Why you may be experiencing hair loss during menopause

Hair loss (alppecia in medical terms) is definitely not among the top common symptoms of menopause, so if you are reading this because you were worried you WILL experience it then exhale that breath you've been holding. Some women do experience hair loss and I wanted to discuss it little of what may be going on.

All causes of hair loss will occur when hair spends less time in the 'anagen', or growth, phase relative to static or loss phases.

The 3 most common hair loss conditions for women perimenopausal and post menopausal are:

Female pattern hair loss (FPHL)
Telogen effluvium (TE)
Frontal fibrosing alopecia (FFA)

Female pattern hair loss is the most common hair loss condition that I see in clinic. This looks like your hair thinning around the top of your head, most noticeable with a center part. It's diffuse hair loss and not patchy. I mention this, because there are forms of alopecia that are patches and those are not being discussed in this blog post. This hair loss has a chronic onset usually.

This is the hair loss that can be influenced by lowering estradiol levels. Although testosterone lowers during menopause it doesn't drop as much as estradiol does and this results in a relative 'hyperandrogenic state'. Hair follicles respond and are influenced on which growth phase they should be in as well as which hair follicles end up being shrunk (miniaturized). Other impacting factors here are microinflammation, deficiencies, smoking, medications, diseases like diabetes or thyroid conditions, and even hypertension.

Telogen Effluvium is abrupt and sudden when it starts. It can be due to a variety of instigating factors that stress the body such as: a high fever or illness (a couple months before hair loss is actually seen), stress, iron or vitamin D deficiencies, etc. And confusingly for patients, sometimes TE can trigger FPHL. The good news is that while the onset can be abrupt and 2-3 months after the insult, it isn't necessarily long lasting.

Frontal Fibrosing Alopecia is more of an up-and-coming diagnosis. This is marked by hair loss on the front of the face; eyebrows and hair around the forehead and bordering the face. There is marked microinflammation of the hair follicles in this condition.

You have probably noticed that there is some overlap with the causes. Truthfully hair loss is not fully understood. What's even more confusing are some of the treatment options. First and foremost the options listed below are not going to include things like "treat your diabetes/thyroid condition". The list is going beyond correcting deficencies and treating underlying health conditions.

For FHPL there are the following "pharmaceutical" options:

Minoxidil (Rogaine): How can I not mention rogaine?! This comes in 2% and 5% concentrations, with the 2% requiring a twice daily dose though lower risk of side effects. It has good research showing that it can slow hair loss.
Anti-androgen medications: Spironolactone, Finasteride. These have a bit more consistent evidence in helping with some of the symptoms of hormone changes than estrogen does. Spironolactone is a diuretic used for lowering blood pressure, though may cause symptoms of light headedness if you don't have high blood pressure going into treatment. Finasteride is a 5alpha-reductase inhibitor meaning that it will limit the conversion of testosterone so that there is relatively less of its impact on hair changes. However, Finasteride doesn't have a great track record in clinical trials for efficacy.
Estrogen therapy. This should be a no-brainer based on the effect estradiol has on hair. Research right now is actually producing inconsistent results so this is not looking like the panacea you may have thought it would be (yet).

What about Supplements? Diet? Lifestyle? What can a naturopath do to help with menopausal hair loss?

Lifestyle option: low level laser (red light) has some evidence coming out. It's not all positive but there are varying methodologies being used and until they all use the same treatment it's hard to judge something as clutch. If it was me, I'd add it in as it is promising.

Diet: I've probably said it a hundred times a day. Nothing revolutionary here - try to eat a balanced diet and avoid highly processed foods that will increase inflammation or worsen any preexisting health conditions. A mediterranean diet is a great goal.

Cheaper topical options other than Minoxidil, though there is very little research to support their use there is very little risk with them as well: