Menopausal hair loss. What can be done?

Many women experiencing hair loss during the menopause think that the best action is to get a wig or topper (to hide the visible scalp in the central parting). This clinic is delighted to help these women – but with the rising price of a good quality wig or hair piece ranging from hundreds of pounds to over £1000 it may be worth seriously thinking about preserving and optimising the growth of your own hair if you are able to, as the cost is likely to be similar, or in some cases less!

This clinic has partnered with the Menopause Support Resource Over the Bloody Moon to provide a streamlined virtual consultation service for hair loss in women experiencing hair loss which they think is due to the menopause. (Please note that if you decide to use this service the 2 follow up appointments which are included in the consultation service booked through this clinic will not be included. You may also be advised to attend the clinic for TrichoLab imaging for confirmation of the diagnosis, which will incur an additional charge.

Please click here to book a virtual appointment using the Over The Bloody Moon platform.

Some clients visiting the clinic may have done their own research about treating hair loss in the menopause and come to their own conclusions about what is best. The remainder of this blog shares a medical, trichological and aesthetic view of menopausal hair loss and what can be done about it.

What is the menopause?

The menopause is defined the ending of periods for 12 months.  The several years leading up to the menopause are known as the perimenopause.¹ The age women experience the menopause is varies, with the average usually falling between 50 and 53 years in Europe.²  This age group often makes up a large proportion of patients for  aesthetic practitioners who also may be able to provide treatments for hair loss. Aesthetics practitioners can come from a range of backgrounds including medical, nursing and pharmaceutical. We often expect doctors to know about hair loss, but it may surprise most people to learn that most GPs will have only received a few hours’ training at the most on hair loss before they qualify. This is important because hair loss can cause a loss of confidence and significant impact on quality of life. Many aesthetic clinics may be providing hair loss treatments, but may not have undergone detailed training in diagnosing the causes of hair loss.

Generally, people are not aware of the wide range of causes of hair loss which can range from being nutritional deficiencies, underlying systemic diseases and stress as well as age related changes.

Hair loss can start to be noticed by women in the perimenopause, as oestrogen levels decline. There will be physiological changes that occur because of the menopause and ageing that affect the hair as well as any other reasons for hair loss which are not related to the menopause.

There are often several different factors driving hair loss, so it is important that you make sure that you understand what is causing your hair loss in detail before getting aesthetic treatments, supplements or medications.  It can be tempting to follow bloggers, influencers and social media adverts who are unlikely to  have been trained in diagnosing and treating hair loss. Sometimes taking multiple supplements with the incorrect nutrients for hair can inadvertently make things worse. A combination of correct and targeted approaches is always recommended for slowing down the progression of hair loss. Treating hair loss correctly at an early stage is more likely to lead to more successful outcomes.

How Can Menopause Affect Your Hair’s Health? (the science behind it all) 

Oestrogen is key in regulation of the hair cycle, with increased levels promoting the anagen growth phase.[1]  At any time most of the hairs on the scalp are in the growing phase. A reduction in the proportion of anagen hairs has been demonstrated to occur in postmenopausal women, and these findings are more apparent over the front of the  scalp rather than the back (occipital) region[2]

Like our skin, our hair changes with age, as does the skin of the scalp in which the hair sits.  This includes changes in the diameter, lustre and texture of the hair. Age associated changes in the human hair follicle include loss of pigmentation, reduced hair growth rate, hair thinning, reduced activity of hair follicle stem cells and thin and brittle hair. Sebum production decreases in the post-menopausal period which may affect hair quality and texture. The hair and scalp can feel dry and lifeless. Hair becomes more brittle. The scalp can sometimes feel itchy.

As we enter the perimenopause we will start to notice more grey hair, which is due to the loss of the pigment melanin. There are also changes going on in the scalp and hair follicle which leads to ageing hair. The hair follicles sit within the dermis, the lower layer of the skin under the epidermis.  As we age the skin’s collagen structure becomes disorganised, and there are less hair follicles.

The hair follicle is sensitive to changes in androgens (male hormone) and oestrogens, and the local metabolism of both hormones at the follicle influences hair growth.  At the time of the menopause the oestrogens decrease and there is a relative increase in androgens which is associated with a decreased rate of growth of the hair, changes in the hair diameter and time spent in the growing phase.  This will present as hair thinning.

It is difficult to understand the role of the menopause on hair loss and subsequent decreased hair coverage as age-related changes may coexist and overlap with hormonal changes. In reality the 2 are considered together.

The good news is that over the last few years many new treatments have become available which provide a range of options at different price points. Along with appropriate lifestyle choices, appropriate supplementation when needed and medications, the outlook is less bleak for women with menopausal hair loss who in the past may have believed that wigs and hairpieces were the only option.

