Hair Loss During Menopause: Why It Happens and What Helps

Why does hair thin during menopause?

Each hair follicle cycles through a growth phase that lasts years, a short transition, and a resting phase after which the hair sheds and a new one starts. Thinning happens when that cycle shifts: growth phases get shorter, more hairs rest and shed at once, or follicles gradually shrink and produce finer hairs. Menopause can nudge the cycle in all of these directions.

Falling estrogen and the influence of androgens

Estrogen appears to help keep hairs in their growth phase, which is one reason many women notice thicker hair in pregnancy and heavier shedding a few months after giving birth. As estrogen declines through perimenopause and menopause, the androgens (such as testosterone) that women make in smaller amounts have relatively more influence. In follicles that are sensitive to them, androgens can cause miniaturization: each new hair grows back a little thinner and shorter. This is female pattern hair loss, the most common type of hair loss in women, and it becomes more common with age. Our article on how estrogen decline affects the body explains the wider hormonal shift.

Shedding triggered by stress or illness

A different pattern, called telogen effluvium, happens when a shock to the system pushes many follicles into the resting phase together. Two to three months later, hair comes out in noticeably larger amounts. Common triggers include illness or fever, surgery, major emotional stress, crash dieting, low iron and starting or stopping some medications. Midlife often brings several of these at once. Learn more in our guide to high cortisol symptoms.

Thyroid problems and low iron

Both an underactive and an overactive thyroid can cause diffuse thinning, and thyroid disease becomes more common in women in midlife (NIDDK). Heavy perimenopausal periods can drain iron stores, and low iron is a frequently missed contributor to shedding (NHLBI). See thyroid and menopause for how these overlap.

When does menopausal hair loss start?

You don't have to have reached menopause (12 months without a period) to notice changes. Many women first see thinning in their 40s, during perimenopause, when hormone levels are swinging rather than steadily falling. Pattern thinning usually develops slowly over years, while stress-related shedding tends to appear suddenly a couple of months after a trigger.

Normal shedding or menopause hair loss: how to tell

Losing about 50 to 100 hairs a day is normal (MedlinePlus). Signs that point to something more:

• A widening part. More scalp shows along a center part than it used to.
• Thinning at the crown. Scalp is visible on top under bright light, while the front hairline usually stays intact.
• A thinner ponytail. It feels noticeably less full in your hand.
• Sudden handfuls. Much more hair in the shower or brush for weeks at a time suggests shedding (telogen effluvium) rather than pattern loss.

What tests should you ask for?

A clinician will usually start with your history and a look at your scalp. Blood tests often include:

• Ferritin and a complete blood count, to check iron stores and anemia
• TSH, to screen thyroid function
• Vitamin D, in some cases
• Androgen levels, if there are signs of excess such as acne or new facial hair

Also bring a list of medications and supplements, and mention any recent illness, surgery, weight loss or major stress.

Which menopause hair loss treatments actually work?

Topical minoxidil

Minoxidil, applied to the scalp as a solution or foam, is FDA-approved for pattern hair loss and is available over the counter (Suchonwanit 2019). It extends the growth phase of follicles. Expect to use it for several months before judging results, and to continue it to maintain them. Early on, some women notice a temporary increase in shedding. Scalp irritation is the most common side effect.

Off-label prescription options

• Low-dose oral minoxidil. Increasingly used by dermatologists for women who don't tolerate or don't respond to topical minoxidil. It is off-label for hair loss and can affect blood pressure and heart rate and cause unwanted hair growth elsewhere, so it needs a clinician's assessment and monitoring.
• Spironolactone. An anti-androgen used off-label for female pattern hair loss, especially when there are signs of androgen excess. It can raise potassium and lower blood pressure, and isn't suitable for everyone.

Correcting deficiencies

If tests show low iron, low vitamin D or a thyroid problem, treating it is an important part of the plan. Supplements like biotin and collagen are popular, but there is little evidence they help hair unless you are actually deficient, and high-dose biotin can interfere with some lab tests, including thyroid tests. Tell your clinician if you take it.

Hair care habits

• Avoid tight ponytails, buns and braids that pull at the roots, which can cause traction hair loss.
• Go easy on high heat and harsh chemical treatments, since hair often becomes drier and more fragile in midlife.
• Wash as often as you like. Washing doesn't cause hair loss; hairs that come out in the shower were already shed.
• Scalp massage is pleasant and low risk. One small study of nine men found increased hair thickness after 24 weeks of daily massage with a device (Koyama 2016), but evidence in women is lacking.
• Eat enough protein, since crash diets and very low intake can trigger shedding. Our guide to protein and menopause has practical targets.

Can hormone therapy help hair loss?

Menopausal hormone therapy is prescribed to treat symptoms like hot flashes, night sweats and vaginal dryness, and to prevent bone loss (NAMS 2022). It is not a hair loss treatment, and good evidence that it improves hair is limited. Some women do feel their hair and skin are better on it, but it shouldn't be started for hair alone. Some progestins have androgen-like activity, so if hair loss is a concern, ask your clinician how the type of hormone therapy might affect it.

If you have other bothersome menopause symptoms, hormone therapy may be worth discussing as part of the bigger picture. For women younger than 60 or within 10 years of menopause without contraindications, The Menopause Society considers its benefit-risk ratio favorable for treating bothersome hot flashes and night sweats. Options include FDA-approved estrogen and progesterone products from your own doctor, and Amie HRT+, a compounded estradiol and progesterone cream whose strength is chosen by a licensed clinician. Compounded hormones are not FDA-approved, and Amie HRT+ is not a hair loss treatment; pair it with a dermatology-backed hair plan if thinning is a priority.

The bottom line