Dealing With Hair Loss During Menopause – The Ultimate Guide

Written by Rali Bozhinova, Superintendent Trichologist, The Belgravia Centre

How Does Your Body Change Before And After Menopause

Menopause is a completely natural process and we cannot prevent it. The average age for a woman to go through menopause is 45-55 years of age however, many women experience menopause at a much younger age. This may happen for various reasons such as genetic predisposition to early menopause, a surgery that requires removing the ovaries or uterus, and some medical conditions.

Peri-menopause is the time before you officially reach menopause. Your hormones change over several months or even years before you reach menopause. For some women, this process can start as early as their 30s. Due to the hormone change, many women experience symptoms such as irregular menstrual cycle, difficulty concentrating, mood changes, sleep problems, changes in sexual function and hot flashes. The levels of your main female sex hormone, oestrogen, gradually drop, and you may start noticing changes in your hair growth and texture.

Menopause is officially reached once you have had 12 consecutive months without menstruating. At this point, oestrogen would be at its lowest and it would remain low. Post-menopause is the period after that.

Hair loss is common in women of any age, especially after puberty. However, there is evidence that the hormonal changes experienced around menopause can also cause changes in the hair growth cycle. For many women, this is the time when they first notice hair loss. For others, this is the time when their pre-existing hair loss condition may get worse.

Types Of Hair Loss During Menopause

Hair loss can be experienced due to many reasons, often due to a combination of several triggering factors. However, there are some types of hair loss that are more commonly seen during menopause.

Female Pattern Hair Loss

The most common type of hair loss that we see after menopause is female pattern hair loss (FPHL), also called androgenic alopecia. This is a complex genetic type of hair loss in women and any hormonal change can influence the condition. Women have both male and female sex hormones. Both types of hormones are present in the hair follicles and influence how quickly or how thick the hair grows.

The drop in oestrogen during menopause changes the ratio between male and female sex hormones in the follicles. It becomes easier for the male hormones to influence the hair follicles, depending on where they are in the body. For example, you may notice more hair growth on your face and more hair loss on your scalp.

The most potent male hormone that affects the hair is dihydrotestosterone (DHT). It is a metabolite of testosterone in the presence of the 5-alpha-reductase enzyme which is found in specific areas such as the scalp. DHT can cause hair loss in those who are genetically predisposed to it, and the hormone changes that naturally occur during menopause can aggravate this process. As a result, the hair follicles around the hairline and the top of the scalp become smaller and weaker over time. They start producing thinner and sometimes, shorter hair. In the long term, some follicles may be completely lost. You may notice the following signs:

• Loss of volume and your hair looking flat;
• Thinner hair strands, difficult to style;
• Smaller ponytail;
• Seeing your scalp through your hair, especially at the front and top;
• Your hair parting may look wider, you may start parting your hair to the side to cover it;
• Recession at your temples;
• Thinner hair on top of your scalp, whilst the hair at the back still feels thick and strong;
• Your hair may feel as if it is not growing as long as it used to.

 

Telogen Effluvium

Oestrogen is thought to be stimulating the hair to grow. A common example of this is pregnancy - during pregnancy oestrogen raises and this results in thicker and stronger hair growth. However, the drastic fluctuation in hormones during peri-menopause and drop in oestrogen during menopause often result in hair loss.

The hair follicle changes its hair cycle and stays in its actively growing phase, called the anagen phase, for much shorter. This means that the affected hair remains in its follicle for less time, does not reach its usual length, and falls quicker than before.

The follicle may also remain in its resting phase, also called the telogen phase, for longer. This means it may remain empty for some time before producing new hair again.

Many anagen follicles may be prematurely pushed to their telogen phase, losing their hair quicker than normal, resulting in increased hair shedding.

When this happens to many follicles on the scalp, you may notice increased hair loss due to a condition called telogen effluvium. Common signs include:

• Increased hair shedding;
• Long hairs falling out with their root which looks like a white firm bulb;
• Finding more hair in the shower, in your hair brush, on the floor or on your clothes;
• Loss of volume and hair density across the entire scalp;
• Feeling like the hair does not grow in length;
• You may notice short new hairs growing but if the condition continues for a long time, they may be falling quickly, too;
• You may then notice hair growing at different lengths.

Telogen effluvium is a disturbance in the normal hair growth cycle which is why when it happens, it feels like a significant amount of hair is lost over a short period of time. It is a type of hair loss which has the potential to recover on its own, especially as the hormones stabilise post-menopause and many of the other menopause-related symptoms wear off. However, telogen effluvium can also be aggravated by a number of other factors such as increased stress, dietary deficiencies and some medical conditions. It is therefore important to discuss all of these factors with a hair loss specialist.

Dryness of the scalp and hair

Dryness is not a hair loss condition however, an unhealthy scalp and constant scratching of the scalp can lead to hair loss and breakage. The decline in oestrogen during menopause can impair the skin barrier functions in several ways:

• Less sebum and hyaluronic acid are produced and therefore, the skin feels dry and sometimes itchy and inflamed;
• Reduced anti-oxidant function of the skin;
• Poor wound healing which means scratch marks may heal slower;
• Less collagen and elastin production which means the skin may feel thinner and with more wrinkles.

 

We often see dry and itchy scalp, as well as dry and brittle hair in post-menopausal women. Those who are prone to eczema or dermatitis on the scalp may find themselves scratching more, especially in winter when the cold temperatures dry the skin further. The constant friction from the scratching, as well as the unhealthy scalp, may sometimes aggravate hair loss and hair breakage.

