Perimenopause Hair Loss: A Guide to Causes and Treatment Options

When You Start Noticing More Hair in the Drain

Hair loss during perimenopause is one of the most emotionally distressing symptoms many women experience. Hair is deeply tied to identity and self-image, and noticing it thinning or shedding more than before can feel alarming. You might find more hair on your pillow, in the shower, or on your brush. Your part may appear wider. Hair may feel less full or look thinner at the temples.

If this is happening to you, you are not imagining it, and you are far from alone. Hair changes are a recognized part of the hormonal transition of perimenopause. The good news is that for most women, the underlying causes can be identified and addressed, and hair loss related to perimenopause is often substantially reversible with the right approach.

What Is Happening Hormonally

Hair follicles are highly sensitive to hormonal changes. During perimenopause, several things happen simultaneously that affect the hair growth cycle.

Estrogen prolongs the anagen (growth) phase of the hair cycle. As estrogen levels decline, hair follicles spend less time in active growth and cycle through more quickly, resulting in more shedding relative to growth.

The shift in the ratio of estrogen to androgens (male-pattern hormones) during perimenopause can also trigger a form of hair thinning called female-pattern hair loss, or androgenetic alopecia. Androgens can shrink hair follicles over time, producing the progressive diffuse thinning on the top of the scalp that many women recognize.

High cortisol from chronic stress is another driver of hair shedding. Telogen effluvium (a stress-related form of hair loss) causes large numbers of hair follicles to shift from the growth phase to the shedding phase at once, often appearing two to three months after a significant stressor.

Thyroid hormone, which regulates metabolic rate and cellular function throughout the body, is also required for healthy hair growth. Hypothyroidism produces hair thinning that looks very similar to hormonal hair loss and is common in midlife women.

Ruling Out Other Causes

Not all hair loss in perimenopause is driven by sex hormones. Before assuming the cause, it is worth ruling out contributing factors that are independently treatable.

Iron deficiency and iron-deficiency anemia are among the most common causes of hair shedding in women, and they are particularly common in women who are still having heavy or frequent periods during perimenopause. Low ferritin (iron stores), even without full anemia, is associated with hair shedding. Ferritin below about 30 to 40 ng/mL is sometimes linked to hair loss even when hemoglobin is normal.

Thyroid dysfunction, both underactive (hypothyroidism) and overactive (hyperthyroidism), causes hair loss. A TSH test is a simple and essential starting point.

Vitamin D deficiency has been associated with hair follicle health in research, and low vitamin D is very common. Zinc and biotin deficiencies are also sometimes involved, though biotin deficiency is actually rare in people eating a normal diet despite being heavily marketed as a hair supplement.

Certain medications, including some blood pressure drugs, retinoids, and anticoagulants, can contribute to hair shedding. If hair loss began or worsened after starting a new medication, mention this to your doctor.

Treatment Options That Have Evidence

Minoxidil (Rogaine) is the most evidence-backed topical treatment for female-pattern hair loss. Available over the counter in 2 percent and 5 percent formulations, and in foam or liquid, minoxidil prolongs the hair growth phase and can produce noticeable regrowth with consistent daily use over three to six months. It works best when started early and used continuously; stopping it leads to return of hair loss. Side effects are uncommon but include scalp irritation and, rarely, unwanted facial hair with the stronger formulation.

Oral low-dose minoxidil (0.25 to 1 mg per day) is a newer approach that has shown promising results in women and may be better tolerated for some. This requires a prescription.

Spironolactone is an androgen-blocking medication that reduces the effect of androgens on hair follicles. It is commonly prescribed off-label for female-pattern hair loss, particularly when there is evidence of hormonal involvement. It can also improve acne and other androgen-related symptoms.

Hormone replacement therapy may improve hair loss for some women by restoring a more favorable hormonal environment. Some studies show that women on HRT have better hair density compared to those not on it. This is not a guaranteed outcome, but it is a factor worth discussing.

Nutritional support is appropriate when deficiencies are identified. Correcting low ferritin or vitamin D often produces noticeable improvement in shedding within several months.

What Does Not Work (and Why It Is Marketed Anyway)

Biotin supplements are among the most heavily marketed products for hair loss, but the evidence supporting them is limited to people who are actually deficient in biotin, which is uncommon. If you are not deficient, adding more biotin will not produce more hair growth.

Many shampoos and hair growth products claim to stimulate follicles, but none have the evidence base that minoxidil has. That does not mean shampoos are useless: a good shampoo for fine or thinning hair can make existing hair look fuller, and avoiding harsh chemicals and heat damage reduces breakage. But managing cosmetic appearance is different from treating the underlying cause of hair loss.

Collagen supplements have become popular, and while the evidence for skin and joint benefits is growing, the specific evidence for hair growth is limited. Protein intake overall is more relevant to hair health than any single supplement.

What to Discuss With Your Doctor

Track Your Progress

Hair loss and regrowth are slow processes. Most treatments take three to six months before any visible change, and it can be hard to know whether what you are doing is working without some form of tracking.

Photographs taken under consistent lighting, from the same angles (particularly the part and the top of the scalp), every four to six weeks give you a real comparison over time. This is far more useful than daily mirror-checking, which amplifies anxiety without giving you accurate information.

Logging your symptom days and any changes to your routine in PeriPlan helps you connect patterns over time, whether that is noticing improvement after starting treatment, or identifying stress-related shedding cycles.

This content is for informational purposes only and does not replace medical advice. Always consult your healthcare provider about your specific situation.