Hair Loss During Perimenopause? A Dermatologist Has Advice

You’re drying your hair after a shower and notice that more of it than normal is ending up on the bathroom floor. Or you’re fixing your hair before going out with friends and see that your part looks a little wider.  

No, ladies, it's not just your husbands who might start losing hair as they age. Along with all the other super fun symptoms of perimenopause, hair loss can be particularly difficult to handle.

But the good news is that hair loss isn't just something you have to deal with — there are treatments that are proven to help.  

What is female-pattern hair loss?

You may have heard of male-pattern hair loss, where men get a characteristically thinner hairline and lose hair from the crown of their heads. Doctors call this androgenic alopecia, and it’s the primary cause of hair loss in women, too — with some important differences.

Women typically experience hair loss throughout the top of the head, where the hair just looks generally thinner. They do not typically get a receding hairline or go bald.  

“And if a woman is experiencing really significant hair loss, they should see a dermatologist because it’s probably a different type of hair loss,” says Song Park, MD, a dermatologist and hair disease specialist at the Dermatology Clinic at UW Medicine’s Eastside Specialty Center. “Around one in every 10 women who comes to see me for hair loss has something other than androgenic alopecia.”

Other, rarer types of hair loss that can affect women are:

• Frontal fibrosing alopecia, a type of scarring hair loss that also affects eyebrows and eyelashes and can progress if not treated  
• Central cicatricial centrifugal alopecia, a permanent form of hair loss that is more common among Black women and involves symptoms like burning or tingling scalp

With these other types of hair loss, it’s important to get a diagnosis early to prevent losing more hair permanently.  

What causes female-pattern hair loss?

If you have perimenopausal hair loss, rest assured it’s not because of that new shampoo you tried or because you brushed your hair when it was wet.  

A handful of things can contribute to female-pattern hair loss in women:  

• Genetics (it can run in families)
• Hormonal changes: estrogen falls while relative androgen levels rise
• Hypersensitivity to hormonal changes in certain areas of the scalp
• Lower amounts of stem cell regeneration in the scalp
• Less blood flow in the small blood vessels around hair follicles

Is there a good treatment for female hair loss?

Despite all the shampoos, serums and other expensive treatments out there that claim they help with hair loss, there is only one thing that has been approved by Food and Drug Administration (for decades) to help: a medication called minoxidil.  

You can buy it over the counter as a topical cream or foam, which you apply daily to your scalp. Park is a particular fan of the foam formulations because they’re a little easier to apply and are less likely to make your scalp itchy. (Fun fact: Minoxidil was originally developed as a pill to treat high blood pressure.)  

Most formulations contain 5% minoxidil, but there are 2% versions out there as well; if you get a product with less minoxidil, you’ll have to apply it twice a day to see results. (And the men’s formulations are just as safe and effective as the women’s, FYI, if you don’t want to pay a pink tax.)

If applying something to your scalp each day isn’t appealing, you can ask a dermatologist for an oral prescription.  

You should notice more hair growth within a few months of starting to use minoxidil. You’ll get long-lasting results if you continue using it, though it isn’t a disaster if you stop using it.

“The most common misleading thing I hear from patients is that they think if they stop using minoxidil, they’ll lose all of their hair, but that won’t happen,” Park says. “Your hair may thin again, though.”

Another misconception is that minoxidil causes additional hair loss.  

“Hair that has not been growing is now starting a new cycle, so the old hair is falling out,” Park says. “That will start a new, healthier, thicker hair cycle.”  

This means that you might start shedding more when you initially use minoxidil, but as you continue to use it, the shedding should decrease and you’ll notice less hair loss.

Minoxidil won’t give you the hair you had in your 20s, Park says, but it can make a noticeable difference.

Are there any natural remedies for hair loss?  

If minoxidil isn’t of interest to you, you could give rosemary oil a try. While it hasn’t been studied in women, Park says, it has been shown to be slightly helpful for men — though more research needs to be done with men, too.  

Other than rosemary, there aren’t any other natural treatments that have been proven to be effective.

“There is some research looking into other things like pumpkin seed oil or caffeine, but the efficacies are low, or studies are not specifically designed for female pattern hair loss,” Park says.

If you try a natural remedy or a hair care product that contains an ingredient like rosemary, make sure you’re using a leave-on treatment. A shampoo or conditioner typically won’t stay on the scalp long enough to make any difference, Park says.  

And be careful around biotin, which hasn’t been shown to help hair loss and can mess with any lab results you get, like when you have a blood draw.  

The bottom line

Hair loss isn’t completely reversible (unless you try something like a hair transplant), but it can be effectively treated with minoxidil. Make sure to ask your doctor for a referral to a dermatologist if you’re concerned about perimenopausal hair loss — and don’t waste your money on products that won’t do anything.