Categorized | Women's hair loss

Hair Loss: Another Disturbing Symptom of Menopause?

menopause_hair-lossWomen usually expect to experience mood swings and hot flashes during menopausal transition and menopause itself but many women are unaware that hair loss or alopecia is another fairly common and unpleasant sign of the approaching change.  According to statistics, more than 40% of women suffer from hair loss in the postmenstrual period of their life.  But, if this is true, you may ask why we don’t see a lot of bald women on the streets?  The fact is, unlike male pattern baldness, hair loss in females is subtler as a rule. Thus, the early signs can be easily missed.  Women tend to have diffuse hair loss which means that the hair thins over a wide scalp area rather than in one concentrated area.

Hair loss for women who are perimenopausal, menopausal and postmenopausal is mainly attributed to the hormonal changes happening in the female body during these periods.  Such type of hair loss is sometimes called Menopausal Alopecia.

So what is the connection between hair loss and menopause?

There are two types of sex hormones in the human body – estrogen (female sex hormones) and androgen (male sex hormones). In women, both these hormones are produced in varying amounts by the ovaries and adrenal cortex.  Before the onset of menopause, the amount of estrogen in a female body predominates greatly over the amount of androgen and this production of estrogen by the sex glands ‘inhibits’ the activity of androgen, the male sex hormone.

Menopause is associated with the decrease in estrogen production and the amount of androgen starts to predominate.  This does not mean that the levels of male hormones in women who are going through menopause rise above the norm.  Rather, in the estrogen-androgen ratio, the latter starts to prevail.  The production of androgen declines during menopause as well but not as quickly as estrogen.  Ovaries continue to produce small amounts of testosterone even when estrogen production has stopped.  So it is a purely hormonal balance issue.

How does this affect the hair?  Androgen, and particularly dihydrotestosterone, has a negative influence on the hair follicles which grow hair.  This causes the shortening of the growing (anagen) phase of the hair follicles and the resting (telogen) phase begins earlier.  As a result, the hair falls out before it can grow long.  Dihydrotestosterone also causes miniaturization and regression of the hair follicles which then begin to produce finer vellus hair.  With the increased influence of androgen, women, if they are genetically predisposed to hair loss, usually develop Androgenetic Alopecia or Female Pattern Baldness(FPB).

However, it is not always FPB.  Other medical disorders, often diagnosed in women undergoing menopause, can also cause considerable hair loss:

  • Hypothyroidism – This condition occurswhen the thyroid gland does not produce enough hormones and it is one of the most common disorders.  Women who suffer from this condition have menopause-like symptoms – weight gain, fatigue and loss of energy, dry skin, constant feeling of cold, etc.  They also tend to experience thinning of the hair and gradual hair loss – more hair is left on the brush and comes off in the hands when shampooing.  All these symptoms can be rather subtle which allows many women to believe this hair loss is a normal part of the menopausal transition. In order not to overlook hypothyroidism, The American Association of Clinical Endocrinologists recommends that all females over 40 have a screening test for TSH (Thyroid-Stimulating Hormone).
  • Frontal Fibrosing Alopecia is another type of hair loss diagnosed mostly in postmenopausal women.  It is a fairly rare type of Cicatricial Alopecia with a distinctive hair loss pattern characterized by a symmetrically receding hairline on the front and sides of the scalp, with or without the loss of eyebrows.  The exact causes of this condition are still unknown.
  • In postmenopausal and premenopausal women, alopecia can also result from nutritional deficiencies(low iron levels or biotin deficiency), autoimmune disorders or stress.  Some drugs may cause hair loss as well.  Therefore, it is crucial for these women to see a doctor and have their blood tested to eliminate other possible causes of alopecia.

How to cope with hair loss during menopause?

Hair loss associated with menopause is mainly a secondary process resulting from the hormonal alteration occurring in the female body and is not a separate disease.  According to the report provided by The American Journal of Clinical Dermatology, Androgenetic Alopecia, unfortunately, cannot be reversed by any medical treatment.  However, there are some medications that can stop or slow down the process during menopause.

If you are worried about your hair becoming thinner, experts recommend you to begin with a visit to your health care provider to have a thorough workup – review of your stress, activity levels, diet and other factors that can affect your hair.  The treatment plan for hair loss should be based on your lifestyle and medical information. Doctors usually recommend combining both lifestyle changes and pharmaceutical treatment:

  • Medical options – Dr. Mary Jane Minkin, a Clinical Professor of Gynecology, Reproductive Sciences and Obstetrics at Yale School of Medicine, believes, when considering the treatment of menopause-associated hair loss, hormone replacement therapy with the use of estrogen for a short term (a few months) can give an indication whether or not the problem can be solved. As soon as the cause of hair loss is determined, the therapy usually begins with administering topical preparations containing minoxidil.  Other options may include such anti-androgens as spironolactone, finasteride or cyproterone acetate.1,2
  • Lifestyle changes. Stress management is very important during menopause.  Relaxation techniques such as meditation or deep breathing, exercising regularly, eating healthy food and getting adequate and regular sleep can all help to cope with other annoying symptoms of menopause.

The Bottom Line

Alopecia is a very frustrating problem for every woman.  If you notice hair loss and it is becoming a problem, it is highly recommended youseek the opinion of a doctor to eliminate the possibility of a nutrient deficiency or a medical condition.  Never assume that alopecia is a normal part of menopause because other potentially serious conditions may be overlooked as the cause of hair loss.

 

References

  1. Management of Androgenetic Alopecia in Postmenopausal Women. (Rivera R, Guerra-Tapia A.; Actas Dermosifiliogr. 2008 May;99(4):257-61.)  http://apps.elsevier.es/
  2. A review of hormonal therapy for female pattern (androgenic) alopecia (Noah Scheinfeld; Dermatology Online Journal 2008 Mar 15;14(3):1.) http://escholarship.org/uc/item/3b81s01s