Menopausal Hair Loss & Thinning Hair

Menopause marks a significant transition in a woman’s hormonal profile, notably characterised by a decline in oestrogen levels. This hormonal shift increases the relative influence of androgens (male hormones), which can activate underlying predispositions to hair thinning.

The imbalance of hormones may cause both a diffuse shedding telogen effluvium and the start of androgenetic alopecia (genetic thinning). Androgenetic alopecia in women, unlike in men, tends to manifest as diffuse thinning to the front area and top of the scalp rather than localised total baldness.

The onset of hair loss during menopause can significantly impact psychological well-being, contributing to a sense of ageing and loss of femininity, exacerbating the effect of the hair loss to the point that it severely affects the quality of life of the sufferer, even though they may understand it is part and parcel of the ageing process.

The relationship between HRT and hair health is complex and multifaceted. Oestrogen supplementation in HRT is well known to have a positive effect on the skin, preventing the dermis from thinning; there is a known direct correlation between the depth of the follicle and the diameter (the deeper the hair, the thicker it grows) and as we age the skin gradually atrophies, and so the hair becomes thinner. So oestrogen supplementation will help preserve hair density over time. It is unclear if HRT  directly enhances hair growth, quality or density.

However, the choice of HRT formulation is pivotal, as different combinations exert distinct effects on hair follicles. Formulations containing medroxyprogesterone acetate or dydrogesterone (e.g., Tridestra, Premique) are generally considered more conducive to hair health. Conversely, HRT formulations with progestogens like norethisterone and levonorgestrel may adversely affect hair due to their inherent androgenic properties.