Perimenopause hair loss: Cause and how to support healthy hair in midlife

If you’ve noticed your hair feels thinner or you’ve found more strands than usual in your brush, then you might be feeling concerned and wondering what is going on. Hair loss is often thought of as a ‘male problem,’ but many women also experience unexpected changes to their hair, especially during midlife.

Hair loss during perimenopause is surprisingly common, yet it’s not always talked about. While most of us expect our hair color to change with age, it can be unsettling to realize that the texture, volume, and overall thickness can change too. 

In this article, we’ll explore why perimenopause can cause hair loss, how you can support healthier, stronger hair, and when it might be time to seek professional advice.

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Does perimenopause cause hair loss?

The words “menopause” and “perimenopause” are often used interchangeably, but they actually describe different stages. Let's take a quick look at what each one means:

• Perimenopause: This transitional phase can begin up to 10 years before menopause occurs. During this phase, your hormones, particularly estrogen and progesterone, fluctuate unpredictably causing an array of symptoms, including hair changes in some women. It usually begins in your 40s but can start earlier or later and can last anywhere from several months to several years.
• Menopause: This is the point at which your menstrual cycle has completely stopped. We say you have reached menopause when you have had 12 consecutive months without a menstrual period. The average age of menopause is 52.
• Postmenopause: After hitting menopause, you enter postmenopause, and you remain in this phase for the rest of your life. Menopausal symptoms can continue for the first few years but should become milder as your hormone levels stabilise at a new, lower level. Post menopausal women are at increased risk of osteoporosis due to low estrogen levels. 

What is considered hair loss?

It’s normal to shed between 50-100 strands of hair per day, but when that amount exceeds 125, hair loss in women begins to occur as more hair falls out and less hair grows back.

So, do you lose hair during perimenopause? 

For many women, yes, perimenopause can cause, or at least contribute to hair loss. The hormonal changes specific to perimenopause are known to be independently associated with hair loss and changes in hair quality.

What perimenopause hair loss looks like

Hair loss due to perimenopause can look different from hair loss from other causes, here are some characteristics of perimenopause hair loss that you might notice:

• Hair thinning most commonly occurs on the crown or central scalp. Your scalp might seem more visible, especially under bright light.
• Notice more strands falling out when brushing or washing your hair or on your pillow.
• Reduced hair volume can make your ponytail feel thinner and your hair generally lacks its usual fullness.
• Overall texture changes can leave hair feeling drier, finer, or more brittle than before.

This pattern is also known as female-pattern hair loss and often first appears, or accelerates, during perimenopause. In general, perimenopausal hair loss results in thinning of the hair across the scalp rather than in distinct bald patches.

Other hair loss conditions have also been found to occur more frequently in perimenopausal women including:

• Frontal fibrosing alopecia: A type of scarring hair loss that causes gradual thinning or recession along the hairline.
• Telogen effluvium: A non-scarring and temporary increase in shedding often triggered by stress, illness, or hormonal changes like perimenopause or after childbirth.

Recognizing the pattern and timing of your hair changes can help you and your healthcare provider identify what’s happening, and the best way to manage it.

How perimenopause causes hair loss: The hormone–hair connection

Hormones play a major role in the health and growth of your hair, and during perimenopause, some of those hormones fluctuate dramatically. These changes affect how your hair grows and sheds.

To understand why hair loss during perimenopause happens, it helps to first look at how healthy hair normally grows.

The hair growth cycle has three main stages:

1. Anagen (growth phase): Lasts two to eight years. Around 85%-90% of scalp hairs are in this phase at any time.
2. Catagen (transition phase): A short two to four week period when growth slows and the hair prepares to shed.
3. Telogen (resting and shedding phase): Lasts about three months, at the end of this phase old hairs fall out while new ones start to form beneath the surface.

The hair growth cycle is highly influenced by several hormones including androgens (male sex hormones like testosterone) and estrogen. During perimenopause, the balance of these hormones is severely disrupted, here’s how these hormonal changes play a role:

• Falling estrogen levels: Estrogen keeps hair follicles in anagen (growth phase) for longer and stimulates hair growth. As estrogen levels decline, fewer hairs are found to be in the anagen phase and there is an increase in shedding.
• Relative increase in androgens: With less estrogen and progesterone to counterbalance them, androgens such as dihydrotestosterone (DHT) relatively increase. DHT can inhibit hair follicle growth which leads to finer, shorter hair strands and overall thinning.

Together, these hormonal shifts lead to the gradual thinning often seen across the scalp, particularly along the front and part line, during perimenopause.

Other contributing factors to consider

While hormones play the biggest role in hair loss during perimenopause, several other factors can also contribute to changes in your hair at this life stage.

Common contributing factors:

• Nutrient deficiencies: Low levels of iron, vitamin D, zinc, and protein can make hair more prone to shedding and breakage.
• Thyroid changes: Both underactive and overactive thyroid conditions can cause diffuse hair thinning, and thyroid disorders are more common in midlife women.
• Chronic stress: High stress levels can push more hairs into telogen (resting and shedding phase), leading to increased shedding. This condition is known as telogen effluvium.
• Certain medications: Some prescription medications, including some blood pressure medications and gout medicines can cause hair loss in women.
• Genetics: Some women are more genetically predisposed to developing hair loss.
• Damaged hair follicles: Frequent heat styling, tight hairstyles, or chemicals can weaken hair shafts and increase breakage.

Strategies for healthier hair during perimenopause

While hair changes during perimenopause are common and for many will level out over time, there are strategies you can follow to ensure your hair stays as strong and healthy as possible.

Here are some effective ways to support healthier hair:

• Nutritional support: Eat a healthy balanced diet that includes enough protein, zinc, and iron, and consider supplements for any vitamin or mineral deficiencies.
• Lifestyle changes: Regular exercise, stress management, and ensuring you get enough quality sleep can help regulate hormonal levels and maximize hair quality. 
• Avoid harsh hair styling practices: Avoid excessive heat styling, tight hairstyles, and chemical treatments. 
• Manage underlying health conditions: Certain underlying health conditions like thyroid disorders or hormonal imbalances can contribute to and worsen hair loss. Work with your healthcare provider to ensure you’re effectively managing these.
• Medications and other hair loss treatments: Certain over-the-counter treatments like minoxidil may help stimulate growth and reduce shedding. For more complex hair treatment options your healthcare provider will be able to access the right treatments or specialist for you.

When to see a professional

Some hair thinning during perimenopause is normal, but it’s worth checking with a healthcare provider if the changes seem sudden, severe, or if you’re just generally concerned. Your healthcare provider can help identify the cause of hair loss and recommend any appropriate treatments.

Consider seeking medical advice if you notice:

• Sudden or excessive shedding that continues for several months.
• Patchy or uneven hair loss rather than gradual thinning.
• Scalp irritation, redness, or scaling could indicate an underlying infection or inflammation.
• Other symptoms such as weight changes fatigue, or irregular periods can point to an underlying condition.

Key takeaways

• Hair loss during perimenopause is common and often linked to changing hormone levels, especially the decline of estrogen and progesterone. It tends to be gradual and stabilizes over time.
• Thinning is usually gradual and more noticeable along the front of the scalp or the part line.
• Hormones aren’t the only factor, other contributing factors include nutrition, thyroid conditions, chronic stress, and certain medications.
• Healthy habits and lifestyle changes can help support stronger, fuller hair.
• Seek medical advice to help rule out other causes and create a personalized plan to support your hair long-term.

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