Menopause is a time of change, some good and some not so good. One of the more distressing problems a woman can experience is hair loss after menopause. As a physician, I've seen the impact this can have on a woman's sense of well-being. After all, a man who's losing his hair still looks masculine, while it's less socially acceptable for women to have hair loss. Needless to say, it can have a big impact on a woman's self-esteem. That's why most women with this problem are desperately in search of answers.
Hair Loss After Menopause Is Not Uncommon
About a third of women experience hair loss to some degree after they go through the change of life. The most common cause of hair loss in men is androgenetic alopecia, also known as male-pattern baldness. This frequent cause of hair loss typically has a genetic as well as environmental component.
Women can also have androgenetic alopecia. In women, we call this female-pattern baldness, and it's often related to the hormonal fluctuations that take place around the time of menopause, particularly an increase in androgens. Women who have this type of hair loss usually have family members who also experienced hair loss.
When men have androgenetic alopecia, they typically see their hairline recede and experience hair loss at the back of their scalp. With women, it's usually more subtle and diffuse—all over the scalp rather than in a single spot—although I've seen women with a strong family history of baldness develop a receding hairline similar to what men experience. Frequently, the first sign women notice is a widening of their part or more hairs than usual in their brush. It's not uncommon to lose 100 to 150 hairs a day. More than this should raise a red flag.
Other Causes of Female Hair Loss
When you see a woman who's losing her hair, you have to ask why. It isn't always female-pattern baldness, especially if there's no family history of hair loss. Other medical conditions that are more common around the time of menopause can cause hair loss as well. One of the most common ones I've seen in practice is hypothyroidism, or an under-active thyroid. Women with an under-active thyroid usually experience gradual hair loss and thinning. They may notice more hair in their brush or when they style it, and their hair may come off in their hands when shampooing. They can have other symptoms as well—less energy, gradual weight gain, dry and flaky skin, cold sensitivity, constipation, or memory problems. These signs can be quite subtle and many women simply assume they're a normal part of menopause.
Hair loss can also be caused by nutritional deficiencies, especially low iron levels or deficiency of a B-vitamin called biotin. I've seen women go on crash diets and experience hair loss, and it's also common in people with anorexia nervosa and other eating disorders.
Other medical conditions that cause thinning hair are autoimmune disorders and syphilis. Stress can do it, too. Stress can take many forms—a recent surgery or illness can trigger hair loss. That's why it's important that your doctor runs blood tests to check for other causes of hair loss. Some medications can also be the cause, especially cancer chemotherapy drugs.
Hair thinning due to an under-active thyroid or nutritional deficiencies can be corrected with thyroid supplementation and appropriate dietary changes. If your doctor tells you it's androgenetic alopecia, your best option is a topical medication called minoxidil, which you apply directly to your scalp. Minoxidil doesn't work for everyone, but it slows or stops hair loss in about 25 percent of women with androgenetic alopecia. If it works, you'll have to keep applying the medication to maintain the results.
Another treatment some endocrinologists use is a medication called spironolactone. It works by blocking the effects of androgen on the hair follicles. This helps to reduce hair loss in some women. Balancing hormones with hormone replacement therapy may also help this problem, but that's something women should discuss with their doctor at length due to the potential side effects.
If these treatments don't work, what are your options? Some women wear a hair piece or wig, and there's the more expensive option of getting a hair transplant. This involves removing portions of skin that contain hair from the back of your scalp and implanting it where hair has been lost. Yes, it's expensive, but the results look very natural.
Are There Non-Drug Treatments That Work?
Some people will tell you biotin and zinc supplements work for hair loss. Most research suggests neither are effective unless you're deficient. Of the two, biotin has the most potential for treating hair loss and may be worth a six-week trial to see if it helps. I've seen patients with hair loss experience some improvement after supplementing with biotin. It's important to avoid wearing your hair in a tight ponytail or braid, since this places further stress on the scalp and can worsen hair loss.
The Bottom Line?
Hair loss is a frustrating problem. If you're experiencing hair thinning, see your doctor to rule out a medical problem or nutritional deficiency. You may have an easily treatable condition like hypothyroidism or iron deficiency—or you may be experiencing hair thinning due to stress. Don't assume that hair thinning is a normal part of menopause.