How your hair can change leading up to the menopause

It is a period of life not many of us ladies look forward to, and with a long list of potential symptoms including hot flashes, headaches, brain fog, weight gain, insomnia (the joys!), hair loss is probably the last thing you want to hear about, but it’s on the list. It is important to remember that we will all have a different experience of the peri/menopause, some women may struggle with symptoms, while others may sail through with hardly any issue…….so hair loss will not be an issue for everyone.

Despite popular believe, the changes women may experience with their hair during the 4^th and 5^th decade are not exclusive to peri/menopause and can happen for a variety of reasons.

So, what could be happening?

Natural changes

Hair will go through some natural age-related changes, just like the skin:

• Hair Pigmentation – Perhaps the most noticeable change! Melanocyte cells which give our hair fibre its colour gradually decline leading to those white hairs. This process does not happen at the same time for everyone, but on average by the age of 50 half the population are likely to have 50% unpigmented hairs. White hair can lack lustre and often feel quite dry and course in texture.
• Hair density (number of hair’s per square cm) – There is a gradual reduction in hair density from around our mid 20s onwards!
• Hair diameter – This is an interesting one as numerous studies have now shown that the diameter of individual hairs actually increases over time, reaching a peak somewhere in our mid 40s then reducing somewhat after this. This may explain why many women do not appreciate any loss of density until their mid-40’s.
• Hair length – Hair goes through continuous cycles of growth and rest, with the average growth (anagen) phase lasting on average 2-6 years before entering its resting (telogen) phase where the hair exits the scalp within a 3-month period…..then the cycle starts all over again. The longer the anagen phase, the longer the hair will grow. The anagen phase does reduce over the years meaning hair will not grow as long as it used to.
• Hair growth rate – As cellular activity declines in the hair bulb, so does the speed at which our hair will grow.
• Hair fibre structural changes – Tensile strength can reduce, leading to weaker and a more brittle hair fibre. There are some more recent studies which also suggest there is an increase in hair curvature too!

Female Pattern Hair Loss (FPHL)

There is a misconception that FPHL is age related, which is untrue. In fact, this type of hair loss can appear at any point from puberty onwards, although it is more commonly seen around the peri/menopause years. Oestrogen has some protective qualities for hair follicles and can help to maintain the anagen phase of the hair cycle. As we approach menopause our oestrogen levels gradually decline, shifting the balance of hormones in favour of circulating androgens. Androgens (namely testosterone) then have the opportunity to exert their effects on genetically sensitive hair follicles, leading to a more significant reduction in hair diameter (miniaturisation) and a shorter growing phase. Affected hairs gradually become thinner and shorter with each passing cycle. This type of hair loss mostly affects the upper mid/frontal scalp regions in a diffuse manner, with the frontal hair line often retained and the back and sides generally unaffected. Women may notice an initial increase in shedding, as well as a wider central parting.

Telogen Effluvium (TE)

Telogen effluvium is a type of temporary hair loss associated with a disruption in the hair cycle. The primary symptom of TE is increased (sometimes persistent) hair shedding beyond what is normal. This can start rather suddenly or (in some cases) develop more gradually. There are MANY causes for telogen effluvium, and numerous factors can be contributing at one time. The most common causes associated with women in their 40’s and 50’s are:

• Stress – It is during these years we often experience children leaving home, marital problems, ageing parents and family deaths. Let’s face it, the stress of menopause is bad enough!
• Thyroid issues – There tends to be an increase in thyroid related problems around the age of menopause. An underactive thyroid more commonly affects the hair, including hair loss and a weak or brittle texture. If you have a family history of thyroid disease, it’s a good idea to have this checked with your GP.
• Medication – The need for medication generally increases with age, because of developing issues such as high blood pressure, high cholesterol, and type 2 diabetes. All medications can potentially cause TE, but some have a higher risk than others. The more common culprits include anti-coagulants, beta-blockers, ACE inhibitors, anti-depressants, anti-thyroid medication, and retinoids. *if you are concerned about hair loss its important to continue using your prescribed medication and seek the advice of your GP/Trichologist.
• Hormone imbalance – The sheer rollercoaster ride your hormones go through can be enough to induce an episode of TE.

Senescent/senile alopecia

This is a controversial topic within the hair loss industry, some experts believe it exists, others do not. I believe senescent alopecia to be the natural changes the hair goes through (listed above). It is not androgen related (despite appearances) and does not exhibit miniaturisation/variable hair diameter associated with female patterned hair loss.

Frontal fibrosing alopecia

This is much less common than the issues mentioned previously, but I am including it as it typically presents more frequently in post-menopausal women than at any other time…….and it is unfortunately on the rise! This is a scarring (permanent) type of hair loss affecting the frontal hair line and can extend behind the ears into the posterior hair line too. Its identified by the regression of the frontal hairline in a band like fashion, as well as eyebrow loss and lonely hairs left where the hair line used to be. It can also be accompanied by some burning, itching, and small white papules. If you are experiencing any scalp discomfort with your hair loss, please get in touch with a registered trichologist or a dermatologist (specialising in hair loss) as soon as possible to rule out scarring alopecia. Prompt treatment is essential for effectively treating these issues.

