Hair Loss in Midlife: What is Happening & Are There Functional Solutions?

Why Can Hair Thinning Happen in Perimenopause and Menopause?

Hormonal Shifts: The Main Culprit

During perimenopause and menopause, your ovaries produce much less estrogen and progesterone—hormones that keep hair in its growth phase longer. As these hormones decline, hair grows more slowly, becomes finer, and sheds more easily.

Additionally, in some women during perimenopause the relative effect of androgens (i.e. testosterone) increases and androgens can shrink hair follicles, leading to the hairs having a smaller diameter, so finer, shorter hairs and sometimes as a real slap to the face, increased facial hair.

Genetics & Other Contributors

• Genetics: Many women have a genetic predisposition to this rise in androgens which is called female pattern hair loss or androgenic alopecia, which menopause can trigger or worsen. This is extremely common (unfortunately).

• Stress: Physical or emotional stress and trauma can push more hair into the shedding phase which is called telogen effluvium. This typically occurs 2-4 months after the stressful event.

• Nutrition: Deficiencies in iron (anemia), vitamin D, zinc, or protein can contribute to hair loss. I see these deficiencies involved in hair loss ALL the time; they are very common.

• Thyroid Disorders: Both overactive and underactive thyroid can disrupt hair cycles which I also see in practice frequently.

• Medications: Some medications can also trigger hair loss.

What Types of Hair Loss Are Most Common?

• Female Pattern Hair Loss (FPHL): The most common type, causing diffuse thinning on the top and front of the scalp, often with a widening part but preserved hairline. Studies show that approximately 52% of healthy postmenopausal women experience some degree of FPHL, with prevalence increasing with age.

• Telogen Effluvium: Temporary, stress-related shedding that usually resolves when the stressor is removed and time has passed for new growth cycles to begin.

The Hair Growth Cycle: Why Shedding Happens

Your hair naturally cycles through four phases:

1. Anagen (Growth): 2–7 years, most hair is here when healthy.

2. Catagen (Transition): About 3 weeks.

3. Telogen (Resting): About 3 months; 10–15% of hair at any time.

4. Exogen (Shedding): 2–5 months, old hair is released and new growth begins.

Stress, illness, or hormonal changes can push more hair into the resting or shedding phases, causing noticeable thinning (telogen effluvium).

Evidence-Based Solutions for Hair Loss

Health Canada Approved Treatments

1. Minoxidil: AKA Rogaine, the only Health Canada approved topical treatment for female pattern hair loss. Available over the counter (up to 5% strength), it can slow loss and promote regrowth. Be patient—results take 3–6 months and note that if you stop the product you will not hold the result. Potential relatively common side effects: greasy scalp, irritation, changes in texture, colour, dandruff-like flaking.

2. Spironolactone: this drug is not approved by Health Canada for the treatment of female pattern hair loss (FPHL) but it is widely used off-label for it due to its anti-androgen properties, which can help reduce hair loss and improve hair density in women by blocking androgen receptors and decreasing androgen effects on hair follicles. Spironolactone is prescribed off-label by dermatologists when other treatments are insufficient or contraindicated but is contraindicated in those with low blood pressure.

3. Platelet-Rich Plasma (PRP): Injections of your own plasma to stimulate hair growth. Early studies show potential promise, for recent or mild thinning, but this is not yet validated with enough studies to be Health Canada approved.

4. Red Light Therapy: Uses specific light wavelengths to stimulate follicles and improve hair density. Many well designed studies show this to be effective as part of a comprehensive plan in particular for female pattern hair loss. This is not Health Canada approved, but it is well documented that these devices have strong merit.

5. MHT : menopause hormone therapy: progesterone and estrogen seem to have a role in this - as we know they clearly do due to the timing of how hair thinning happens, but of course we don’t have studies to verify this. In practice, I do frequently see women in my practice reporting that thinning slows or stops frequently when they begin hormone therapy, but it is not consistent.

6. What about supplements & herbs? Saw palmetto, biotin, collagen, maca, astaxanthin, curcumin, tocotrianols, zinc, iron, omega 3, vitamin D andashwaghanda all have some evidence and a potential role in treating hair loss, however, more research is needed. Note that often a “hair health/loss” supplement has ALL of these in it when a woman may not need iron, or Vitamin D or other things - so one and done supplements for hair loss are very rarely how to manage this - treatment usually requires personalization.

7. Rosemary oil is a well-researched as topical support for hair loss, as it reduces inflammation and improves circulation of the scalp, promoting nutrient delivery and hair growth.

Lifestyle Interventions

• Balanced Diet: Ensure adequate protein, iron, zinc and vitamin D. Restrictive diets can worsen shedding, as does extreme fasting or caloric deficit.

• Stress Management: Chronic stress raises cortisol, which can exacerbate hair loss. Mindfulness, yoga, or regular movement can help.

• Gentle Hair Care: Avoid harsh treatments (relaxants, colour, perms), tight hairstyles, and excessive heat.

• Hair re-growth shampoos: Those containing active ingredients such as caffeine and adenosine have shown promising results in reducing hair loss and improving hair strength and thickness in controlled studies.

• Products containing ketoconazole, zinc pyrithione, and piroctone olamine common in anti-dandruff shampoos may improve scalp health by reducing inflammation and fungal overgrowth, which can indirectly support hair health, but they do not directly prevent or reverse FPHL.

Assessment & Lab Testing

If your hair loss is sudden, patchy, or accompanied by other symptoms (such as fatigue, brain fog, or changes in your nails or skin), see your healthcare provider. It’s important to rule out thyroid disease, severe nutritional deficiencies, or autoimmune conditions like alopecia areata. As a general rule, even if the hair loss isn’t tied to other symptoms and is gradual, it really is of value to get a good history taken, and a complete set of labs done as sometimes the cause is singular and sometimes it’s multifactorial.

Key Takeaways

• Early intervention (assessment, appropriate lab work up) is important; time is of the essence!

• You are not alone and you have every right to find it extremely distressing

• There ARE options for treatment that are effective

Can you figure this out? YES. You definitely can. With the right information and support, you can take proactive steps to protect your hair and get your big bad ass self esteem back where up where she belongs.

If you have questions, don’t hesitate to reach out to me at info@drsmithnd.com.

Wishing you fantastic forever luscious locks,

Dr. Kirsten, ND, MSCP

References

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