What are the different types of hair loss typically associated with the menopause?

During the perimenopause, women will be more likely to start to experience female pattern hair loss which presents as  general diffuse hair thinning seen most easily at the crown, where there is a widening of the central parting and retention of the front of the hair line. Some women will experience a thinner frontal hair line though. The hair follicles get progressively finer. This is by far the most common form of hair loss.  It looks different to the pattern of hair loss that men experience which typically begins at the temples with a receding hair line and thinning at the crown.

There are also less common conditions which can be seen more commonly in the menopause

• Frontal fibrosing alopecia  is an important hair loss condition to recognise because it is progressive and can lead to permanent hair loss.  Its management should be overseen by a dermatologist who is a doctor who specialises in skin, hair and nails.   It is seen as a receding smooth band of hair loss at the front, like an invisible alice band.  It can be preceded by eyebrow loss, and in women with darker skin pigment darkening of the facial skin can also  precede hair loss.  Unexplained wrinkling in front of the ear can sometimes be seen.
• Lichen planopilaris  is another form of  hair loss which is known as scarring. Typically it is thought to happen in women  in their perimenopausal years.  This can present as patches of hair loss and itching.
• There can also be additional hair loss conditions present that could precipitate hair loss (telogen effluvium) such as Medications, acute stress, crash dieting. A wide range of medications can trigger or worsen hair loss including statins, thyroid medications, some blood pressure tablets painkillers and antidepressants, which women may find themselves taking during the perimenopausal years and beyond.  Blood tests can be helpful if there is no obvious trigger for hair shedding.

Are blood tests needed for hair loss in the menopause?

Blood tests are not always necessary unless there is something in the medical evaluation that would merit it.  A vitamin D blood test may be worthwhile as low vitamin D levels are linked to a range of hair loss disorders including Frontal Fibrosing Alopecia, Female Pattern Hair Loss and Telogen Effluvium.  A ferritin blood test, which is a measure of iron stores can also be helpful.

Hormone blood tests do not need to be routinely done unless there are signs that merit it such as severe acne, excessive hair growth and deepening of the voice which would indicate too much of the male hormone (androgen)

Menopause Hair Loss Prevention (Can it be prevented or lessened etc?)

• It is important to ensure that a healthy lifestyle is maintained.  This includes good mental health, stopping smoking, exercise, weight control and good Medical Care.
• Prolonged exposure to the sun including UVA and UVB rays can damage the hair cuticle (the outer protective layer of the hair).  Signs of hair damage includes discolouration, dry and brittle strands, broken or split ends.
• We get the majority of our vitamin D from the sun, but in the UK there is not enough sun to guarantee enough vitamin D in the population.  It is recommended that all adults in the UK take a vitamin D supplement for bone and muscle health in the winter months.  In people with darker skin types it is recommended that supplementation with vitamin D happens all the year round.   Lower levels of vitamin D are linked to several different hair loss conditions.
• Avoiding physical stress on the hair itself such as with excessive processing and  tension this will help to slow down any damage.
• There is an increased focus on the scalp microbiome.  The Korean anti ageing hair care regime involves exfoliation and massage as well as scalp skin care and protection.  I have been working with a cosmetic scientist to produce a scalp scrub shampoo which fits in with these principles.  This Cleansing Scalp Scrub Shampoo was designed to cater to the needs of the clients who visited me as a Trichologist. I realised that there was a need for this product, to help maintain scalp health. This sulphate-free formulation was crafted in such a way that it can be used for all hair types from straight – curly to kinky hair textures.
  The scalp is left feeling clean and the gentle formula leaves the hair feeling moisturised, it protects against dandruff and shelters hair from pollution.[IW1]   Further information on the product can be found on Doctor Trichology – Shop for hair and scalp care – Doctor Trichology – Shop for hair and scalp care (drtrichology.co.uk)
  

• Choose a gentle shampoo, and follow with a conditioner or hair mask to help to preserve the strand.  One of the brands I regular recommend for both women and men experiencing hair thinning is the Pharma Hermetic hair recovery shampoo. It is suitable for all hair types and is specifically formulated to help reduce hair fall.  There are also versions for dandruff and greasy scalps.
• Caffeine based shampoos can be helpful in reducing hair fall.  Interestingly your response caffeine based products can be genetically determined.  You could try a TrichoTest which is a DNA test which helps you to predict which topical medications for hair loss and supplements can be helpful based on your genetic profile. It is primarily designed for patients with female pattern hair loss, telogen effluvium ( a hair shedding condition) and early alopecia areata.

Should I ask my GP to prescribe HRT for hair loss?

