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Perimenopause Hair Loss: Symptoms, Prevention, and Treatment
Dr Meena Zareie (GMC)
Medically reviewed by
Dr Meena Zareie (GMC)
Updated on January 29, 2024

The years leading up to menopause can be a trying and confusing time for most women. And perimenopausal hair loss can only make matters worse. While you may have expected to experience common symptoms, such as hot flashes or mood swings, you may not be aware that while over 50% of women experience postmenopausal hair thinning [1], this process can sometimes begin years before you stop menstruating.

This is due to the significant hormonal changes which start to occur in your body during the perimenopausal period. As your female hormone levels start to decline, the delicate balance between oestrogens and androgens is disrupted. This often leads to the onset of female pattern baldness, a condition associated with diffuse hair thinning, a widening of your midline part and in more severe cases, a bald spot on the crown [2].

Fortunately, there are efficient ways to prevent and treat perimenopausal hair loss. Hormone replacement therapy, a reduction in stress levels and a well-balanced diet [3] can help keep hair shedding at bay, while treatments, such as Minoxidil, can stimulate your hair growth.

Keep reading this article to find out all you need to know about:

  • What perimenopausal hair loss is
  • How to identify perimenopausal hair loss
  • What you can do to prevent perimenopausal hair loss
  • The most efficient treatments for perimenopausal hair loss
  • Helpful tips for masking your hair thinning
Table of Contents

What is perimenopause?

woman experiencing hot flash

Perimenopause represents a period of transition towards the end of a woman’s fertile period. It often begins sometime between ages 35 and 45 and can last several years, leading up to menopause.

While a woman is considered to have reached menopause when 12 months have passed since her last menstruation, perimenopause begins with the first menstrual irregularities caused by the incipient decline in female hormones and ends 1 year after her final menstruation [4][5].  

During perimenopause, the production of female hormones, such as oestrogens, begins to fluctuate and gradually decrease. This can cause a hormonal imbalance in the body, as the proportion of male hormones (androgens) increases, leading to symptoms often associated with menopause, such as [5]:

  • Hot flashes
  • Night sweats
  • Vaginal dryness
  • Sleep disturbances
  • Fluctuating moods
  • Memory and concentration issues
  • Changes in your menstruation (e.g. absent, light or particularly heavy menstruation)
  • Hair shedding or hair loss

How does perimenopause cause hair loss?

woman horrified by the amount of hair on brush

There are several ways perimenopause can have a detrimental impact on your hair, potentially leading to hair thinning:

1. It can trigger or worsen female pattern hair loss

advanced female pattern hair loss

Androgenetic alopecia, also known as female or male pattern baldness, is caused by a combination of age, genetic and hormonal factors. This condition is encountered significantly more frequently in perimenopausal and postmenopausal women (37%) than in premenopausal ones (13%) [6][4]. 

That is because it occurs when excessive production of a male hormone called dihydrotestosterone (DHT) causes it to bind to androgen receptors in your hair follicles, causing them to shrink and stop producing hair [2].

Since the level of female hormones naturally starts to decrease during perimenopause, they are no longer able to adequately balance their male hormones, which also start to decline, but less substantially and more gradually. This often leads to the onset of female pattern baldness (or to a worsening of its symptoms, if you were already experiencing it).   

2. It can disrupt your hair growth cycle

Your natural hair growth cycle involves several phases [19]:

hair growth cycle
  • The growing (anagen) phase – 80-90% of your hair follicles are normally in this phase and it usually lasts about 3-10 years.
  • The transition (catagen) phase – 5% of your hair at a time is usually in the transition phase, where they only remain for 2-3 weeks. 
  • The resting and shedding (telogen) phase – 10-15% of your hair at a time is normally in the telogen phase, which usually lasts 6-9 months.

Research has shown that each of your hair follicles has an internal clock which lets it know when it is time to move from one phase to the next [7] Female hormones, such as oestrogens, have been found to play a role in the regulation of that internal clock. 

During perimenopause, your levels of oestrogens fluctuate significantly, and these variations can cause a disruption to your hair follicle’s ability to determine the proper duration of each hair growth stage. This can lead to a shortening of the growing phase, as well as getting stuck in the shedding phase, a condition known as chronic telogen effluvium [7]. 

While regular telogen effluvium is often stress or trauma-induced and only lasts around 6 months, chronic telogen effluvium can last for years. It normally causes diffuse thinning, but doesn’t make your midline parting wider, nor does it lead to bald spots [8].  

3. It can reduce nutrient supply to your hair follicles

Oestrogens play an important role in your metabolism and in the distribution of nutrients in the body. Furthermore, these female hormones help dilate your blood vessels, allowing more oxygen and nutrients to flow to your hair follicles [9]. 

As your oestrogen levels start to dwindle during perimenopause, your hair follicles may no longer receive sufficient blood flow and thus, they may be deprived of some of the nutrients they need to grow and produce healthy hair [3]. 

What does perimenopausal hair loss look like?

Since female pattern hair loss is the most common cause of perimenopausal hair loss, here are the main symptoms you should watch out for:

Diffuse hair thinning (especially around the crown)

diffuse hair thinning around the crown

A widening of your hair parting

before and after hair thinning
Before and after thinning of the midline parting

A Christmas tree pattern around your hair parting

example of Christmas tree pattern around the hair parting

In advanced cases, a bald spot on the top of your head, around your hair parting

example of bald spot on top of the head

However, not all perimenopausal women develop female pattern hair loss. Still, some might find that their hair is falling out due to hormone-induced telogen effluvium [7]. If that is your case, you may only experience diffuse hair thinning and in some cases, a burning sensation on your scalp

hair shedding from telogen effluvium
Patient with telogen effluvium, demonstrating the amount of hair loss in one brushing [17]

While this is not necessarily induced by perimenopause, ageing can also determine changes in your hair texture, as your follicles become smaller and produce fine strands [18]. This can make your hair feel thinner without experiencing significant hair loss. 

