Learn what causes hair loss, when to worry, and treatment options like PRP at Healthy Skin Centre.
Dear Dr. Lili,
I’m 52 and over the past couple of years I’ve noticed that my hair is much thinner than it used to be. My part seems wider, I can see more of my scalp, and my hair feels drier and less full. I’m also finding more hair in my brush and shower.
Is hair thinning actually part of menopause? And is there anything I can do about it?
A.K. – Burnaby
Dear A.K.,
Hair changes are something I hear about frequently from women during perimenopause and menopause—and they can be particularly distressing.
The short answer is yes: hair thinning becomes more common as women age and transition through menopause. But I would be careful about assuming that menopause is always the cause.
Hair loss in women is complicated. Hormones can play a role, but so can genetics, thyroid disease, iron deficiency, illness, significant weight loss, stress, medications and several different scalp and hair disorders.
So before we talk about treatment, we need to understand what is actually happening.
Menopause and Hair Loss: What Happens to Your Hair?
Hair grows in cycles. Each follicle moves through several phases, including a prolonged active growth phase called anagen, followed by transitional and resting phases before the hair eventually sheds and a new cycle begins.
Estrogen influences the hair follicle and hair cycle and as estrogen levels fluctuate during perimenopause and decline after menopause, some women notice changes in hair density, growth and texture.
What Does Hair Thinning During Menopause Look Like?
One of the most common forms of hair loss in women is female pattern hair loss (FPHL).
Women often first notice that their ponytail feels smaller, their part is becoming wider or they can see more of their scalp through the hair on the top or crown.
Unlike the classic receding hairline we often associate with male pattern baldness, women with female pattern hair loss usually retain their frontal hairline while experiencing progressively reduced density over the entire scalp.
The individual hairs also become finer as follicles gradually produce thinner, shorter hairs—a process known as follicular miniaturization.
Female pattern hair loss is influenced by age, genetics and hormones, and its prevalence and severity increase after menopause.
What Else Can Cause Hair Loss in Women Over 40?
This is an important question because hair loss can sometimes be a clue to something else happening in the body.
Another common condition is telogen effluvium, in which a larger-than-normal number of hairs enter the shedding phase of the hair cycle.
This can occur after:
- significant illness or surgery
- rapid weight loss or restrictive dieting
- major physical or emotional stress
- iron deficiency
- thyroid dysfunction
- certain medications
- significant nutritional deficiencies
A woman can have female pattern hair loss and then experience telogen effluvium after an illness, for example, making her hair loss suddenly much more noticeable.
When Is Hair Loss NOT Typical?
Sudden, rapidly progressive or patchy hair loss should not simply be attributed to menopause.
There are autoimmune and inflammatory forms of hair loss, including some scarring alopecias, where early diagnosis is particularly important because permanent follicle damage can occur.
Should You Have Blood Tests for Hair Loss?
The appropriate investigations depend on the history and pattern of hair loss.
Depending on the individual, we may consider testing for conditions such as iron deficiency or thyroid dysfunction and looking for other nutritional or medical contributors.
Routine estrogen, progesterone or testosterone testing is generally not required simply because a woman notices hair thinning during menopause.
Why Does Hair Texture Change During Menopause?
Women frequently tell me that their hair doesn’t just look thinner—it feels different.
Hair is drier, finer, less manageable or more prone to breakage.
Some of this reflects changes occurring in the hair follicle, but changes in scalp sebum production, hair colouring, heat styling and years of environmental exposure contribute as well.
So, once again, hormones are part of the story—but they are not the whole story.
What Can You Do About Hair Thinning During Menopause?
Treatment depends on the cause. Correcting an underlying iron deficiency, thyroid disorder or nutritional problem matters if one is present—but taking supplements when you are not deficient is not necessarily going to make your hair grow.
And this is an area where I think women need to be particularly cautious. The hair-loss industry is full of supplements, shampoos and treatments promising dramatic regrowth.
What About PRP for Hair Loss?
Platelet-rich plasma, or PRP, is one treatment we can consider for certain types of hair thinning, particularly female pattern hair loss.
PRP uses a concentration of platelets prepared from your own blood. Platelets contain growth factors and other signalling molecules involved in tissue repair and cellular communication.
The PRP is injected into targeted areas of the scalp and studies have shown that PRP improves hair density in women with female pattern hair loss, as well as improvements in hair thickness.
PRP treatment involves a series of 4 sessions 1 month apart followed by reassessment. Ongoing treatments every 3 to 6 months is needed to maintain results.
What About PRF for Hair Loss?
I am also frequently asked about platelet-rich fibrin (PRF), which is sometimes promoted as a newer alternative to PRP. Unlike PRP, which is prepared using an anticoagulant to keep the platelet-rich plasma liquid, PRF is generally prepared without an anticoagulant, allowing a fibrin matrix to form that may release growth factors more gradually.
While PRF sounds promising there is currently very little clinical evidence supporting PRF in hair loss and no good evidence that it is superior to PRP. For this reason, at Healthy Skin Centre we recommend PRP for hair loss. As the research evolves, that recommendation may change, but newer doesn’t automatically means better—we should choose treatments based on the quality of the evidence available.
Looking at the Whole Woman
One of the themes you’ll hear me return to again and again when I talk about menopause is that we need to look at the whole woman. Your hair doesn’t exist separately from the rest of the body. Nutrition, thyroid function, medications, illness, stress, genetics, aging and hormonal changes can all influence what is happening on the scalp.
If you are experiencing hair thinning during perimenopause or menopause, don’t assume that you simply have to accept it—but don’t assume that hormones are necessarily the only explanation either.
Find out what is happening first. Then treat the cause.
Have a Question for Dr. Lili?
Menopause, skin, hair, sleep, hormones and healthy aging—there are so many questions women have that don’t always get answered.
Ask Dr. Lili is a place for real questions and evidence-based answers.
Have a question you’d like me to answer in a future column? Send your question through our Contact Us form. Questions may be edited for length or clarity, and identifying details will not be published.
If you are concerned about hair thinning or hair loss, you can also learn more about Healthy Skin Centre’s hair-loss consultations, PRP for hair loss and Healthy Menopause Program in New Westminster, BC.
Ask Dr. Lili provides general health information for educational purposes and is not a substitute for individualized medical advice.
About Dr. Lili
Dr. Lili Nasseri is a family physician with a clinical practice focused primarily on dermatology and more than 20 years of clinical experience. She is a Menopause Society Certified Practitioner (MSCP), Clinical Instructor at the University of British Columbia, and co-founder of Healthy Skin Centre in New Westminster, BC. She is also the author of the upcoming book The Menopause Method, an evidence-based guide to helping women better understand perimenopause, menopause and the years that follow.