Hair Loss in Menopause: Understanding the Causes and Finding Supportive Solutions

Hair loss during menopause is a common—and often distressing—experience that affects nearly 50% of women. It can have a profound emotional and psychological impact, affecting confidence, well-being, and quality of life. Despite how common it is, menopausal hair loss remains under-discussed, making it all the more important to raise awareness and ensure women have access to the knowledge and tools they need to address it.
This article explores the most common causes, signs, and treatment options for hair loss in menopause, from medical therapies to everyday care strategies. 

What Menopausal Hair Loss Looks Like
The most common type of hair loss during menopause is called female pattern hair loss (FPHL) or female pattern alopecia. This condition involves a progressive shrinking of hair follicles, leading to thinner, finer strands and reduced hair density—especially at the crown, along the part line, and sometimes at the temples. Many women first notice more hair in their brush or shower drain, or a smaller ponytail.
Other patterns of loss may occur as well. Telogen Effluvium (TE) is a sudden increase in hair shedding that may follow illness, surgery, extreme stress, or medication use (like anticoagulants or beta blockers). It can coexist with FPHL, further amplifying its effects.
A more severe type, frontal fibrosing alopecia (FFA), occurs primarily in postmenopausal women and involves scarring hair loss at the hairline, temples, eyebrows, or even eyelashes. While rarer, it underscores the need for timely and thorough assessment of any hair loss concern.

Hormones, Genetics, and Hair Health
Declining estrogen and progesterone levels during menopause shorten the hair growth phase (anagen) and increase time spent in the shedding phase (telogen). Without the support of these hormones, the hair shaft becomes finer, drier, and more prone to breakage.
Estrogen plays a crucial role in scalp circulation, follicle nourishment, and sebum production—without it, both scalp and hair tend to become dry and fragile. Meanwhile, as estrogen declines, the relative presence of androgens (like testosterone and DHT) increases. These hormones can trigger follicle miniaturization, especially in those with a genetic predisposition.
Women with androgen sensitivity may experience hair thinning on the scalp while noticing increased hair growth in unwanted areas like the chin or upper lip. In addition, thyroid issues—both overactive and underactive—can also cause or worsen hair loss.

The Role of Genetics
Genetics can also influence how hair changes with age. If your mother, father, or relatives experienced thinning hair after menopause, you may be more likely to experience it yourself. One gene in particular, the AR (androgen receptor) gene, has been linked to hair loss in women. Variations in this gene make follicles more sensitive to androgens, accelerating hair thinning.

Practical Strategies for Healthier Hair
While not all hair loss is reversible, many simple steps can support overall hair and scalp health:
1. Nourish from the Inside Out
Ensure you're getting enough protein, B-vitamins, iron, zinc, magnesium, calcium, and collagen. Consider supplements such as biotin, saw palmetto, or marine-based collagen peptides.
2. Gentle Hair Care
Avoid tight hairstyles, vigorous brushing, and heat styling. Use a sulfate-free shampoo and a nourishing conditioner. Let hair air-dry when possible and use a wide-tooth comb instead of a brush on wet hair.
3. Protect at Night
Sleep on a satin or silk pillowcase to minimize friction and breakage.
4. Scalp Health Matters
Incorporate scalp massage into your routine using essential oils like rosemary or peppermint. Choose serums with niacinamide, ceramides, or caffeine to support scalp health and blood flow.
5. Manage Stress
Chronic stress can contribute to TE and worsen existing hair issues. Gentle movement, mindfulness, therapy, and regular sleep can all help to reduce the impact of stress on the body—including the hair.

Medical Treatment Options
While lifestyle plays a significant role, many women benefit from medical therapies, particularly if loss is severe or persistent:
▪ Topical Minoxidil (Rogaine) is the only FDA-approved treatment for FPHL. It encourages regrowth by prolonging the hair growth cycle. It’s applied directly to the scalp but may cause irritation or increased shedding initially (“dread shed”) before improvement is seen over 4–6 months.
▪ Oral antiandrogens, such as spironolactone, may be prescribed to reduce androgen sensitivity. While not formally approved for hair loss, it’s often used off-label with good results. Finasteride may also be considered in select cases.
▪ Hormone therapy (MHT) may help in some cases, although the evidence remains limited when used alone for hair regrowth.
▪ Laser therapy, LED red light therapy, and platelet-rich plasma (PRP) treatments are additional options that may improve follicle health.
▪ For advanced or scarring forms of hair loss, referral to a dermatologist or hair loss specialist is recommended.

Final Thoughts
Hair loss during menopause is common—but it doesn’t have to be endured in silence. Understanding the hormonal shifts, genetic influences, and lifestyle triggers that contribute to thinning hair can help you take back control.
From nutrition and gentle scalp care to medical therapies and professional guidance, there are multiple paths forward. If you’re concerned about hair loss, don’t hesitate to speak with a trusted health provider who understands the complex landscape of midlife care.
You are not alone, and with the right support, your hair—and your confidence—can feel stronger than ever.

Article written by

Wendy Hildebrand, Nurse Practitioner

Wendy Hildebrand is a Nurse Practitioner based in Victoria, BC, with over two decades of diverse nursing experience spanning medical-surgical, palliative, maternal-child health, and public health. Her passion lies in supporting and empowering women through the complex transitions of midlife with evidence-based education and compassionate care. Wendy brings a warm, collaborative approach to her work with sanoMidLife, where she is proud to partner with women on their journey toward renewed health, confidence, and well-being.