How do I prevent perimenopausal hair loss?

There are several things you can do to prevent perimenopausal hair loss. Here are some of the most effective:

Inform your gynaecologist of your perimenopause symptoms

It is a good idea to see your gynaecologist as soon as you start experiencing menstrual irregularities or other symptoms of perimenopause. They may request tests to determine your hormone levels and may recommend hormone replacement therapy (HRT) if needed [10].

HRT can help maintain the balance between your female and male hormones and thus, reduce your chances of developing androgenetic alopecia. 

See a trichologist as soon as you notice hair thinning 

It is important to see a trichologist from the first signs of hair thinning and balding, so you can get proper diagnosis and treatment. Addressing hair loss in its incipient stages makes it easier to treat and less likely to advance.

Stop smoking  

Smoking is one of the main factors associated with early menopause [11]. So, if you have not yet reached perimenopause, giving up this habit can delay its onset. Moreover, smoking has been proven to accelerate hair loss in androgenetic alopecia [12] and constrict your blood vessels, reducing the amount of oxygen and nutrients that reach your hair follicles [13].

Maintain a well-balanced diet 

A decline in oestrogen levels can also lead to metabolic issues and to a decrease in nutrient absorption. That is why it is important to ensure that you are not developing vitamin deficiencies that can cause hair loss. Getting sufficient biotin for hair, vitamin D, zinc and iron can help keep your hair healthy during perimenopause [3].

Try essential oils for hair loss

While not all essential oils can help with hair loss, you can try some of the best oils for hair growth, which have a proven effect in reducing hair thinning. For example, rosemary oil for hair growth is a natural DHT blocker proven to be as effective as Minoxidil in reducing androgenetic alopecia [14].

Pumpkin seed oil for hair has also been found effective in treating female pattern baldness [15] and black seed oil for hair is known to regulate your hair growth cycle and is effective against telogen effluvium [16]. 

Reduce your stress levels 

Stress can accentuate your perimenopausal hair thinning by triggering telogen effluvium. Practising yoga, meditation or starting psychological therapy can help you clear your mind, relax your body and regain hair loss from stress

Does perimenopause hair loss grow back?

Since perimenopause is merely a transition phase towards the permanent hormonal changes brought on by menopause, the hair loss that it produces is likely to continue unless treated. So it is always a good idea to see a trichologist to help you determine whether your hair shedding is indeed caused by perimenopausal hormone changes and to recommend the most effective treatment. 

The good news is that once you begin hormone replacement therapy and/or a hair growth treatment, you have a good chance to stop and sometimes even reverse your perimenopausal hair loss. Of course, this depends on a number of factors, such as genetics, the extent of your hair loss and your response to treatment. 

The best hair growth treatments for perimenopausal hair loss

Here are some of the most frequently recommended, evidence-based treatments for perimenopausal hair loss:

  • Minoxidil –  often used topically, Minoxidil is one of the most effective hair growth medications for women. It works by increasing blood flow to your hair follicles and thus supplying them with more oxygen and nutrients to help them grow.
  • Dermarolling for hair growth – commonly known as microneedling, this therapy involves the creation of minuscule punctures in the scalp, using a special tool. This stimulates the body’s healing response and at the same time, it allows topical hair growth medication, such as topical Minoxidil, to penetrate your scalp more efficiently.
  • Red light therapy for hair growth – this variation of low-level laser therapy (LLLT) uses a focused beam of red or near-infrared light to increase your cell metabolism, bringing more energy to your hair follicles.
  • Hair transplantfemale hair transplants are becoming an increasingly common solution to female pattern baldness. That is because hair restoration surgery is simple and very efficient. The procedure involves harvesting healthy hair follicles from areas of your scalp unaffected by alopecia and reimplanting them into the thinning areas. 

The best hair transplant clinics in the UK have a 97-100% success rate regardless of whether you choose an FUE or FUT type procedure. This means you can get a natural-looking hair transplant that may solve your hair loss problems for years to come because hair transplants are permanent

However, since perimenopause is a period of erratic hormonal activity, you should discuss with your surgeon whether getting a hair transplant would be a good idea at this time or if it would be best to wait until you have reached hormonal balance again.

Tips to make your hair look thicker during perimenopause

If you are looking for short-term ways to hide your thinning hair or give it the appearance of density and volume, here are some ideas that could help:

  • Volumize your locks with one of the best shampoos for menopausal hair loss. 
  • Use a hair-thickening spray to make your locks appear fuller.
  • Micropigmentation can help if your hair is so thin you can see your scalp. 
  • Check out the best female hair loss hairstyles 
  • Switch to a side or zig-zag parting to mask a widening midline part

Are you concerned about perimenopausal hair loss?

If you are experiencing perimenopause and are starting to wonder whether your hair is thinning or you are paranoid, don’t leave this up to chance, as many women see the onset of hair loss around this time. The sooner you address this issue, the more likely it is to be treatable.

So book a consultation now with one of our top-tier trichologists. They will perform a thorough examination and confirm whether your hair loss is indeed hormone-induced or whether it is a result of a different condition, such as traction alopecia or alopecia areata. They will also be able to recommend the best hair loss treatment for women, fully customized to your needs.

Perimenopause Hair Loss: Symptoms, Prevention, and Treatment, Wimpole Clinic

Dr Meena Zareie (GMC)
Medically reviewed by Dr Meena Zareie (GMC)Updated on January 29, 2024
The Wimpole Clinic offers FUE Hair, Beard & Eyebrow Transplants & Trichology.
Talk to a specialist ☎ 020 7935 1861.

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