What can you do about menopause related hair loss?

For women experiencing any kind of hair loss/hair changes during this time of their life, the first thing I would recommend is to take a long hard look at general health and wellness. How well are you looking after yourself, are you making YOU a priority? The hair follicle is a complex organ and demands a great deal of energy to produce hair. As the body does not prioritise hair growth, your hair can be extremely sensitive to changes in your health. So, consider the following:

1. Reduce Stress – If you were being completely honest with yourself, how much time do you put aside for YOU each day? Do you give yourself time to relax away from work and the various stresses in your daily life? There are lots of effective ways to manage stress, you just have to find what works best for you (getting outdoors, listening to music, yoga……what makes you smile?)
2. Be more active – Think about how you could increase your activity levels (without going to extremes). Walk an extra 1000 steps a day, get out and do some gardening, take the stairs, walk instead of taking the car. Increasing activity will help to improve mental health, sleep quality, blood circulation, as well as helping to prevent long term illnesses such as heart disease, stroke, and type 2 diabetes. Plus……if you are getting outdoors, you will be giving your vitamin D levels a boost too, which is great for immunity!
3. Quality sleep – This can be tricky if you are being kept awake by night sweats etc, but there are several things you can do to help improve your sleep quality. Your bedroom shouldn’t be too hot, so keep a window slightly open and let air circulate. Get into a routine of going to bed and waking up at the same time. Minimise expose to devices emitting blue light. Reduce caffeine and alcohol intake……hydrate more. As mentioned above, increase activity during the day.
4. Eat Well – As a general rule, the things which are BAD for hair health include: crash diets or anything which restricts whole food groups (low carb, keto, intermittent fasting, 5:2). If you are trying to lose weight, do it gradually (no less than 1500 calories a day). You should avoid skipping meals (especially breakfast) and eat at regular intervals. Include good quality (complete) protein sources, iron, healthy fats, complex carbohydrates, vegetables and fruit (in as many different colours as you can manage). Declining oestrogen levels can have an impact on bone health, so including dairy is a good idea which is an excellent source of calcium, phosphorus, potassium, and magnesium. Many dairy alternatives also contain nutrients to support bone health as well as providing vitamin B12. Most important of all, include a little of what you fancy……eating should be an enjoyable experience!
5. Look after your hair – Sebaceous glands gradually reduce in size as we get older, meaning they produce less sebum (oil) which lubricates the scalp and hair preventing loss of lipids and water from scalp and hair fibre. This can leave hair more susceptible to environmental and mechanical damage. Make sure to use a good quality conditioner (especially if you have longer length hair), and look after your scalp by washing regularly, staying hydrated, and including healthy fats in your diet.Be mindful of what you do with your hair, turn down the heat and avoid vigorous brushing. When hair is wet it is much weaker, so make sure to use a wide tooth comb to detangle (no brushes please!).

In the case of female patterned hair loss there are a number of things that can help:

• Is your HRT hair friendly? – Many women opt for HRT to help with their menopause symptoms, but not all will be great for your hair! Some HRT contains synthetic progestogens with a high androgenic affect, which can have a negative effect on hair. HRT containing Norethisterone or Levonorgestrel are best avoided. Good hair friendly options include compounds containing Hydroxyprogesterone, Dydrogesterone, and Medroxyprogesterone.
• Topical Minoxidil – Is an approved medication used to treat female patterned hair loss, which can be highly effective. Originally used as an antihypertensive vasodilator, Minoxidil works by increasing blood flow to hair follicle cells and extending the anagen (growth) phase of the hair cycle.
• Low level Laser Therapy (LLLT) – Available as various home use devises, LLLT uses laser technology at a specific wavelength and frequency to generate chemical energy within the hair follicle cells.

Telogen Effluvium is generally a symptom of something else, including an underlying health issue, medication, or a reaction to a stressful event. The key to resolving telogen effluvium is to identify the cause. A trichologist will investigate this by looking into the events surrounding your issue, as well as general health, medical history, diet etc. Sometimes blood work may be required to establish any underlying causative factors.

If you are concerned about a scalp or hair issue, please get in touch for advice or to book an appointment with our Trichologist. Contact Angie: [email protected]/07946424640.

References

Robbins C, Mirmirani P, Messenger AG, Birch MP, Youngquist RS, Tamura M, Filloon T, Luo F, Dawson TL Jr. What women want – quantifying the perception of hair amount: an analysis of hair diameter and density changes with age in caucasian women. Br J Dermatol. 2012 Aug;167(2):324-32. doi: 10.1111/j.1365-2133.2012.11010.x. PMID: 22524482.

A Comment on the Science of Hair Aging: Ralph M Trüeb, Hudson Dutra Rezende, Maria Fernanda Reis Gavazzoni Dias. Int J Trichology. 2018 Nov-Dec; 10(6): 245–254. doi: 10.4103/ijt.ijt_56_18. PMCID: PMC6369639