• There is not enough evidence now to support the role of HRT in menopausal hair loss, female pattern hair loss or other forms of hair loss.  Although many women on HRT will notice improvements in their skin quality the reason for prescribing HRT is primarily for hot flushes and night sweats although there are a range of other symptoms related to the menopause
• HRT usually is composed of oestrogen and progestogen. The oestrogen in HRT  does not cause hair loss. However, some progestogens in HRT are more hair friendly than others
• For hair health it is best to avoid Hormone replacement therapies with progestogens that possess net androgenic (male hormone) activity are:
  • Norethisterone
  • Levonorgestrel
  • Tibolone
• Utrogestan and Cyclogest are often prescribed as the progestogen component of HRT.  They are natural micronized progestogens that are identical to natural progesterone with minimal effect on the hair. They re also associated with a lower risk of thromboembolic disease and breast cancer

Should I take testosterone?

I have seen some women prescribed testosterone as part of their menopause management. The addition of testosterone may actually increase hair loss, and this is not typically prescribed in routine NHS General Practice.

What can be seen at high magnification?

The hairs usually come out of the hair follicle in groups of 1-3.  The main changes seen around the menopause which are due mainly to female pattern hair loss  are[3]:

• More single hair follicles
• More empty hair follicles
• Decreased thickness of the hair fibre
• Change of terminal hair to vellus hair
• Change in the hair follicle cycle

Are blood tests necessary?

Not always. However a basic set of blood should include Thyroid, ferritin and vitamin D.

It is not necessary unless there are signs of excess male hormones which would show up as acne, excess hair in a male pattern, irregular periods

What sort of treatments are available?

 There are several ways to help with hair loss around the time of the menopause including medical and topical cosmetic treatments which can be helpful.  Each treatment has its own pros and cons. There is no one size fits all. The treatments I use below are offered at Crewe Hair and Skin Clnic

• Topical Minoxidil is the first line treatment for female pattern hair loss.  This can be a purchased from most pharmacies and its brand name Regaine.  It comes as a liquid or foam. It is also used off licence in a range of other hair loss conditions because there is published evidence.  Some doctors  and prescribers will use Low Dose Oral Minoxidil instead in selected patients
• There are a number of other medical treatments that can be used topically.  Again these are off licence but generally considered safe. These treatments include topical latanoprost, topical 17 alpha estradiol and topical Prostaquinon. These medications can be provided by compounding pharmacies.    The response of your hair loss to these and other topical medications and supplements can be predicted by your genetic profile and lifestyle.   This clinic offers Trichotest which will help us to predict which topical medications women with female pattern hair loss are likely to respond to. Further information is on this page TrichoTest – DNA Test for personalising hair loss treatment – Crewe Hair and Skin Clinic 01270 747 393
• There is some evidence that platelet rich plasma treatment is helpful.  [IW2] This is when blood is drawn from you, spun down in a centrifuge to separate out the platelet rich part of the plasma and the red blood cells.  That the platelet rich plasma part is injected using a fine needles into the thin areas of the scalp.  The growth factors in the platelet rich plasma are extremely safe.  This is  a well known treatment that clients often ask for, and when clients complete a course of treatment as recommended I do notice results.  It is even in pan-European guidance about managing male and female pattern hair loss, and there is also evidence of benefit in some forms of scarring hair loss. As with all aesthetic treatments, results will vary and there is a lack of international consensus around the protocols (which method of centrifuging, types of tubes used etc)
• The great thing about PRP treatment is that it can be combined with other treatments such as Pharma Hermetic Hair Recovery Programme which is based on peptide and microneedling.  What I really like about this treatment is that it can be used on almost any kind of hair loss including after cancer, and is incredibly safe.  It uses the physical treatment of microneedling along with the cosmetic topical solution which can be administered either in clinic or at home over a series of 5 treatments every 1-2 weeks[IW3] . In 2024/25 the clinic will be participating in a study in which women with non-scarring forms of hair loss will be able to access the in-clinic treatment at an extremely favourable price
• There are also other medical treatments which can be combined with topical minoxidil such as anti androgen therapies like Cyproterone acetate (which is found in a contraceptive pill  called Dianette combined with  Ethinyloestradiol) , or Spironolactone which is a medication that has many uses including for blood pressure , heart failure, acne and hirsutism at different doses (some of these uses are unlicensed but accepted uses).
• Low dose Oral minoxidil is another option if the first line treatments have not worked. The main adverse effect is excess hair on other parts of the body away from the scalp and rarely swelling of the feel, around the eyes or around the heart. At very low doses the drug is safe in selected patients. This option can suit people who struggle with the formulation of the topical products
• Other options such as and low level laser light therapy (Theradrome or HairMax) are sometimes recommended as an additional modality for improving hair health. Unfortunately the clinical studies on this technology has not included the darker skin types, but this only seems to be because the imaging wasn’t done. Some leading US dermatologists who specialise in hair loss include their use in darker skin types including in hair loss where there is inflammation. The link to purchase is here , and the discount code is CREW50
• Some women experience sweaty scalps linked to the menopause. Botulinum toxin injections (popularly known as Botox) can be used to reduce the sweating, and there is some evidence that at the correct doses Botulinum Toxin can be used to help with hair loss
• Calecim Professional is a technology based on PTT6, derived from the Mesenchymal Stem Cells of Umbilical Cord Lining, the richest source of stem cells in the body.  This clinic is able to supply the home kit either directly or through the Get Harley portal.
• Microneedling with the XCellaris Pro Twist was introduced to the clinic in 2024 as a more comfortable microneedling option.
• Polynucleotides are another popular treatment.  This is basically fragments of DNA derived from Trout or Salmon which help with hair growth and hair strength. A series of 8 treatents are recommended. The first 4 are every 1-2 weeks, the next 4 are every 3-4 weeks.  They basically help the cells to behave in the way they used to before. They act mainly by thickening the individual hairs.
• Regenera Activa AMT is Autologous Micrografting Technology is an innovative, simple and effective regenerative method to obtain Autologous micrografts using Rigenera technology. AMT protocols are based on stimulating self- regeneration by activating native progenitor cells located in the homologous tissues. AMT obtains injectable micrografts composed of cells stem cells and progenitor cells , extracellular matrix, and growth factors derived from the patient’s own cells, with no other manipulation than mechanical disaggregation.  It can be used optimally 6 months before a hair transplant as there is some evidence that it can help reduce the chances of scarring and improve the blood supply of the scalp. Some hair transplant surgeons are also using it during the transplant process itself.  It can be used as a standalone treatment repeated every year or two if needed. .  This is the ideal treatment for female pattern hair loss if you don’t have the time to come to clinic for repeated treatments.  This is using Regenerative technology in the form of scalp micrografts which are mechanically disagregatted in saline. Again totally natural.

