- Menopause-related hair and scalp changes are primarily driven by decreased estrogen and progesterone levels, disrupting the natural cycle of hair growth, retention, and shedding.
- Symptoms include reduced hair growth, changes in hair texture, hair thinning, dryness, frizziness, hair loss, hirsutism, and scalp dryness, sensitivity, or tingling.
- Diagnosis may involve a medical history evaluation, physical examination, hair pull test, blood tests, scalp biopsy, trichoscopy, and ultrasound.
- Treatment options include hormone replacement therapy, topical medications like minoxidil, light laser therapy, hair transplant surgery, and dietary supplements like biotin.
- Management options include mindfulness practices, limiting hair exposure to heat, scalp massage, a diet rich in biotin, iron, and zinc, and limiting toxins like alcohol and smoking.
What is it?
Menopause-related hair and scalp changes result in a variety of alterations in body and head hair growth and the scalp. Changes are primarily driven by hormonal fluctuations, particularly the decrease in estrogen and progesterone levels, which impact hair growth and scalp health.
Symptoms include reduced hair growth, alterations in hair texture, and hair thinning. Head hair often becomes dry and frizzy. Hair loss can be experienced and is characterized by a gradual thinning of head hair, particularly on the crown and frontal scalp.
An increase in androgens can lead to excess hair growth (hirsutism). Scalp changes are also common, with many women experiencing a dry, sensitive, and sometimes tingling scalp. Understanding these changes is important for managing them effectively, whether through lifestyle changes, hair care changes, or seeking medical advice for more significant concerns.
What causes it?
A myriad of factors contribute to the hair and scalp changes experienced during menopause, with hormonal fluctuations playing a significant role. During this period, the body produces less estrogen and progesterone, hormones that promote hair growth and scalp health. The hormonal shift can disrupt the natural cycle of hair growth, retention, and shedding. It can also change the natural oils in the scalp, change the hair follicle shape, and change the hair’s protein structure. This hormonal shift can cause hair thinning, dryness, and textural changes.
Increased androgens can lead to conditions such as Female Pattern Hair Loss (FPHL) and hirsutism, characterized by excess hair growth. Scalp changes, such as dryness, sensitivity, and tingling, may also occur, often exacerbated by age-related reductions in sebum production.
Stress, poor diet, and certain health conditions like Polycystic Ovarian Syndrome (PCOS) and Cushing’s syndrome can contribute to hair and scalp changes, as can certain medications like testosterone and hair regrowth treatments like minoxidil.
What are the symptoms?
Menopause-related hair and scalp changes manifest a spectrum of symptoms that can significantly affect a woman’s appearance and emotional well-being. Common symptoms include variations in hair growth, with many women experiencing reduced hair growth, changes in hair texture, and noticeable hair thinning. Head hair often undergoes changes, becoming dry and frizzy, which can affect its manageability and appearance.
Head hair loss, specifically FPHL, is characterized by a gradual thinning of hair, especially on the crown and frontal areas of the scalp. Concurrently, some women may encounter hirsutism. Scalp changes are also common, with symptoms such as dryness, sensitivity, and a tingling sensation. These changes not only affect physical appearance but can also have a psychological impact, influencing self-esteem and emotional well-being.
Body and Head Hair Growth Changes
During menopause, you may notice significant alterations in your body and head hair growth, density, and fullness. Aging can cause hair follicles to shrink and produce thinner and weaker hair strands. This may include reduced hair growth, changes in hair texture, and hair thinning. The rate of hair growth may slow down considerably. You may also notice new gray hair coming through as levels of melanin, the hormone responsible for color, reduce.
Changes in hair texture can manifest as hair becomes coarser, weaker, or finer than before. Hair thinning may become noticeable when hair falls out more than usual, often resulting in widened hair partings on the head, and reduced volume or fullness and increased shedding. You may also notice hair becoming more wavy and curly, or patchy pubic hair changes. Symptoms such as hair thinning typically slow as hormones level out post menopause.
Head Hair Changes
Menopause-related head hair changes include dryness and frizziness. Dry hair often feels rough to touch, and is dull in appearance, more brittle, and more prone to breakage. This is because of the diminished oil production on the scalp, resulting in inadequate moisture for your hair.