Frontal Fibrosing Alopecia

Frontal fibrosing alopecia (FFA) is a scarring type of hair loss. It can cause inflammation in the hair follicles which gradually destroys them and replaces them with scar tissue. This type of hair loss is unfortunately permanent and can affect the margins of the hairline, as well as the eyebrows. FFA is still a poorly understood condition and the exact triggers are unknown. It is thought to be an autoimmune hair loss however, environmental and hormonal factors are also likely to influence the severity of the condition. FFA is not necessarily caused by menopause. It is possible to have FFA before having menopause and there have also been reports of men experiencing FFA. However, the condition is most commonly seen in post-menopausal women which is why experts believe that hormonal changes are likely to influence the condition. If you have FFA, you may notice the following signs:

• Hair loss around the margins of your hairline in a band-like pattern;
• Hair loss of your eyebrows;
• Slight itching or tingling in the areas of hair loss;
• Slight redness or mildly rough texture around the follicle openings on the affected areas;
• Very smooth pale looking skin in the places that have lost their hair.

 

The treatments at The Belgravia Centre cannot stop the progression of FFA or regrow the hair that has been lost as a result of FFA. It is therefore important that you speak with a dermatologist if you are suspecting that you may have FFA.

How To Treat Hair Loss During Menopause

If you notice any signs of hair loss, it is always important to consult with a hair loss specialist. They will ask you about your medical history, family history, hair care routine and lifestyle. They will also examine your scalp and hair, and discuss a suitable treatment plan tailored to you. There are many types of hair loss, not all of them are solely caused by menopause but may be aggravated by it. A thorough consultation is therefore important so you can get comprehensive advice and a treatment plan. There are several things that you can do to help manage hair loss:

Eat Well

A healthy balanced diet will ensure that you are getting all necessary nutrients for healthy skin and hair. Additionally, don’t forget to include foods rich in calcium so you can keep your bones healthy. If you are suspecting any vitamin or mineral deficiency, such as low iron or low vitamin D, you can speak with your GP who can help you check this and treat any deficiencies. The Belgravia Centre asks that all women bring a blood test to their consultation so that we can determine whether there are any nutritional or hormonal factors that could be contributing to their hair loss. Many women use Hair Vitalics which are a food supplement designed by our hair experts at The Belgravia Centre. They provide an excellent blend of vitamins, minerals, antioxidants and amino acids to help maintain normal hair health.

Have Some Me-Time

It might be easier said than done, but getting plenty of rest, regular sleep and managing stress are all essential. The hormonal changes associated with menopause can affect some women’s mental health, sleep patterns, trigger anxiety and make it difficult to manage stress. Make sure that you look after your mental health and do activities that make you happy – this could be catching up with family or friends, reading a book, doing yoga, exercising or simply just resting.

Hydrate

As the skin and hair can feel dryer during this time, it is especially important to hydrate well. Drink plenty of water and use hydrating hair products such as leave-in conditioners, hair masks and specialised shampoos suitable for dry scalp and hair. At the clinic we also offer clinical therapy sessions which involve a range of soothing and nourishing treatments, steaming of the hair with a protein treatment and a relaxing hair wash with our specialised shampoos and conditioners. These treatments can help hydrate the hair and leave it feeling soft and shiny, as well as help with dryness or itching of the scalp.

Be Mindful Of Your Hair Style

If your hair is already weak, you have to ensure that you are not causing any further strain on it. Here are several dos and don’ts that you can follow.

Do:

• Leave your hair natural;
• Use hydrating products such as shampoos suitable for dry hair;
• Use a heat protector when drying your hair;
• You can speak with your hairdresser for hairstyles that will give you more volume such as adding layers to your hair and trimming any split ends.

Don’t:

• Don’t use strong heat such as hair straighteners on a regular basis;
• Don’t wear tight hairstyles such as tight ponytails and braids;
• Don’t add any extra tension to your hair such as that from hair extensions;
• Don’t cause any chemical trauma to your hair such as that from bleach, perms and relaxers.

Speak With A Hair Loss Specialist

If you notice hair loss, always consult with a specialist before you start any medication. Minoxidil is often used in this case because this is the only MHRA licensed and FDA approved treatment for female pattern hair loss. Minoxidil increases blood circulation which increases the nutrients delivered to the hair follicles, makes the follicles bigger and stronger, and helps them stay in their growing phase for longer, resulting in the prevention of female hair loss and regrowth of the hair in most cases. Due to the positive effects on the hair follicles, minoxidil is also successfully used in other types of hair loss such as chronic telogen effluvium.

The Belgravia Centre’s pharmacy is dedicated to preparing bespoke treatment formulations tailored to our patients. Medications are prepared in various strengths and with various additives to maximise their effectiveness. This helps us choose a treatment plan that suits your type and severity of hair loss, your medical history, and lifestyle. Additionally, our qualified hair loss specialists are available 7 days a week to support you with advice and answer your questions. Although we can offer you extensive support during your hair loss treatment, we will not be able to treat any other symptoms associated with the menopause and it is therefore important to discuss these with your doctor.

If you are worried about hair loss you can arrange a free consultation in our Central London clinic with a hair loss expert or complete our Online Consultation Form from anywhere in the world and we will talk to you on Zoom. Take a look through our hair regrowth photo gallery – which is the largest gallery of its kind in the world and contains over 1,000 sets of hair growth photos and verified reviews from patients of The Belgravia Centre.