The latest in treatment options for hair loss around the menopausal transition were highlighted at NAMS 2021.
Do you ever look in your shower drain or hairbrush and wonder how you still have any hair left on your head? Is your scalp easily sunburned, or are you noticing thinning hair around your part? You may be experiencing female pattern hair loss, a problem that’s much more common than you might think.
“About half of all women will have some element of hair loss by the age of 50, and by the age of 60, approximately 80 percent of women will experience some hair loss,” says Glynis Ablon, MD, an associate clinical professor at the University of California in Los Angeles and a dermatologist at Ablon Skin Institute and Research Center in California.
We all know hair loss or balding can happen to men in midlife, but we don’t talk about it as much when it comes to women, she says. “It usually impacts women in a different way, especially their self-confidence. Someone like Bruce Willis can just shave their head look fine, but it tends to be a bigger deal for women,” says Dr. Ablon.
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The good news: Various treatments are available to address hair loss in menopausal women, says Stephanie S. Faubion, MD, the director of the Center for Women’s Health at the Mayo Clinic in Rochester, Minnesota, and the medical director of NAMS. “There are simple fixes for female pattern hair loss, but we shouldn’t assume that is always the reason for hair loss; sometimes there are underlying issues causing the condition,” says Dr. Faubion.
The most common type of hair loss in women is called androgenetic alopecia, or female pattern hair loss (FPHL). Hair follicles shrink, causing the hair to become thinner and finer, with decreased numbers of hairs overall. The hair’s growing phase also gets shorter and fewer hairs are in the active growing phase.
“Usually in female pattern hair loss, the frontal hairline stays about the same, but there can be a widening of the part and a central thinning of the hair,” says Alison Bruce, MBChB, a dermatologist at Mayo Clinic. Dr. Bruce presented information on common causes of midlife hair loss and new therapy options at the North American Medical Society (NAMS) Annual Meeting in Washington, DC, held September 22–25, 2021.
If you’re bothered by your thinning hair or hair loss, a visit to your primary care doctor is a great place to start, says Bruce. “It’s likely that female pattern hair loss is probably the cause, but a clinical examination can confirm this,” she says.
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If the hair loss doesn’t follow the typical appearance of female pattern hair loss, your doctor will likely perform a few tests to explore potential causes.
“It’s important for women to realize that a lot of why they may experience hair loss is influenced by genetics and the aging process,” says Bruce. A genetic cause doesn’t mean that it’s necessarily something you’ve inherited directly from your mom or dad, she adds.
“There are multiple different genes related to hair loss, and this is a very complex interplay of many genes. You shouldn’t assume you’ve done anything to cause your hair loss, especially if you are otherwise healthy,” says Bruce.
“Extreme stress can be a problem and cause hair loss,” says Faubion. The condition is called telogen effluvium, and fortunately, the hair loss it causes is temporary, she says.
All hair follicles are on a cycle, and significant physical or emotional stress can push more follicles than usual into a resting phase, which can lead to a significant amount of hair loss at one time, says Faubion. “It can take a while after that stress for the cycle to go back to normal,” she says.
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The pandemic seems to have increased stress levels and subsequent hair loss for a lot of women, says Ablon. “I saw a lot of patients about hair loss pre-pandemic, and I probably see about three times that many compared to a year ago,” she says.
Hair loss might also be related to a shift in hormones, says Faubion. Androgens, a group of hormones that include testosterone and androstenedione, don’t increase during the menopause transition, but the ratio between estrogen and androgen changes, so you have less estrogen and relatively more androgen, she explains.
DHT, a metabolite of testosterone, has been linked to male baldness in research. “There’s a theory that changing ratios may be related to hair loss in women,” says Faubion.
The simplest solution is to start using 5 percent minoxidil, which is available without a prescription, says Bruce. “The trade name is Rogaine, but there are also generic versions available. This treatment is effective in about two out of three people who use it,” she says.
Compliance can be an issue, because you have to use it every day to retain the benefits, she says. “There are medications marketed to both men and women, but women can use the men’s formulation and it is often less expensive.”
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Oral prescription drugs have been shown to help with female pattern hair loss. These drugs have been approved for use in other conditions, but are used by doctors “off-label” for FPHL, according to the American Academy of Dermatology Association (AAD).
Spironolactone, a blood pressure medication that is a diuretic (a drug that increases the production of urine) can prevent hair loss from worsening and restore hair growth, according to the AAD. Other drugs block the effects of circulating androgens or lower androgen levels.
These oral medications should not be used by women who are pregnant or planning to become pregnant, according to the AAD.
Although there is no “miracle cure,” says Bruce, other options that can help with FPHL include:
Discuss any treatment, drug or nondrug, with your doctor and assess potential medication interactions or issues, as well as medical causes for your hair loss, before beginning treatment. Do not assume any procedure or treatment is covered by medical insurance.
Women who are more distressed by their hair loss or have more significant hair loss may consider hair transplantation, says Bruce. “This is an expensive and somewhat invasive procedure. You’re taking hair from a donor site, typically at the back of the scalp, and then redistributing those hair follicles to areas where the hair is thinner,” she says.
If you feel self-conscious about thinning hair, there are options beyond treatments and procedures that may make hair loss less noticeable, says Bruce.
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