Menopause and hair loss: what is known

Many women notice, around the menopause, that their hair is thinner, that the parting has widened or that the ponytail has lost volume. It is not imagination: female androgenetic alopecia becomes much more common with age and affects up to about 40% of women by the age of 70. The fall in oestrogen at the menopause is one of the contributing factors.

The good news is that there are effective treatments, especially when you start early. Minoxidil remains the first-line treatment. Menopausal hormone therapy, on the other hand, which many women hope will fix their hair, has no consistent evidence of benefit for hair loss, according to a 2026 systematic review.

There is also a condition worth knowing about: frontal fibrosing alopecia, which mainly affects women after the menopause, makes the front hairline and the eyebrows recede, and leaves scarring. Recognising it early is important, because lost hair does not grow back.

What changes in hormones and hair

Hormones

At the menopause, the ovaries stop producing oestrogen and progesterone in quantity. Androgens, the "male" hormones that women also have, decline less. The result is a relative imbalance in favour of androgens.

In follicles with a genetic predisposition, especially on top of the head, androgens cause the hairs to become progressively thinner and shorter, a process called miniaturisation. Oestrogens, on the other hand, seem to prolong the growth phase, which explains why many women have fuller hair in pregnancy.

The hair

With age, regardless of the menopause:

• hairs become thinner and their diameter decreases;
• the growth phase becomes shorter;
• there are fewer hairs per follicle;
• hair becomes drier and more fragile, because the scalp produces less sebum;
• grey hairs become more frequent and have a different texture.

Other menopausal factors

• Hot flushes and insomnia, which disturb sleep and increase stress.
• Changes in weight, sometimes with diets to compensate for them.
• Thyroid changes, more common at this age.
• New medicines, for blood pressure, cholesterol or mood.

Each can add up and make hair loss worse. See Sleeping well and hair and Stress and hair loss.

The most common types of hair loss in the menopause

Female androgenetic alopecia: the most common

It affects 3% to 6% of women under 30 and 29% to 42% of women over 70, according to data gathered in the European guideline (Kanti et al., 2017). It is therefore very common in the years around the menopause. Hair loss is slow and the main sign is not "heavy shedding" but hair gradually becoming thinner and sparser on top. Learn more in Female hair loss: what it is and how to recognise it.

Telogen effluvium

It can appear on its own or add to androgenetic alopecia and make it more visible. The triggers are the usual ones: intense stress, illness, surgery, weight loss, iron deficiency, thyroid changes. We explain in Hair loss: why it happens and what to do.

Frontal fibrosing alopecia: recognising it early

It is a scarring alopecia that mainly affects women after the menopause; about 20% of cases appear before the menopause and men are rarely affected. The typical signs are (Dermatology Times):

• a band of smooth, paler skin between the forehead and the hairline, which keeps receding;
• loss of eyebrows, in 50% to 95% of cases, which may appear before or after that of the scalp;
• isolated hairs left behind in the lost area;
• sometimes also affecting the area behind the ears and the nape.

The number of cases has risen sharply in recent years. Some studies have linked it to the use of sunscreens and facial creams, but this relationship has not been demonstrated. Because the follicles are destroyed, the aim of treatment is to halt progression, and the earlier it starts, the more hair is preserved.

If you notice your front hairline or eyebrows receding, seek an assessment without waiting. See also Higher forehead: normal or worth checking?.

Other causes to rule out

Not all hair loss in the menopause is hormonal. Before concluding, it is worth ruling out:

• Thyroid disease, especially hypothyroidism, more common at this age;
• iron deficiency, especially if there were still heavy periods in the perimenopause;
• vitamin D or B12 deficiency;
• medicines started recently, such as some for blood pressure, cholesterol, osteoporosis or mood;
• restrictive diets to lose weight gained at the menopause;
• scalp conditions, such as seborrhoeic dermatitis or lichen planopilaris.

The most useful tests are, as a rule, a full blood count, ferritin and TSH, with others depending on the history. Male hormones are only requested if there are signs of excess, such as excess facial hair, acne or rapid hair loss. See Thyroid, iron and hormones: which tests to ask for.

Treatments: what has evidence

Treatment depends on the type of hair loss. For female androgenetic alopecia, the most common, the evidence points to the following:

Hormone therapy is not a treatment for hair

Many women ask whether menopausal hormone therapy fixes hair loss. A systematic review published in 2026 in the Journal of the American Academy of Dermatology analysed 13 studies and found no reproducible benefit of oestrogens for menopausal hair loss or female androgenetic alopecia (Farkas et al., 2026):

• topical oestradiol was inferior to minoxidil in a randomised trial;
• adding oestrogen to minoxidil did not improve the result;
• studies with systemic hormone therapy have had mixed results;
• two studies, including a large retrospective study, associated hormone therapy with a higher risk of frontal fibrosing alopecia.

Hormone therapy may be used for good reasons, such as hot flushes or bone protection, and that decision is made with your gynaecologist. But it should not be started with the aim of treating hair.

Frontal fibrosing alopecia

The treatment is different and aims to halt the inflammation. Options include oral anti-inflammatory medicines, corticosteroid injections and topical treatments, depending on each case. It is a condition for specialist follow-up.

What to expect

• Treatments for androgenetic alopecia are assessed at 6 months and the peak result is at around 12.
• The realistic aim is to halt progression and recover part of the density.
• The gains are kept as long as the treatment is kept up.
• All medical treatments require assessment and a prescription.

Daily care and lifestyle

• Enough protein and iron. Diet tends to change at this stage, and many women diet to compensate for weight gain. See Protein, iron and zinc: what your hair needs.
• Strength training. It helps to maintain the muscle and bone that are lost more quickly after the menopause.
• Sleep well, despite hot flushes: a cool bedroom, light bedding, regular hours.
• Gentle shampoo and conditioner for drier hair; moisturising masks on the ends.
• Less heat and chemicals. Fine hair breaks more easily. Cut down on straighteners and bleaching and prefer gentle colouring.
• Hairstyles that add volume: layered cuts, side parting, drying with your head upside down.
• Protect the scalp from the sun, which is more exposed when hair thins: a hat or sunscreen made for the scalp.
• Hair fibres and coloured powders can disguise the parting while treatment takes effect.
• Photograph the parting and the top every 3 months, in the same light, to track progress.

Excess facial hair: the other side of the same coin

The same hormonal imbalance that thins the hair on top can make coarser hairs appear on the chin, upper lip or neck. It is common at the menopause and, as a rule, mild.

• If the increase is slight and gradual, it is usually part of the menopause. It can be treated with hair removal methods or laser.
• If it is rapid and accompanied by a deeper voice, increased muscle mass, acne or hair loss that progresses quickly, a prompt medical assessment is important, to rule out a rare hormonal cause, such as a tumour that produces androgens.

In some women, the spironolactone used for hair loss also reduces these hairs. On the other hand, oral minoxidil can increase them, so the choice of treatment must take both aspects into account.

When to seek a medical assessment

Without waiting, if:

With a routine appointment, if:

• Your hair is getting thinner on top or your parting is widening.
• Diffuse hair loss lasts more than 3 months.
• You have tiredness, changes in weight or other symptoms.
• You want to start a treatment and find out what suits you.

At Luxmed, the Hair Medicine consultation assesses the type of hair loss with trichoscopy, which helps to distinguish androgenetic alopecia from scarring alopecias, and, when indicated, blood tests.

This article is for information only and does not replace a medical consultation.

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