Can perimenopause cause hair loss? Why it happens, and what can help

Hair is such an integral part of a person’s identity that even the smallest changes can have a huge impact on your life. If you notice your hair is getting noticeably thinner or you’ve spotted more strands in your brush, it's understandable if it starts to affect your self-esteem and your mental health.

If hair loss is starting to get you down, it may help to know that you’re not alone. It’s actually quite common and can happen for a number of reasons. Hair thinning can be hereditary and can be caused by stress or a health condition. We also know that hair changes color and texture as you get older. Always speak to your doctor if you’re worried.

If you’re somewhere between your late 30s and 50s, your cycle-tracking app shows your periods have been a little hit and miss lately, and your hair is starting to thin, it could be a sign of perimenopause. “During the perimenopause time, a significant number of women can experience thinning of their hair,” explains Dr. Allison K. Rodgers, reproductive endocrinologist, obstetrician, and gynecologist, Fertility Centers of Illinois, Illinois, US. 

Hormone-related hair loss is something that can be difficult to control, but treatment options are available. There are also lots of clever styling tricks you can use to help disguise the effects of thinning hair to make it appear thicker and healthier. Let’s look at why it happens.

Key takeaways

• Half of women will experience hair changes thought to be linked to a drop in hormones during perimenopause, including hair thinning, loss of volume, and a difference in hair texture. 
• By the age of 70 (at which point they will be postmenopausal), it’s thought that around 38% of women will have experienced hair loss.
• Losing any amount of hair can be distressing. Fortunately, there are a few things you can do to make your hair appear thicker and fuller.
• Hormone therapy (previously known as hormone replacement therapy or HRT) may help to slow down perimenopause hair loss, although more research is needed to confirm whether it can be effective in this way.
• Simple lifestyle changes, such as eating a balanced diet, getting plenty of exercise, and easing off heat styling, may help.

Is perimenopause causing my hair to fall out?

If you’re not sure of the difference between perimenopause and menopause, you’re not the only one. 

These medical terms often get mixed up, but they’re actually two separate things. Simply put, perimenopause refers to the years leading up to menopause (your final period). Usually, this phase begins somewhere between your late 30s and 50s but most often happens in your 40s and usually lasts around four to eight years. 

You’re classed as having gone through menopause when you haven’t had a period for 12 months (usually between the ages of 45 and 55). From then on, you are postmenopausal.

Just like other, more widely known signs of perimenopause, such as hot flashes, mood swings, and brain fog, hair loss is linked to perimenopause, thanks to shifting hormone levels. 

Hair loss is thought to affect over a third of women as they get older, so if it’s bothering you and you think your changing hormones might be to blame, ask your doctor for advice. Only they will be able to confirm whether it’s perimenopause causing your hair to thin, and if so, they’ll be able to guide you on what to do next. 

As a general rule, hormone-related hair loss tends to be gradual, so sudden or excessive hair loss will need further investigation, says Dr. Rodgers. “Most of the time, hormonal changes from perimenopause lead to a receding hairline and thinning hair mainly on the top of your head, not on the sides,” she says.

What causes perimenopausal hair loss?  

To make sense of perimenopause hair loss, it may be helpful to understand your hair growth cycle. Hair growth occurs in a process which repeats over and over throughout your life. Each stage has its own time line, and at any given time, each strand is in a different phase of this cycle.

• Anagen: The active growth phase lasts about seven years, during which your hair follicles are busy producing new cells and enabling your hair to grow.
• Catagen: Next up, the resting phase takes about two weeks. Here, your hair stops actively growing as it separates from its blood supply.
• Telogen: Finally, during the inactive phase, your hair falls out of its follicle, making way for a new hair cycle.

It’s normal to lose between 50 and 100 strands a day as part of your natural hair cycle. However, if this cycle is interrupted and the hair follicle is damaged or more falls out than grows, this can lead to hair loss. “Several factors influence hair cycles, growth, and shedding,” explains Dr. Rodgers. “This can include hormonal changes.”

Before perimenopause, your levels of the hormones estrogen and progesterone rise and fall in a continuous cycle every month in preparation for a potential pregnancy. But when perimenopause kicks in, these hormones start to change, fluctuating to high and low levels, which can trigger hair loss.

Estrogen is obviously important in your menstrual cycle, but it also promotes hair growth too. So when estrogen levels start to drop, this can interrupt your hair cycle and make it look and feel thinner, too. 

Over time, a decline in estrogen can also trigger an increase in androgens, the sex hormones responsible for hair growth and reproduction. “This shift in the levels of estrogens to androgens can influence hair on our chins to grow but hair on our heads to thin,” explains Dr. Rodgers. We know it’s not exactly the dream combination, but the reassuring thing is that it’s totally normal for this to happen as we age. Androgens have also been known to make new hair grow thinner with each cycle. 

What else can cause hair loss?

