6 Ways to Combat Hair Loss During Perimenopause

About the Experts:

Nathan Goodyear, M.D., is the medical director of Brio-Medical, a holistic, integrative healing center in Scottsdale, AZ. In addition to being board-certified in obstetrics and gynecology, Dr. Goodyear is a Fellow in Functional and Regenerative Medicine.

Jerilynn Prior, M.D., is a professor of endocrinology at the University of British Columbia, in Vancouver, Canada who focuses on, among other things, the menstrual cycle and the study and treatment of vasomotor symptoms.  

Jim Staheli, D.O. is the medical director of Broad Health, and a family medicine doctor in Atlanta, GA. His areas of expertise include hormone health, metabolic and nutritional medicine, anti-aging, and functional medicine.

How Does Perimenopause Cause Hair Loss? 

The hormones estrogen and progesterone—the very two that are going hog wild fluctuating during perimenopause—are both involved in maintaining healthy hair. Literally each of the 80,000 to 120,000 strands of your hair goes through the same three-phase cycle (although not in unison): growth, transition, and resting, during which the hair drops out (1, 2).

When hormone levels are just right, they support more growth and help strands stay in the growth phase longer. And the more strands that stick around on your head at any given time, the fuller your hair will be. The converse is also true: The shorter the growth phase of any given hair, the sooner it will get to the resting phase and fall out, and the more hair that falls out…well, you get the idea. 

Estrogen and progesterone in perimenopause 

Your hormone levels are less likely to be just right during the menopause transition. “Hormones are best described in the context of a symphony,” says Nathan Goodyear, M.D., medical director of Brio-Medical in Scottsdale, AZ. When they’re in sync, they make beautiful music, but when they’re not, it’s more like middle school band practice—and chaotic imbalance is responsible for several perimenopausal symptoms. “Hair loss in perimenopause is a good example of this,” he says. 

If you have kids, you’ll remember that thick and lush Disney Princess “pregnancy hair” you had when you were expecting and your whole system was awash with estrogen—and the subsequent mass shedding, which left you picking strands off your breasts and your baby’s head while nursing. That was all the work of fluctuating hormones, and perfectly normal, per the American Academy of Dermatology (AAD). 

In perimenopause, your wildly changing hormones are at it again. The dip in both estrogen and progesterone affects circulating serum levels of estradiol, follicle-stimulating hormone, and luteinizing hormone, which will affect the health of your scalp, function, and size of your hair follicles (they tend to shrink and each strand gets thinner, which is called miniaturization). The fluctuation even affects the natural oils that keep your locks looking smooth and feeling soft (3). About half of women will experience some degree of androgenetic alopecia, also called female pattern hair loss by perimenopause (4).

Health conditions

Of course, it may be a coincidence that you’re having hair loss during perimenopause, as other factors can also cause us to shed more than usual and impact hair growth. Underlying health issues including thyroid disease, deficiencies in zinc or iron, scalp psoriasis, and polycystic ovary syndrome (PCOS) can all cause hair thinning, according to the AAD. 

Stress

“Significant stress can cause telogen effluvium,” says Jerilynn Prior, M.D., a professor of endocrinology at the University of British Columbia, in Vancouver, Canada. This is a condition where large numbers of hair follicles go into a resting phase all at once, then shed simultaneously a few months later, according to the Cleveland Clinic. 

And who do you know who isn’t stressed out? Let’s face it: life can be a lot in midlife, especially if you’re balancing the needs of ailing parents, school-age kids, and a demanding career. Oh right, and perhaps also the symptoms of perimenopause. 

But try not to stress too much—you’re unlikely to end up with bald patches or a totally naked noggin like your Uncle Marv. It’s more of a general thinning, or you may notice a higher hairline or wider part (which, not for nothing, is easier to hide with a creative hairdo). “Hormonal hair loss in perimenopause tends to occur in the forehead and central areas,” says Goodyear. 

What Can I Do to Stop Perimenopause Hair Loss? 

You can’t halt hair loss altogether. But there are a few things you can do to stimulate growth and encourage healthier-looking hair as you make your way to menopause. Keep in mind that some overall thinning as we age is (sigh) inevitable and that while some regrowth is possible during peri and meno, our aim is to hold on to the density we’ve got for as long as we can. With that in mind, here are a few approaches that can help.

Hormone therapy (HT)

There’s not a lot of research on the effects of HT on hair loss (or regrowth), but if you are already taking it to address your other symptoms, it’s likely to help your ‘do, too. In theory, the bump in estrogen levels should decrease androgen production, slow the shrinking of follicles, and keep your hair in the growth phase for longer, according to research (5).

Eat well

A balanced diet ensures your body has the necessary nutrients to support healthy hair growth and maintenance throughout perimenopause (6). The Cleveland Clinic recommends key nutrients to focus on, including:

• Biotin, a vitamin that helps with the production of keratin (a protein that is essential for forming hair, as well as nails and skin). It’s found in egg yolks, seeds, and sweet potatoes. 
• Iron is used by red blood cells to carry oxygen throughout the body, and it also supports hair growth. Iron-rich foods include red meat, lentils, and dark leafy greens. 
• Vitamin C fights free radical damage and is essential for creating collagen, which is a building block of hair. Adding more peppers and citrus fruits to your plate can help. 
• Omega-3 fatty acids, found in fish and flaxseed, may help to support the health of your hair and scalp, too.

Pop a supplement 

If you don’t think you’re getting everything you need from your diet, it might be time to lean on a supplement. Talk to your doctor about testing your blood to see which nutrients you might need more of, and whether you should supplement. Iron levels are important to check, because they can be low if you are a vegetarian, have a history of anemia, or have been dealing with crazy-heavy perimenopausal periods, for example, according to the National Institutes of Health. 

Try a topical treatment 

Over-the-counter hair loss treatments containing minoxidil can help slow the rate of hair loss and regrow dropped strands more quickly. You’ll need to use it consistently for at least six months to tell if it’s working, then continue using it to maintain your mane. 

Investigate hair loss treatments

There are a few that the American Academy of Dermatologists say can be effective: Low-level laser therapy is safe and painless, but often requires several in-office treatments with a dermatologist. In some cases, corticosteroid injections by a doctor can stimulate regrowth of hair in sparse areas, as can microneedling. There’s some research showing that using a red light device at home could help stimulate hair growth, too. If it bothers you, make an appointment with a derm who specializes in hair loss to explore all your options.

Lean into a healthy lifestyle

Managing stress is key for surviving the side effects of hormonal ups and downs, including mood swings, anxiety, and depression, as well as hair loss. “You really need to eat whole foods, get enough sleep, and carry on with exercise,” says Prior. “Those all reduce stress and will help you manage the physiological as well as emotional changes you are going through,” she says. Plus, stress management techniques like yoga, meditation, and even talking to a friend will all help you maintain a better balance throughout perimenopause.