Perimenopause Hair Thinning: What Causes It and What Actually Helps

More hair in the brush than there used to be

You might have noticed your ponytail feeling thinner. Or more hair on your pillow, in the shower drain, or in your hairbrush than ever before. Hairline changes. A wider part. The kind of noticing that makes you pause and worry.

Hair thinning during perimenopause is common and it is genuinely distressing for many women. Hair is tied closely to identity and how we feel about our appearance. You are not being dramatic for being bothered by this. And you are not powerless. There are things that can help, though setting realistic expectations matters.

Why perimenopause affects your hair

Estrogen and progesterone support hair growth and extend the anagen phase, which is the active growing phase of the hair cycle. When these hormones decline during perimenopause, more hair follicles shift earlier into the telogen phase, which is the resting and shedding phase. The result is more hair loss and slower regrowth.

Androgens, including testosterone, do not decline during perimenopause in the same way estrogen does. As estrogen drops, the relative effect of androgens on hair follicles increases. On the scalp, androgens can shrink follicles and produce finer, shorter hair over time. This is the same mechanism behind male pattern baldness, and it is why perimenopausal hair thinning often begins at the part and crown rather than diffusely.

Rule out other contributors first

Before attributing all hair thinning to perimenopause, it is worth checking a few other common causes. Thyroid dysfunction, both hypothyroidism and hyperthyroidism, causes significant hair shedding and is more common in women during this life stage. Iron deficiency, including ferritin levels below 50 even without full anemia, is a very common and very treatable cause of hair thinning in women.

Vitamin D deficiency, protein deficiency from inadequate dietary intake, and chronic stress can each cause or worsen hair shedding. A basic blood panel with ferritin, thyroid function, vitamin D, and iron levels is a reasonable first step before investing in other solutions.

Nutrition that supports hair health

Adequate protein is the most fundamental nutritional factor for hair growth, because hair is made almost entirely of protein. Many women do not eat enough protein during perimenopause, especially as appetite changes. Aim for at least 1.2 to 1.6 grams of protein per kilogram of body weight daily. Eggs, fish, poultry, legumes, and Greek yogurt are all practical sources.

Iron-rich foods matter particularly if your ferritin is low. Red meat, dark leafy greens, beans, and fortified cereals provide iron. Vitamin C consumed with plant-based iron sources improves absorption. Zinc, found in seeds, nuts, and shellfish, supports follicle function. Biotin is often marketed aggressively for hair growth, but the evidence only supports it if you are actually deficient, which is uncommon with a varied diet.

Scalp care and hair handling practices

How you handle your hair and scalp affects the rate of cosmetic thinning beyond what is purely hormonal. Tight hairstyles that pull on the scalp, like tight ponytails, braids, and extensions, cause traction alopecia that adds to hormonal loss. Heat styling at high temperatures damages the hair shaft, making existing hair more prone to breakage.

Gentle scalp massage, done daily for five minutes, increases blood circulation to follicles. Some small studies suggest regular scalp massage may actually increase hair thickness over time. Use a soft brush and detangle gently when hair is conditioned rather than dry. Sulfate-free shampoos are milder on already fragile hair.

Evidence-backed treatments worth knowing about

Minoxidil is the most evidence-supported topical treatment for female pattern hair loss related to hormonal changes. It is available over the counter in 2% and 5% formulations and works by extending the anagen phase and increasing follicle size. It requires consistent use and typically takes three to six months to see results. Once stopped, the regrowth is lost. It is worth discussing with your dermatologist before starting.

Some women find that hormone therapy, particularly estrogen, helps slow or partially reverse perimenopausal hair thinning by restoring the hormonal environment that supports follicle health. This is a conversation worth having with a healthcare provider if hair loss is significant. Platelet-rich plasma therapy and low-level laser therapy are newer options with emerging evidence, available through dermatologists.

Track symptoms to identify patterns and progress

Hair thinning can be hard to track subjectively because we tend to focus on bad days and forget improvements. Taking a consistent monthly photo of your part and crown in the same lighting can give you a more objective measure of whether things are stabilizing or improving.

Logging your symptoms in PeriPlan alongside any treatment changes helps you connect dots over time. If you start eating more protein, taking iron, or using minoxidil, having a dated symptom log lets you see whether the pattern changes over the following weeks and months.

When to see a dermatologist or healthcare provider

If you are losing hair rapidly, if it is patchy rather than diffuse, or if hair thinning is accompanied by scalp changes like itching, scaling, or redness, see a dermatologist. These patterns can indicate conditions like alopecia areata, scalp infections, or other issues that require specific diagnosis and treatment.

Your primary care provider is a good first stop for checking the nutritional and thyroid factors that often contribute. A dermatologist who specializes in hair loss can offer a scalp examination and targeted treatment recommendations if needed.

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