puberty and pregnancy, “menopause and perimenopause is not a disease,” Williams said. “It’s just a cycle. It’s a normal process.”
While we all understand that our periods will come to an end, there’s much less awareness about the many potential symptoms of perimenopause — and what can be done to treat them.
What does perimenopausal hair loss look like?
You may be familiar with male pattern baldness, which often appears as a receding hairline and thinning of the hair around the crown of the head. Hair loss in women tends to look different.
“The most common type of hair loss during perimenopause involves thinning of hair around the scalp, which is known as female pattern hair loss. Usually with this condition, the frontal hairline remains intact, and it is a gradual thinning of hair,” said Dr. Susan Loeb-Zeitlin, an OB/GYN at New York-Presbyterian and Weill Cornell Medicine.
What causes perimenopausal hair loss?
“Perimenopausal hair loss likely occurs due to the change in our hormones, as the ratio of androgenic to oestrogen hormones changes during the menopause transition,” Loeb-Zeitlin said. By the time they turn 70, 38% of women show androgenic (hormone-driven) hair loss. Unfortunately, as noted above, hormone levels vary so widely from person to person that blood tests aren’t a reliable way to assess whether shifting hormones are to blame for thinning hair during the perimenopausal years. Instead, your doctor will note if there is a pattern to your hair loss and any other symptoms of perimenopause you may be experiencing, and rule out other potential causes.
“Most women do not experience hair loss through menopause, but probably half of women notice some hair changes during the [menopause] transition,” Loeb-Zeitlin said.
Just because you notice your hair thinning during this time, it doesn’t mean that changing hormones are necessarily the culprit. There are a number of other possibilities.
What are other possible causes of hair loss?
Other potential causes of hair loss include: genetic predisposition, stress, chronic illness, thyroid disease, medications, nutritional deficiencies and even certain hairstyles.
Telogen effluvium is the name for sudden-onset hair shedding, “often occurring a few months after a major life stress or due to chronic illness or certain medications,” Loeb-Zeitlin explained.
Wearing your hair pulled tightly into a ponytail, bun or cornrow braids can cause traction alopecia, hair loss typically appearing at the temples and the hairline.
Williams noted that certain hair products can dry out follicles and limit hair length. When it comes to hair care, “when you’re younger, sometimes you can get away with things that you couldn’t as you age, because of, once again, those hormone changes.”
“People who have vitamin D deficiencies can often find themselves having a slow hair growth or hair loss,” Williams said. She also looks at patients’ levels of iron, folic acid and B vitamins: “These are all deficiencies that can absolutely cause women ... significant shedding of their hair.”
Fibrosis alopecia is a loss of hair on the front and sides of the scalp. This kind of hair loss is seen in postmenopausal women. It is “an inflammatory reaction,” and “seems to be due to an immune response,” Loeb-Zeitlin said.
Most people experience changes in their hair as they age, but these vary significantly among individuals. Some people maintain the ability to generate new hair follicles, or to hold onto the follicles they already have, more so than others, Williams explained.
It’s important to note that hair growth follows a cycle, which ends with the hair falling out. Losing up to 100 strands a day is considered normal, as these are (usually) continually being replaced by new hairs growing in.
“Sometimes what you think is broken off hair, is actually new hair coming in,” Williams said.
What treatments are available, and how effective are they?
Because so many different things may trigger hair loss, it’s important to consult with a medical provider about which treatment might be appropriate.
“There’s not just one solution, because there’s not just one cause for the problem,” Williams said.
Loeb-Zeitlin recommended seeing an OB/GYN or dermatologist. “A complete history and physical and blood work should be obtained,” she said.
Once certain causes have been identified or ruled out, your provider can come up with a treatment plan for you.
In spite of the fact that hormone changes may lead to hair thinning, “there is no great evidence to support the use of hormone therapy for hair loss,” Loeb-Zeitlin said.
“Minoxidil is the only FDA-approved treatment for female pattern hair loss,” she said. “Sometimes it can be combined with antiandrogens, spironolactone [a diuretic], but this use is not FDA-approved.”
Minoxidil is available over the counter, usually in a foam that you apply topically. Williams noted that one issue with minoxidil is that “it’s only working while you’re using it. In other words, unless you’re putting it on, you’re probably not going to see the retained growth.”
A drug called finasteride, for male-pattern hair loss, is also sometimes used off-label for women, and ketoconazole is an anti-dandruff shampoo that some doctors recommend.
Because hair loss is fairly common with age, and because it’s a cosmetic issue, women may feel that it’s not a big deal, or something they should learn to live with. But given all the potential causes and treatments available, hair loss is definitely something worth discussing with your doctor.
Your feelings matter, too. “Hair loss can have significant psychological consequences that affect emotional well-being,” Loeb-Zeitlin said.