Menopause and hair loss: what changes and what may help

Menopause is when periods stop for good, usually between the ages of 45 and 55, and perimenopause is the time leading up to it when hormone levels change and symptoms often begin ¹. Along with hot flushes, sleep problems and mood changes, many women notice that their hair feels finer, the ponytail is thinner or the scalp shows more through the parting. This article explains why, what else might be going on and what may help.

Why hair can change around menopause

Hair follicles respond to hormones. During the reproductive years, oestrogen is thought to help keep hairs in the growing phase for longer. As oestrogen falls around menopause, the balance between oestrogen and androgens (hormones such as testosterone, which women also make) shifts. Reviews describe this hormonal transition as one reason why thinning becomes more noticeable at this stage of life ².

The most common type of thinning seen in this age group is female pattern hair loss. It causes a gradual reduction in hair density over the top and crown of the head, with a widening central part, while the front hairline usually stays in place ³. Studies have found that it is common in postmenopausal women ⁴. Genes play a part, and not every woman is affected. See a widening part for the early signs.

Other causes worth ruling out

Not all hair loss around menopause is caused by menopause itself. Other common causes at this age include:

• Thyroid problems. An underactive thyroid is more common in women and can cause tiredness, weight gain, feeling cold and dry hair or hair loss ⁵. Some of these symptoms overlap with menopause. See thyroid problems and hair loss
• Low iron. Heavy or irregular bleeding in perimenopause can lower iron levels. Iron deficiency anaemia can cause tiredness and hair loss ⁶. See anaemia and hair loss
• Telogen effluvium. An illness, operation, crash diet or major stress can trigger heavy shedding about two to three months later ⁷
• Medicines. Some medicines list hair loss as a side effect. See medicines that can cause hair loss
• Frontal fibrosing alopecia. A less common, scarring condition that mostly affects postmenopausal women, causing the hairline at the front and sides to move back, often with loss of eyebrows ⁸. It needs prompt assessment by a dermatologist

Reviews of hair loss in older women note that several of these causes can overlap ⁹.

What a doctor may do

A GP or dermatologist will usually ask when the change started, whether it is shedding or gradual thinning, about your periods and menopause symptoms, your medicines and family history, and then examine the scalp ¹⁰. Blood tests for thyroid function and iron may be suggested depending on your symptoms ¹¹. If the hairline is moving back, or the scalp is red, sore or shiny, a dermatologist should see it.

Treatment options with evidence

Topical minoxidil is the main treatment with good evidence for female pattern hair loss ¹². It is applied to the scalp daily and usually needs several months before any change is visible. Some women notice extra shedding in the first weeks, and results last only while it is used. See minoxidil and minoxidil side effects.

Other medicines. A dermatologist may discuss other options for some women, such as anti-androgen tablets or low-dose oral minoxidil, which need a prescription and monitoring ¹³. Our guide to female pattern hair loss treatment covers these in more detail.

Hormone replacement therapy (HRT). HRT is used to relieve menopause symptoms such as hot flushes ¹. It is not a standard treatment for hair loss, and the evidence for its effect on hair is limited. Decisions about HRT should be based on your overall symptoms and health, discussed with a doctor.

Treating other causes. If low iron or a thyroid problem is found, treating it may help the hair as well ^{6 5}.

Everyday hair care

Finer hair can break more easily. Gentle habits help keep the hair you have ¹⁴:

• Use a mild shampoo and conditioner
• Avoid tight ponytails, buns or clips that pull at the hairline
• Keep heat styling on lower settings and limit chemical treatments
• Consider a shorter or layered cut, which can make hair look fuller

A balanced diet with enough protein and iron supports general health ¹⁵. There is no strong evidence that supplements help hair unless you have a deficiency.

Looking after how you feel

Hair changes at this stage of life can affect confidence. It may help to know that this is a very common experience, and that there are practical options, from treatment to styling and camouflage. Talking to a doctor about menopause symptoms in general, including sleep and mood, is also worthwhile.

When to see a doctor

See a GP or dermatologist if:

• Hair fall is sudden or heavy
• You notice bald patches, or the hairline at the front is moving back
• The scalp is itchy, painful, red or scaly
• You have other symptoms such as tiredness, weight change or very heavy bleeding

The bottom line

Hair often becomes finer around menopause, mainly because of hormonal changes and female pattern hair loss. Other causes such as thyroid problems or low iron are worth checking. Minoxidil has the strongest evidence, and early treatment usually works best. For a wider look at causes, read hair loss in women.

Frequently asked questions

Does menopause cause hair loss?

Hormonal changes around menopause can make female pattern thinning more noticeable, and many women see finer hair at this stage ^{2 4}. Other causes such as thyroid problems or low iron should also be considered.

Will HRT help my hair?

HRT is used to treat menopause symptoms. It is not a standard hair loss treatment and the evidence for hair is limited. Discuss it with a doctor based on your overall symptoms ¹.

Is minoxidil safe after menopause?

Topical minoxidil is widely used for female pattern hair loss. Side effects can include scalp irritation and unwanted facial hair. Check with a pharmacist or doctor if you have heart problems or take other medicines ¹⁶.

Will my hair grow back after menopause?

Pattern thinning is long-term, but treatment may help keep the hair you have and improve density for some women. Results take months and last only while treatment continues ¹².

Educational content. Not medical advice.