Can you help with a sweaty scalp?

Some menopausal women are troubled by a sweaty scalp. Botulinum Toxin (popularly known as Botox), can be used to help with this as a temporary measure. Further details are on WOW Fusion Mesotherapy for hair loss – Crewe Hair and Skin Clinic 01270 747 393

What about nutrition?

This is Important[. Various parts  of  the diet contained in various groups of consumed food products are both precursors in steroid hormones synthesis as well as have direct impact on structure, growth and keeping hair in the outer layer of the skin. L-lysine is mainly present in the inner part of hair root is responsible for hair shape and volume. Fats present in the diet take part in steroid hormones synthesis (from cholesterol) thus have influence on keeping hair in the skin. Women’s diet should contain products rich in complex carbohydrates, with low glycaemic index  food and include fibre. The correct balance of vitamins also influence the state of the hair.

A supplement that I am now recommending because of published evidence of benefit in menopausal women is Pycnogenol. Pycnogenol is a French maritime pine bark extract. It has anti-inflammatory, antioxidant effects, and improved skin. There is a study on its benefit of hair density in menopausal women which is a randomised controlled double blind intervention study done in China on 63 women aged 45 to 60 years of age. The dose was 3 x 50 mg tablets daily for a total of six months. The outcome measures were hair density, scalp, microcirculation, skin physiological parameters. Pycnogenol intake significantly increase her density by 30% and 23% after two and six months of treatment. The mechanism of action is microcirculation in the skin and antioxidant activity. The 40mg dose can be purchased here Pycnogenol Supplements | Pharma Nord UK  There is a 15% discount of RRP if the code CREWE15 is entered at the checkout.[IW4] 

Also, does Menopausal Hair affect Black Women differently or present differently? 

There are some hair loss conditions that are more commonly found in black women.  CCCA which stands for central cicatrising centrifugal alopecia is thought to affect one in 20 women of African descent.  It is a gradual form of hair loss which starts at the crown and spreads out gradually at tends to look more shiny.  I noticed that women come and see the that this hair loss in their fifties, by which time it is usually quite advanced.

How can I hide menopausal hair loss?

People tend to think first of wigs and hair pieces.

Hair fibres can actually make a significant cosmetic improvement in hiding visible scalp. They work by the electrostatic forces between fibres. Please see https://Linktr.ee/CreweAnd for further details.

[1] https://doi.org/10.1111/ced.15327

[2] Hair through the female life cycle: overview of research and treatment options for female hair concerns: British Journal of Dermatology: Vol 165, No s3 (wiley.com)

[3] https://doi.org/10.3390/ijms21155342

[4] https://doi.org/10.5114/pm.2016.58776