Increased frizziness is due to the hair cuticles becoming raised, causing them to absorb more light and seem duller. This is exacerbated by the reduction in estrogen affecting the hair’s ability to retain moisture, and dry hair is more prone to frizz. This can lead to coarser texture and an increase in flyaways.
Head Hair Loss
Head hair loss during menopause typically includes a noticeable thinning of hair on the top and crown of the scalp with preservation of the frontal hairline. This happens as hair follicles shrink over time, leading to shorter and finer hair. It may start with a widening of the center hair part. The front hairline mostly remains unaffected.
Unlike males, female hair loss rarely results in complete baldness. However, hair thinning can become significant and bald spots may appear. Hair loss in females can be classified as FPHL or Female Pattern Baldness, also called Androgenic Alopecia.
Hair loss can be seen from early adulthood, however, commonly presents in menopause. More causes may include diet, eating disorders, fatigue, fevers, genetic factors, medical conditions, nutrient deficiencies, stress, and thyroid conditions. Hair loss is typically progressive, meaning it worsens over time without treatment.
Excess Hair Growth (Hirsutism)
Hirsutism can result in the development of dark coarse hair on areas of the body where hair growth is typically finer and in locations where men, not women, typically grow hair. Hair appears mostly on the face, particularly the chin and upper lip, resembling whiskers or a mustache, as well as the neck, chest, abdomen, back, buttocks, and thighs.
Hair growth is triggered by an increase in androgens, which are a group of sex hormones that help people enter puberty and mature physically, and men have more than women. The extent of hair growth varies; however, it can be a cause of emotional distress and impact on self-esteem.
Hirsutism may also come with virilization, which involves the development of secondary sex characteristics of men. Symptoms include acne, a deeper voice, decreased breast size, increased muscle development, menstrual irregularities, increased sex drive and clitoris enlargement, or clitoromegaly.
It is essential to consult a healthcare professional if these symptoms emerge to ensure appropriate diagnosis and treatment. These symptoms may also indicate other conditions, such as congenital adrenal hyperplasia or a tumor on your adrenal glands or ovaries.
Scalp Changes
Menopause-related scalp changes manifest as dryness, sensitivity, and a tingling sensation. These symptoms may start as subtle and become more noticeable over time.
Dryness can lead to flakiness or dandruff, causing discomfort and potential embarrassment. The increased sensitivity may make the scalp more susceptible to irritation from hair products or environmental factors. The tingling sensation, often described as a prickling or burning feeling, can be intermittent or constant and is typically more pronounced at night.
It’s essential to consult with a healthcare professional if these symptoms persist or cause significant discomfort. Symptoms may indicate other underlying health conditions such as psoriasis, seborrheic dermatitis, nerve damage, and scalp infections, or may be exacerbated by environmental factors including cold climates, humidity, and sunburn.
How is it diagnosed?
Diagnosis of menopause-related hair and scalp changes typically involves a comprehensive evaluation of a woman’s medical history, symptom presentation, and sometimes, a physical examination of the hair and scalp. This may include a hair pull test where your hair is gently pulled to test how many hairs come out. Healthcare professionals might consider blood tests to assess levels of sex, thyroid, and adrenal hormones, as well as ferritin, vitamin, and mineral levels. These tests help to exclude other conditions that could cause similar symptoms.
In certain cases, a biopsy of the scalp, where a small piece of scalp skin is examined, may be necessary to rule out skin conditions or infections. Trichoscopy, a non-invasive imaging technique using a dermatoscope (a device with a magnifying lens and power lighting system), may be used to evaluate hair density, structure, and scalp health.
Using these diagnostic tools, combined with a thorough patient history, allows for a correct diagnosis of menopause-related hair and scalp changes. Other diagnostic tests, such as ultrasound or X-radiation (X-ray) may be used to examine the ovaries, uterus, and adrenal glands to rule out other conditions. You may also be referred to a dermatologist who specializes in conditions that affect the skin, hair, and nails, or a trichologist who specializes in conditions related to the hair and scalp.
How is it treated?
Treatment for menopause-related hair and scalp changes involves a combination of medications, therapies, and dietary supplements. Where symptoms are related to an underlying cause, that condition requires treatment.
