By Alisha Haridasani Gupta
Q: Since going through menopause, I’ve noticed changes to my scalp and hair texture – my scalp is dry and flaky, and my hair is dry and falling out. What’s going on, and is there anything I can do to address it?
A: These things will be familiar to many women going through menopause, says Dr Shilpi Khetarpal, a dermatologist at Cleveland Clinic. About half of menopausal women notice accelerated hair loss and changes in texture at this life stage, according to a recent study.
Hormonal changes are believed to contribute to changes in hair growth and scalp texture.Credit: iStock
The years leading up to and after menopause are characterised by dramatic shifts in levels of female sex hormones. Though research specifically into menopausal hair loss is sparse, the hormonal changes are believed to contribute to changes in hair growth and texture as well as in scalp texture, Khetarpal says.
Hair follicles, which are tiny organs under the skin that contain the root of the hair, contain receptors for sex hormones like estrogen, testosterone and other androgens. There isn’t much conclusive research on how female sex hormones specifically affect hair. However, some preliminary studies in mice and on skin cells suggest that estrogen affects hair growth, possibly stimulating it, and may also be responsible for maintaining the diameter of each strand of hair.
“There’s probably more that estrogen is doing that we don’t know of, but a lot of women come in and tell me, ‘My hair is not as shiny or radiant as it once was,’ and the only change is that they’ve been through menopause,” Khetarpal says.
Other hormones, particularly testosterone, which has been more extensively studied, are responsible for sebum production, which are oils that nourish and moisturise the scalp and hair shaft (the part of the hair that is visible above the skin). During menopause, those hormones can also be thrown out of whack, possibly leading to an increasingly dry and flaky scalp and more brittle hair.
What other factors might change hair?
In many cases, menopause-related hormonal changes may be exacerbating an existing hair issue, says Dr Emma Guttman-Yassky, chair of the dermatology department at the Icahn School of Medicine at Mount Sinai, whose research focuses on alopecia. Other factors might chip away at hair quality and growth before a woman enters perimenopause, like chronic inflammatory conditions (which are often tied to hair loss) and other stressors, such as COVID-19, which can lead to temporary hair loss, she says.
Age is also associated with changes in hair growth, thickness and texture in both men and women, says Dr Paradi Mirmirani, a dermatologist at Kaiser Permanente who specialises in hair disorders and loss.
Even a lack of nutrients can play a big role in hair changes, Khetarpal says, particularly of vitamin D and iron. “We’ve done a lot of research looking into this, and we know vitamin D acts more like a hormone in the hair than a vitamin,” she says. “So with all of my patients we test vitamin D.”
Another major factor in hair change over time is genetics, Guttman-Yassky says. “I always ask my patients about family history, and many times somebody with female-pattern hair loss will say, ‘Oh, yeah, my mother in her 40s or 50s had the same pattern of hair loss.’”
Are there ways to manage these hair changes?
“Time is of the essence,” Guttman-Yassky says, and the sooner you seek help for hair changes, the better the results of interventions will be. The first thing you should do when you notice hair loss or changes in scalp texture is to ask a dermatologist for a full examination and blood tests to tease out whether the changes are hormonal or if there are other confounding factors, she says.
For some women, hormone therapy – which is regularly used to manage other menopause symptoms, like hot flashes and brain fog – may help with hair changes, but there is no real data on the effectiveness of that option, Mirmirani says.
The tried and tested methods to curb hair loss are effective, even if the hair loss is related to menopause, experts say. Those include low doses of minoxidil in pill form or topical versions. Steroid injections into the scalp are also an effective method for stimulating hair growth, Guttman-Yassky says.
Vitamin supplements may also work if you are deficient, Khetarpal says. Some dermatologists offer scalp injections of vitamins to help with patches of hair loss, but, she says, vitamins will never outperform drugs like minoxidil.
More brittle hair also means that it may no longer be able to withstand styling methods like straightening irons or hair dyes, Mirmirani says. “I have women come in and say, ‘This is not my hair — I’ve always coloured my hair,’ or ‘I’ve always used heat on my hair and now it’s not behaving the same,’” she says. In those cases, it might be worth considering changing your practices, she says, like minimising the use of heat and chemicals or reducing how often you wash your hair.
The New York Times
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