Perimenopause Hair Thinning: Why Your Hair Is Changing and What Actually Helps

It starts with the shower drain. A clump of hair sitting there that seems larger than it should be. You tell yourself it's normal, that everyone sheds. But then you notice your part line. It's wider than it used to be. You can see more scalp than you remember. Your ponytail feels thinner in your hand, like half the volume quietly disappeared when you weren't paying attention.

Maybe you've started avoiding certain hairstyles because they reveal too much. Maybe you've found yourself staring at old photos, trying to figure out when the change happened. Maybe you've Googled "why is my hair falling out" at midnight, heart pounding, hoping the answer isn't something serious.

Here's what you need to know first: you are not imagining this. Perimenopause hair thinning is one of the most common, and most emotionally distressing, symptoms of this transition. Research published in the British Journal of Dermatology shows that up to 40% of people experience noticeable hair changes during the perimenopausal years. Your hair is responding to real shifts happening inside your body. And once you understand what's driving those shifts, you can start doing something about it.

What hair thinning looks like during perimenopause

Hair thinning during perimenopause doesn't usually look like what you'd expect from movies or TV. You're probably not finding bald patches. Instead, what most people experience is diffuse thinning, a gradual, all-over reduction in hair density that's most noticeable at the crown of the head and along the part line.

Dermatologists call this female pattern hair loss, or androgenetic alopecia. It's different from male pattern baldness. Rather than a receding hairline or a bald spot at the back, your hair slowly becomes finer and less dense across the entire top of your scalp. The temples can thin too, making your hairline look like it's pulling back slightly at the sides.

Then there's the shedding. You may notice significantly more hair coming out when you wash, brush, or simply run your fingers through it. This type of excessive shedding is called telogen effluvium, and it happens when a larger-than-normal number of hair follicles enter the resting phase at the same time. Instead of the usual 50-100 hairs per day, you might be losing 150, 200, or more. It can feel alarming, especially when you see it accumulating on your pillow, your clothes, and your bathroom floor.

Texture changes are common too. Hair that was once thick and smooth may become drier, more brittle, and harder to manage. It might feel wiry in places where it used to feel soft. Curl patterns can shift. Hair that held color well may start looking dull.

Growth also slows down. You might notice that your hair doesn't grow as long as it used to before it breaks or falls out. The growth cycle itself is shortening, which means each individual strand spends less time in its active growing phase.

All of these changes can happen gradually over months or years, which is part of what makes them so disorienting. By the time you're sure something is different, the change has been underway for a while.

Why this is happening in your body

Your hair is incredibly sensitive to hormonal changes, and perimenopause creates a perfect storm of shifts that affect every stage of the hair growth cycle.

Let's start with estrogen. During your reproductive years, estrogen acts as a protector of your hair follicles. It keeps hair in the anagen (active growth) phase longer, which is why many people notice their hair feels thicker and healthier during pregnancy when estrogen levels are high. As estrogen levels fluctuate and trend downward during perimenopause, that protective effect weakens. Hair spends less time growing and more time resting, which leads to gradual thinning and slower regrowth.

Here's where it gets more complex. As estrogen declines, the relative influence of androgens (including testosterone and its more potent form, DHT, or dihydrotestosterone) increases. Your body isn't necessarily producing more testosterone. But with less estrogen to balance it out, the androgens you do have become more dominant. DHT binds to receptors in the hair follicles on your scalp, particularly at the crown and temples, and causes those follicles to miniaturize over time. Each growth cycle produces a finer, shorter, less visible strand until the follicle eventually stops producing visible hair altogether.

But hormones aren't the only factor. Iron and ferritin (stored iron) levels play a critical role in hair health, and many people in perimenopause have depleted iron stores, especially if you've been experiencing heavier or more frequent periods. Ferritin levels below 30 ng/mL have been associated with increased hair shedding, even when standard blood tests show your iron is technically "in range."

Thyroid function is another piece of the puzzle. Both hypothyroidism and hyperthyroidism can cause hair loss, and thyroid disorders become more common during the perimenopausal years. If your hair thinning is accompanied by fatigue, weight changes, dry skin, or feeling unusually cold or warm, your thyroid is worth investigating.

Finally, stress and cortisol deserve attention. Chronic stress pushes hair follicles into the telogen (resting) phase prematurely, triggering the shedding known as telogen effluvium. Perimenopause itself is a physiological stressor, and many people are simultaneously navigating career pressures, caregiving responsibilities, and sleep disruption. That sustained cortisol elevation compounds the hormonal hair loss that's already underway.

What you can do about it, starting today

Hair thinning during perimenopause responds to a multi-pronged approach. No single strategy will reverse everything overnight, but combining several of these evidence-backed actions can make a real, visible difference over the course of a few months.

1. Get your bloodwork done. Before anything else, ask your doctor to check your ferritin, iron, thyroid panel (TSH, free T3, free T4), and vitamin D levels. These are the most common nutritional and hormonal contributors to hair loss, and all of them are treatable. Pay special attention to ferritin. Many labs list anything above 12 ng/mL as "normal," but dermatologists who specialize in hair loss often want to see ferritin at 70 ng/mL or above for optimal hair health. If yours is low, supplementing can make a noticeable difference within three to six months.