Hormone Replacement Therapy (HRT) may help hair and scalp symptoms by balancing hormone levels, helping to reduce hair loss and improve scalp health. Medications include topical Minoxidil to stimulate hair growth and thickness, however, continued use is required. Anti-androgens may be prescribed where Minoxidil is unlikely to succeed. Prescription creams can slow hair growth, medicated shampoos, topical creams, and medications can treat scalp changes, and a range of medications may be suitable for excessive hair growth depending on the cause, including oral contraceptives, androgen-suppressing medications, low-dose steroid medications and gonadotropin-releasing hormone (GnRH) agonists.
Procedures to encourage hair growth include light laser therapy, hair transplant surgery, injections of protein-rich plasma (PRP) and microneedling of the scalp. Procedures to remove unwanted hair include electrolysis, where the growth cells in hair follicles are destroyed so they can’t grow back and laser hair removal, using a laser or concentrated beam of light, to remove dark hair, when looking for a more permanent solution over tweezing, threading, bleaching, waxing and hair removal creams.
Dietary supplements, such as biotin, iron, multivitamins, vitamin E, and zinc, support hair and scalp health. Biotin is an essential B vitamin (B7 and sometimes referred to as vitamin H) that helps the body make protein used to form skin, hair, and nails. Lack of iron is a common deficiency in women with thinning hair, and may be partly responsible for symptoms. Zinc deficiency can lead to the breakdown of the protein structures in hair follicles, which can lead to hair loss. Phytoestrogens, plant-based compounds that mimic estrogen in the body, can be an alternative to HRT.
The effectiveness of these treatments varies among individuals and should be discussed with a healthcare professional.
How is it managed?
Menopause-related hair and scalp changes can be managed through lifestyle modifications and a preventive and protective approach to hair and scalp health.
Mind-body exercises like yoga and Tai Chi and mindfulness practices like meditation and deep breathing can help reduce stress, which can exacerbate symptoms, and help manage the psychological impact associated with hair and scalp changes.
Behavioral changes include limiting hair exposure to hair dryers and styling tools as the heat damages weakened follicles and already brittle hair, avoiding harsh dyes or chemicals that can damage hair and follicles, brushing hair gently with a soft brush to reduce hair loss, avoiding tight ponytail hairstyles, using silk pillowcases and wraps to reduce hair breakage, massage your scalp to stimulate blood flow, condition your hair to reduce dryness and frizz, add hair oil for moisture and shine, get your hair layered and cut shorter for more volume or texture or grow longer to weigh down curly or wavy hair, choose products without harmful ingredients like sulfates, parabens and synthetic fragrances, and shower with cooler water for less drying of the scalp.
Consuming a diet with nutrient-dense foods that contain biotin, iron, and zinc can help support hair and scalp health. Food options include salmon, shellfish, eggs, and red meat, including organ meat like liver. Staying hydrated with purified water can help hydrate the body, scalp, and hair.
Regular physical exercise and activity help manage weight, reduce stress hormones, such as adrenaline and cortisol, and increase blood flow and circulation in the body, including the scalp. Weight loss is effective in lowering androgen levels and thus reducing or stopping excessive hair growth. Exercise can help improve sleep quality and reduce disrupted sleep, which can affect stress levels and reduce blood flow. Inadequate blood flow to the scalp can result in weaker and thinner hair.
Maintaining social connections, engaging in stimulating activities, and taking part in enjoyable activities can help reduce stress levels supporting hair and scalp health. Reducing alcohol and smoking, both of which are toxins to hair and skin, can help support hair and scalp health and mitigate hair loss.
Menopause can bring hair and scalp changes, rooted in the reduction of estrogen and progesterone. This reduction can disrupt the natural cycle of hair growth, and change hair follicle shape and natural oils in the scalp. As covered, women may experience reduced hair growth, changes in hair texture, hair thinning, dryness, frizziness, hair loss, hirsutism, and scalp dryness, sensitivity, or tingling. Once a diagnosis is confirmed, treatment options range from HRT to topical applications to hair transplant surgery. Dietary supplements, such as biotin, iron, multivitamins, vitamin E, and zinc, support hair, and scalp health. Management strategies like limiting toxins like alcohol and smoking, and scalp massage to enhance circulation to the scalp, can reduce the effects of hair and scalp changes, and enhance well-being and self-esteem.
