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Does Perimenopause Cause Hair Loss? Ob/Gyns Share the Truth

By Beth Ann Mayer,

1 day ago

Hot flashes , mood swings and irregular periods are among the commonly-discussed signs a person is heading toward menopause, a natural occurrence that's often misunderstood (including that a person goes right from reproductive years to menopause. Perimenopause serves as a bridge between the two).

However, a person who has reached menopause, which occurs 12 months after a final period, or in perimenopause might notice another potential side effect: Hair loss .

It can be emotional to see the shower drain clogged more than ever during a time that naturally brings mood changes.

"Any physical change can cause concern, but hair loss, in addition to other outwardly appearing physical changes that are apparent to others, can be of particular concern," says Dr. Alyssa Dweck, MS, MD, FACOG , the chief medical officer of Bonafide Health. "Hair loss has significant psychological effects affecting self-esteem, body image and emotional well-being."

However, what’s the link between perimenopause and hair loss? Is there even one? TL;DR: There might be, and knowledge is power.

"Sometimes, having a basic understanding of things can make you feel better," says Dr. Christine Greves, MD , an OB/GYN with Orlando Health. "Also, if you are aware that your hair may be more brittle, then [you might make] different choices."

Experts discussed the theories behind the link between perimenopause, menopause and hair loss. They also shared other factors that could be contributing to thinning hair during this time, solutions and when to see a doctor.

What To Know Perimenopause Hair Loss (Including Whether It’s a Thing)

Dr. Greves explains that not every person will experience hair loss in perimenopause or menopause. However, she and Dr. Dweck say it's common.

"Some women experience hair thinning on the scalp throughout the menopause transition," Dr. Dweck says. "While the cause is not fully understood, genetic, hormonal and environmental factors are likely involved."

Again, the menopause transition refers to the perimenopausal period. Additionally, data suggests that, after menopause, hair loss can also accelerate. A 2022 study of 178 postmenopausal women found that more than half of them experience female-pattern hair loss. What gives? Perhaps unsurprisingly, hormones likely play a crucial role in perimenopause hair loss (and hair loss after menopause).

Hormones are crucial to hair growth cycles, says Dr. Ken Williams, Jr., D.O., FISHRS, ABHRS , a surgeon and founder of Orange County Hair Restoration and author of Hair Transplant 360—Follicular Unit Extraction .

Dr. Williams points to research, including from 2024 , that these hormones include:

Androgens
Estrogens
Stress hormones, like ACTH and cortisol
Thyroid
Growth hormone

" Estrogens include estrone, estradiol and estriol, and they exert their effects on two receptor sites in the hair—alpha and beta," Dr. Williams says. "Estrogens can exert a positive influence on hair growth and are assumed to promote hair growth. Menopause is associated with lower estrogen and thus is associated with hair loss."

An older 2006 study of mice and skin cells indicated that estrogen can affect hair growth.

Other Factors That Could Contribute To Hair Loss In Menopause

1. Age

Age is more than a number when it comes to hair quality, at least for some people.

"As we age, the total number of hair follicles decreases," Dr. Williams says. "Aging causes loss of normal cell function and regenerative capacity. As the hair follicle becomes less active, we begin to observe signs of aging. Hair loss is one of the signs of aging and graying of the hair shaft."

Dr. Williams notes that people most often notice hair loss when 50% of the follicles are gone. At this point, the loss is referred to as alopecia. A 2023-published overview also pointed to research that reports of hair loss in females increased with age.

2. Nutrient deficiencies

"In my clinical practice, I observe diet and nutrition plays a role in hair loss and thinning," Dr. Williams says.

Dr. Williams cited 2019 research that showed that nutritional deficiencies that can factor into hair loss included:

Vitamin A
Vitamin B-Complexes (B1, B2, B3, B5, B6, B7, & B12)
Vitamin C
Vitamin D
Vitamin E
Iron
Selenium
Zinc

Other research also indicates that vitamin D and iron deficiencies can contribute to hair loss.

3. Genetics

"Genetics surely play a role as well," Dr. Dweck says.

Dr. Greves also points to genetics as a potential reason for hair loss. A 2023 review found that female-pattern hair loss might be an inherited trait.

If your mother had hair loss in her 40s, 50s or 60s, there's a chance that's part of the reason you are experiencing it, too.

4. Illnesses and disease

Dr. Williams says other, more severe issues may contribute to hair thinning or shedding. For this reason, it's important not to automatically assume perimenopause or menopause is the sole reason for hair loss. Dr. Dweck agrees, saying other medical reasons for hair loss include chronic illness, such as autoimmune conditions and thyroid disorders. Additionally, Dr. Dweck says medications to treat illnesses can come with side effects like hair loss.

What To Do About Menopause Hair Loss (And Hair Loss, Generally)

First, experts recommend flagging hair loss concerns with a doctor to rule out underlying health conditions. "First, a full medical evaluation with a thorough history, physical, blood work and possible dermatology consultation and even scalp biopsy are in order," Dr. Dweck says.

Dr. Williams agrees. Even if no underlying conditions exist, flagging hair loss early is best. "Most patients don’t notice hair loss until 50% of the total hair follicles have transitioned into a permanent resting phase," Dr. Williams says. "In this phase, the hair shaft cells that create hair no longer can produce the individual hair follicle shaft. Early intervention and treatment can allow patients to regenerate and strengthen their hair follicles."

Dr. Dweck says treatment might include addressing nutrient deficiencies. Dr. Williams says medication management can also help. "Medication management includes the regular and consistent use of a DHT inhibiter (DHTi), Minoxidil and laser treatments demonstrates excellent clinical results," Dr. Williams says. "Platelet-rich plasma (PRP) is also a procedure that demonstrates good clinical outcomes in most of our patients."

You may also be able to tweak your haircare routine. "For example, you may need to stop using heat on the hair given that it may be more brittle," Dr. Greves says. "Also, speak with your hairdresser about your concern to see if they have any ideas."

One potential remedy? "As simple as it sounds, avoidance of super tight ponytail/bun is recommended," Dr. Dweck says.

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Sources

Dr. Alyssa Dweck, MS, MD, FACOG , the chief medical officer of Bonafide Health
Dr. Christine Greves, MD , an OB/GYN with Orlando Health
Prevalence of female pattern hair loss in postmenopausal women: a cross-sectional study. Menopause .
Dr. Ken Williams, Jr., D.O., FISHRS, ABHRS , a surgeon and founder of Orange County Hair Restoration and author of Hair Transplant 360 – Follicular Unit Extraction
The Hormonal Background of Hair Loss in Non-Scarring Alopecias. Biomedicines .
The hair follicle as an estrogen target and source. Endocrine Reviews .
Female Pattern Hair Loss: An Overview with Focus on the Genetics. Genes (Basel).
The Role of Vitamins and Minerals in Hair Loss: A Review. Dermatology and Therapy .
Role of vitamin D in hair loss: A short review. Journal of Cosmetic Dermatology .
The diagnosis and treatment of iron deficiency and its potential relationship to hair loss. Journal of the American Academy of Dermatology .