For many of us, our hair is a big part of our self-image. The cut, the color, the style all communicate something about who we are and how we want others to see us. It’s no surprise, then, that in the myriad symptoms we experience during menopause, hair loss can be one of the most distressing.
But as board-certified dermatologist, Anthony Nuara, MD, PhD, tells his patients experiencing hair loss due to menopause: There’s no need to panic. As upsetting as it is to see hair fall in menopause, it’s totally normal and very common, and with timely intervention, a dermatologist can help slow the changes and encourage regrowth. (Phew!)
We recently talked with Dr. Nuara about what helps hair loss during menopause and how we can prevent it in the first place.
Does menopause cause hair loss?
Dr. Nuara: Menopause can cause hair loss, but it’s not the only cause. As we get older, our hair has a shorter anagen phase. And the antigen cycle is what's responsible for hair length, but also, to some degree, the hair shaft diameter. So, most of us will notice some changes.
These changes are gradual, and many women may not notice changes in their hair until menopause, when the dip in estrogen causes shedding.
What hormonal changes during menopause can cause hair loss and thinning?
Dr. Nuara: It's really the loss of estrogen. This impacts the follicle, the skin, and hair density — and also our collagen, our elasticity, our healing. All of it changes with the drop in estrogen. And so, at menopause, it’s not just thinning hair, my patients also complain of thin, dry skin and easy bruising.
What does menopausal hair loss look like?
Dr. Nuara: As you get older, your hair won't grow as fast, it won't grow as long, and it won't grow as dense. You're losing some, but it's also the hair itself is changing — the skin is changing, the growth rate is changing. It's not necessarily increased shedding. It's really a slow onset of changes in women that starts typically in their mid-40's and accelerates as they approach 50. So, it’s really just normal aging, but as we try to increase our healthy lifespan, we’ll want to do things to keep it healthier and prolong that desired hair.
Can hair loss during menopause be prevented?
Dr. Nuara: Absolutely. When patients ask how to stop hair thinning during menopause, I always tell them it's easier to prevent or slow down hair loss than it is to reverse it. It’s the same as with our skin. If you come in before you have skin damage and say, “How can I slow aging?”, we can use sun protection, retinol. But if you come in after significant damage is already done and say, “How can I look like I'm 30 again?”, nobody can do that for you. So, it's about slowing down the aging process before the damage is done.
When I talk with patients who are in their 40’s — women who don't really identify any sort of issue yet — I ask: Are they getting enough protein in their diet? Are they experiencing any perimenopause symptoms? Are they able to take either oral minoxidil or topical minoxidil? And I always recommend supplements. It's actually part of the reason I developed the UnTangled Hair Supplement, because almost every patient has something lacking in their diet or their metabolic reserves that's affecting their hair growth.
Think of your head of hair as a building that is constantly being remodeled. It is in a constant cycle of being torn down and rebuilt. If the crew putting up the bricks slows down, then the wrecking ball will be working faster than they are. And if the builders run out of materials, no building can occur. You need the construction site to build better than it takes down. And that's really where hormones and a good protein diet and supplements come in — they’re like the raw materials we need to build the building. And then if you don't have workers, nobody's going to build the building: That's where things like minoxidil can be used to kind of speed up the workers.
Will hair loss during menopause grow back?
Dr. Nuara: Really only if you address it. Once those follicles have started to go dormant, they're dormant until you can either wake them up or, even better, keep them from going to sleep in the first place.
Waking them up is, as we've said, certainly more difficult than preventive. And the waking up really varies very much per person — it's hit or miss. I tell patients: I may be able to help you get back 30 to 50% of the hair you've lost, but wouldn't it have been nice to keep 80% of it?
What are the treatment options for hair loss during menopause?
Dr. Nuara: An easy first step is start taking supplements that address nutritional deficiencies as well as a hair-health supplement that will boost keratin production, like UnTangled.
Then you’d want to think about hormone replacement therapy (HRT) to address the estrogen loss that causes thinning hair during menopause. Estrogen replacement, in the absence of other risk factors like heart disease or strong family history of breast cancer, is safer than we used to give it credit for, and it can improve skin, hair, bone density, a lot of things. But HRT isn’t a one-size-fits-all, so I recommend getting guidance from an endocrinologist or an OB/GYN who actually specializes in this.
For stimulating hair growth, I’d recommend using topical or oral minoxidil or our Hair Serum, which is minoxidil-free and gives us noticeable results within about three months. And if you’re fully through menopause, there’s a class of medications called 5-alpha reductase inhibitors (such as finasteride), which are proven to slow hair loss. These drugs can cause severe birth defects, so their use has limitations.
Bottom line is, we can usually slow down hair loss with some relatively simple interventions that won’t cost you your life savings. But the sooner you start, the better.
Anthony Nuara, MD, PhD, is a board-certified dermatologist and the founder of Foundation Skincare. Dr. Nuara conducts clinical trials and educates other physicians on new medications, furthering advancements in dermatological treatments and therapies. His research and clinical work are driven by a commitment to improving patient outcomes through cutting-edge science and personalized care. Dr. Nuara is in private practice in Arizona.