While hormonal changes play a role in hair loss, they’re not the only trigger. A number of factors other than perimenopause might cause excess hair loss. These are some of the most common:

• Family history: If you have thinning hair along the crown of your scalp, this could be female pattern baldness, which usually runs in the family. “Family history is nothing you can change. If your mom had thin hair, you may too, but not always,” says Dr. Rodgers.
• Hair treatments: Certain hair styling or hairstyles that pull your hair very tight can cause a type of hair loss called traction alopecia. Treatments with excessive heat may also cause hair damage.
• Hormonal changes: Pregnancy and childbirth can lead to differences in your hair because they cause changes to your hormones.
• Medical conditions: Alopecia areata is a condition that triggers patchy hair loss when your immune system attacks your hair follicles. It affects nearly 2% of the general population at some point during their lifetime. Other medical conditions, including thyroid problems, can also cause hair loss because the hormone imbalance can stop hair from growing. 
• Medications: Hair loss can be a side effect of certain drugs. “Some medications can play a role in hair loss throughout life but especially during perimenopause,” says Dr. Rodgers. “Medications often used to treat or prevent breast cancer can act as an antiestrogen on the hair follicle, increasing hair loss and hair thinning.”
• Stress: Telogen effluvium is a common type of hair loss that affects people after they experience severe stress or a change to their body. “We often will see this a few months after delivering a baby,” explains Dr. Rodgers. “When you are pregnant, your hair becomes synchronized by the hormones. Then, when the placenta is delivered and estrogen levels drop, you can have more of the hair in the shedding phase at the same time.”

If hair loss is getting you down, book an appointment with your health care provider. They’ll be able to provide advice and refer you to a specialist who treats hair loss in women, should you need one. If it is perimenopause related, they can help you manage any other symptoms you might be experiencing, too.

How long does perimenopause hair shedding last?

Research is still ongoing, so experts don’t fully understand hair loss just yet. What we do know is that everyone is unique when it comes to perimenopause — that means no two people have the exact same symptoms. But hair loss often increases with age, and more than half of women report hair thinning postmenopause, so while shedding can be distressing, it’s also perfectly normal.

You might like to take comfort in knowing that menopause-related hair loss can slow down over time. “Perimenopausal hair loss can start in your 40s and can continue for many years after menopause,” says Dr. Rodgers. “Some women often have a worsening thinning. Others have an initial thinning, and then it stabilizes.” And your doctor can support you, so reach out to them if hair loss is getting you down.

Remember too that you’re not alone in perimenopause. Flo’s safe community space, Secret Chats, allows you to anonymously share how you’re feeling and read through other people’s experiences of perimenopause symptoms. Download the app now to get involved in these conversations, as well as keeping track of your symptoms and your cycles.

How to manage hair loss during perimenopause

Losing any amount of hair can be distressing, we know. Menopause is a natural process that anyone with a female reproductive system goes through, so it can be difficult to stop resulting symptoms like hair loss from happening altogether. But the following tips may help you to improve the health of your hair and make you feel better about the way it looks:

Make some small lifestyle changes

Try to reduce stress

During perimenopause, stress can intensify symptoms, including hair loss. That’s because stress can push more follicles than usual into the resting (telogen) phase. This can then cause excess hair loss (known medically as telogen effluvium). To try to combat this, focus on stress-busting techniques such as yoga, meditation, breathing techniques, playing music, journal writing, and massage therapy — whatever helps you feel calmer! There’s no saying how much this could slow your hair thinning, but in any event, it’ll make you feel better generally, so it’s worth a shot. 

Eat hair-friendly foods

It’s hard to control hormone-related hair loss, but making healthy diet choices is important for hair health at any time, whether you’re perimenopausal or not. Foods like fish, avocado, nuts, eggs, and leafy green vegetables contain healthy fats and essential vitamins and minerals that will help to take care of your skin and hair. 

Use more gentle hair care 

To disguise the effects of thinning hair and make it appear thicker and healthier, now would be a good time to revisit your hair care routine. Minimize harsh treatments or chemical procedures such as heat straightening, bleaching, relaxing, and perming, which can be damaging. To reduce hair breakage and potential hair loss, it’s also worth avoiding tight ponytails, tight braiding, or heavy extensions. Try letting your hair dry naturally and using a wide tooth comb gently.

Speak to your doctor about medical treatments

If perimenopause hair loss is impacting your life, you can talk to your health care provider about the following medical treatments:

Over-the-counter treatments

Minoxidil is a medication used for the treatment of high blood pressure, but, applied to the scalp, it may have some success with female pattern hair loss.

Prescription treatments

Hormone therapy may slow down or even stop hair loss for some people, although more research is needed to confirm it works. “You may be prescribed antiandrogens, estrogens, progesterones, or steroids,” says Dr. Rodgers. Theoretically, these options could work in different ways to balance your hormones. As with many things, there are pros and cons of hormone therapy. Chat with your doctor about it, and they can help you decide whether it’s a good option for you. 

Hair transplant

Hair restoration surgery, more commonly known as a hair transplant, can be an effective solution. This involves harvesting healthy hair follicles from areas of your scalp where there’s plenty and reimplanting them into the thinning area. 

Hair loss therapies

The following procedures have been found to help promote hair growth for some people: 

Laser treatment

Low-level laser therapy works by stimulating your hair follicles in order to increase the anagen (growth) phase of your hair cycle and stimulate hair growth.

Microneedling

Other hair loss treatments include microneedling and injections of platelet-rich plasma to encourage hair growth. “This is when they take your own blood, spin out the blood cells, and inject the plasma into your scalp, which has growth factors,” says Dr. Rodgers.

Consider cosmetic treatments

If you’d prefer not to try any of the above just yet, there are a few things you can do to create the illusion of thicker and fuller hair:

• Experiment with a wig, hair extensions, or a hairpiece. Visit a specialist store where you can buy hairpieces made from real hair that look more like the real thing.
• Try styling your hair in a different way to make any hair loss less noticeable, or consult a stylist who specializes in thinning hair.
• Colored hair powders can be sprinkled onto your scalp to give the appearance of fuller hair and cover up any patches.
• Try scalp micropigmentation. Similar to tattooing, needles are used to deposit tiny dots of pigment color on the scalp, giving the appearance of thicker hair.