2. Support your body with targeted nutrition. Biotin (a B vitamin) supports keratin production, the protein your hair is made of. Collagen peptides provide amino acids that your body uses to build hair structure. Omega-3 fatty acids reduce inflammation around hair follicles. While supplements can help fill gaps, prioritize getting these nutrients from food first. Eggs, salmon, sardines, leafy greens, nuts, and legumes are all excellent choices.

3. Be gentle with your hair. This sounds simple, but it matters more than you might think. Reduce heat styling. When you do use heat, always use a heat protectant and keep the temperature moderate. Switch to a sulfate-free shampoo, which is less stripping on already-compromised hair. Avoid tight hairstyles that create tension on the follicles (this type of loss, called traction alopecia, is entirely preventable). Use a wide-tooth comb on wet hair instead of a brush. Pat dry instead of rubbing.

4. Try scalp massage. A 2019 study published in Dermatology and Therapy found that regular scalp massage (about 4 minutes daily) increased hair thickness over a 24-week period. The mechanism is improved blood flow to the follicles and reduced tension in the scalp tissue. You can use your fingertips or a silicone scalp massager. Make it part of your shower routine.

5. Consider rosemary oil. This isn't just a folk remedy. A randomized clinical trial published in SKINmed Journal found that rosemary oil was as effective as 2% minoxidil for improving hair count after six months, with less scalp itching as a side effect. Add 3-5 drops to a carrier oil (like jojoba or coconut) and massage into your scalp several times a week. Results take time, typically three to six months, so consistency is key.

6. Know your options for minoxidil. Minoxidil (the active ingredient in Rogaine) is the only FDA-approved topical treatment for female pattern hair loss. It works by extending the growth phase of the hair cycle and increasing blood flow to the follicles. The 5% foam formula, applied once daily, tends to be most effective. It does require ongoing use to maintain results. Talk to your dermatologist about whether it's right for you.

7. Prioritize protein and manage your stress. Your hair is made of protein, and inadequate protein intake is a surprisingly common contributor to thinning. Aim for at least 1.2 grams of protein per kilogram of body weight daily. At the same time, take your stress seriously. Chronic stress directly triggers telogen effluvium. Sleep, gentle movement, breathwork, and boundaries around overcommitment are not self-indulgence. They're part of protecting your hair at a biological level.

Why movement matters for hair health

Exercise might not be the first thing you think of when it comes to hair thinning, but the connection is more direct than you'd expect.

Regular physical activity improves circulation throughout your body, including to your scalp. Better blood flow to the hair follicles means better delivery of oxygen, nutrients, and the hormonal signals that support healthy growth cycles. Research in the journal Microvascular Research has shown that consistent moderate exercise increases capillary density, the number of tiny blood vessels available to nourish tissues like your scalp.

Movement also helps regulate cortisol. Since chronically elevated cortisol is one of the drivers of telogen effluvium, keeping your stress hormones in check through regular exercise directly supports your hair's ability to stay in the growth phase longer. Yoga, walking, swimming, and strength training are all effective at lowering baseline cortisol when done consistently.

There's a hormonal balance component too. Regular exercise, particularly strength training, improves your body's sensitivity to insulin and helps regulate androgen levels. Since excess androgen activity is a key factor in follicle miniaturization, supporting healthier hormone balance through movement can slow that process.

PeriPlan can help you build a consistent, sustainable movement routine that accounts for your energy levels, your cycle patterns, and how your body is feeling on any given day. That consistency matters more than intensity when it comes to long-term hair health.

Track it to understand it

Hair changes happen slowly, which makes them difficult to evaluate in real time. You might feel like things are getting worse when they're actually stabilizing, or you might miss early signs of improvement because the change is too gradual to see day to day.

Start by taking a monthly photo of your part line and hairline in the same lighting, at the same angle. This gives you an objective record to compare over time. It's one of the most common tools dermatologists use to assess hair loss progression, and it works just as well at home.

Track your shedding levels, even roughly. You don't need to count every hair. Just note whether it seems light, moderate, or heavy each day. Over a few weeks, patterns often emerge. You might find that shedding increases during higher-stress periods, after poor sleep, or at specific points in your cycle when hormone levels shift.

Correlating hair changes with your other symptoms can reveal connections that aren't obvious at first glance. PeriPlan's daily check-in lets you log energy, stress, sleep, and symptoms alongside your cycle data. When you look back after a month or two, you may start to see which factors are making your hair worse and which interventions are helping. That kind of personal data is far more useful than generic advice, because it tells you what's true for your body.

When to talk to your doctor

Your hair is changing, and it's okay to grieve that. Hair is tied to identity, confidence, and how you see yourself in the mirror each morning. Feeling upset about losing it doesn't make you vain. It makes you human.

But here's what's also true: perimenopause hair thinning is not a one-way street. With the right combination of nutritional support, gentle care, stress management, and medical guidance when needed, many people see real improvement. Your hair follicles are not dead. In most cases, they're miniaturized and dormant, which means they can be coaxed back into producing healthy hair with the right signals.

Be patient with the process. Hair grows slowly, about half an inch per month. Changes you make today may not become visible for three to six months. That's normal. Stay consistent, track your progress, and give your body time to respond.

You are navigating a significant transition, and your body is doing its best. Give it the support it needs, and it will show you what it's still capable of.

This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider before making changes to your health routine, starting supplements, or beginning new treatments.