Hair Changes in Perimenopause: Causes, Treatments, and What to Do
Hair thinning and texture changes are common in perimenopause. This guide explains what drives them, which treatments have evidence, and how to manage the process.
Why Hair Changes in Perimenopause
Hair changes are among the most distressing and least openly discussed aspects of perimenopause for many women. Unlike hot flashes, which are widely recognised as a menopausal symptom, hair thinning and texture shifts are often attributed to stress, ageing, or diet without the hormonal connection being made. In reality, oestrogen and progesterone both play significant roles in the hair growth cycle, prolonging the active growth phase known as anagen and delaying the resting and shedding phases. As these hormones fluctuate during perimenopause, the hair growth cycle shortens, individual hairs spend less time in the growth phase, and the scalp sheds more hair than it replaces at any given time. Simultaneously, androgens, including testosterone, may become relatively more prominent as oestrogen declines, which can cause the hair follicles on the scalp to miniaturise in women who are genetically predisposed to androgenic alopecia.
What Changes Women Actually Experience
Hair changes in perimenopause are not uniform. Some women primarily notice increased shedding, finding more hair in the shower drain, on pillows, or in hairbrushes. Others notice a gradual thinning of overall density, with the hair feeling less full or the scalp becoming more visible through the top or crown. A smaller group notices a widening of the parting or a receding at the temples, which reflects a more androgenic pattern. Texture often changes alongside density: many women find their hair becomes drier, more brittle, less responsive to styling, or that it breaks more easily. Body hair may also change during perimenopause, with some women experiencing new facial or chin hair growth driven by the relative increase in androgen activity, while leg and underarm hair may thin.
Ruling Out Other Causes First
While perimenopause is a significant driver of hair changes, it is not the only one, and several other conditions can cause or worsen hair loss in midlife women. Thyroid disorders, particularly hypothyroidism, produce hair thinning as one of their most common symptoms, and thyroid function can change during perimenopause, making this worth checking. Iron deficiency anaemia is another common and treatable cause of hair loss in women, particularly those who experience heavier periods during perimenopause. Vitamin D deficiency, B12 deficiency, and zinc insufficiency have all been associated with hair thinning. A blood test covering these markers, alongside thyroid function and hormones, gives your doctor a clearer picture and avoids attributing everything to perimenopause when a correctable nutritional deficiency may be contributing.
Treatments With Evidence Behind Them
Minoxidil is currently the most evidence-backed topical treatment for hair loss in women. Available over the counter as a two percent or five percent solution or foam, it works by extending the hair growth phase and increasing blood flow to follicles. Results typically take three to six months to become visible, and hair shed often worsens temporarily at the start as the cycle resets. Stopping minoxidil causes any gained density to reverse over time. Scalp-applied spironolactone or finasteride are prescription options that target the androgenic component of hair loss and may be considered by a dermatologist when androgenic alopecia is the primary pattern. Low level laser therapy devices and platelet-rich plasma injections have some supportive evidence but are less established and more costly.
Nutritional Support for Hair During Perimenopause
Hair follicles have high metabolic activity and are sensitive to nutritional deficiencies. Protein is the building block of hair keratin, and inadequate intake directly contributes to thinning and breakage. Aiming for adequate protein across the day, rather than concentrating it in one meal, supports follicle health consistently. Iron, zinc, biotin, and vitamin D are the micronutrients most commonly linked to hair loss when deficient. Supplementing these without confirming deficiency first is not necessarily harmful but is also unnecessary if levels are already adequate and wastes money. A hair-specific supplement combining these nutrients may be worth considering if blood tests confirm multiple low-normal levels, but these supplements are unlikely to produce dramatic results in the absence of deficiency.
Hair Care Practices That Protect Fragile Hair
During perimenopause, hair is often more fragile than it was before, and hair care practices that were previously harmless may now contribute to breakage. Heat styling at high temperatures, tight hairstyles such as ponytails or braids that place tension on the root, aggressive brushing when wet, and chemical treatments including bleaching and perming all increase mechanical and thermal stress on already compromised hair. Switching to a wide-tooth comb for detangling, allowing hair to air dry when possible, keeping heat styling tools on lower settings, and deep conditioning regularly can all help reduce breakage. Scalp massage, which can be done with fingertips or a silicone scalp brush, stimulates blood flow to follicles and may support the effectiveness of topical treatments applied at the same time.
Emotional Impact and When to Seek Support
Hair has significant personal and cultural meaning, and the changes that perimenopause brings can have a real emotional impact that goes well beyond the physical. Many women describe feeling less like themselves, more self-conscious, or more anxious about the future trajectory of hair loss when these changes begin. These feelings are valid and deserve acknowledgment rather than dismissal. A dermatologist with a special interest in hair loss can provide a proper diagnosis, distinguish between different types of alopecia, and discuss realistic treatment expectations. A GP can check for and treat any nutritional or thyroid contributions. Connecting with others who are experiencing the same changes, whether through perimenopause communities or peer support, often reduces the sense of isolation. Tracking symptoms over time, including noting whether hair shedding correlates with stress peaks, dietary changes, or hormonal fluctuations, can provide useful information to share with a specialist.
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