A reader submitted the following question to The New York Times’ Ask Well section: Since going through menopause, I’ve noticed changes in my scalp and hair texture. My scalp is dry and flaky, and my hair is dry and falling out. What is happening? Is there anything I can do to combat this?
The answer to that question is that these problems are familiar to many women going through menopause, said dermatologist Shilpi Khetarpal of the Cleveland Clinic. According to a recent study, roughly half of menopausal women experience increased hair loss and changes in hair texture at this stage of life.
The years leading up to and following menopause are characterized by dramatic changes in female sex hormone levels. While there is little research specifically on menopausal hair loss, hormonal changes are thought to contribute to changes in hair growth and texture as well as the texture of the scalp, Khetarpal said.
Hair follicles, tiny organs beneath the skin that contain the roots of hairs, contain receptors for sex hormones such as estrogen, testosterone, and other androgens. There isn’t a lot of conclusive research on how female sex hormones specifically affect hair. But some preliminary studies with mice and skin cells suggest that estrogen affects hair growth, possibly stimulating it, and that it may also be responsible for maintaining the diameter of each hair shaft.
“There are probably more things that estrogen does that we don’t know about, but a lot of women come to me and say, ‘My hair isn’t as shiny and strong as it used to be,’ and the only thing that’s changed about them is that they’ve gone through through menopause,” said Ketarpal.
Other hormones, especially testosterone, which has been studied most extensively, are responsible for producing sebum—oils that nourish and moisturize the scalp and hair shafts (the part of the hair that is visible above the skin). During menopause, these hormones can also become out of balance, possibly resulting in an increasingly dry, flaky scalp and more brittle hair.
What other factors can lead to hair changes?
In many cases, hormonal changes linked to menopause can exacerbate a preexisting hair problem, said Emma Guttman-Yassky, director of the department of dermatology at the Icahn School of Medicine at Mount Sinai, whose research focuses on alopecia. Other factors can impair hair quality and growth before a woman enters perimenopause, such as chronic inflammatory conditions (which are often linked to hair loss) and other stressors, such as COVID-19, which can lead to hair loss. temporary hair, she said.
Age is also associated with changes in hair growth, thickness and texture in both men and women, said Paradi Mirmirani, a dermatologist at Kaiser Permanente who specializes in hair disorders and hair loss.
Even a lack of nutrients can play a role in hair changes, Khetarpal said, especially a lack of vitamin D and iron. “There’s been a lot of research on this, and it’s known that vitamin D acts on hair more like a hormone than a vitamin,” she said. “So we tested all my patients for vitamin D.”
Another important factor influencing hair changes over time is genetics, Guttman-Yassky said. “I always ask my patients to tell me their family medical history, and often female patients who experience hair loss will say ‘my mother had the same pattern of hair loss in her 40s and 50s.’
Are there ways to manage these hair changes?
“Time is of the essence,” said Guttman-Yassky. That is, the sooner you seek help to combat the changes, the better the results of the interventions. When you notice hair loss or changes in scalp texture, the first thing you should do is ask a dermatologist for a thorough exam and blood tests to determine if the changes are hormonal in origin or if there are other factors at work, she said. .
For some women, hormone replacement therapy — regularly used to control other menopausal symptoms, such as hot flashes and brain fog — can help with hair changes, but according to Mirmirani, there is no hard data on the effectiveness of this option.
Tried-and-true methods of limiting hair loss are effective, experts say, even if hair loss is linked to menopause. They include oral minoxidil in small doses or the topical version, Rogaine. Scalp steroid injections are also an effective way to stimulate hair growth, Guttman-Yassky said.
If you have a vitamin deficiency, taking vitamin supplements can also help, Khetarpal said. Some dermatologists offer vitamin injections into the scalp to combat localized hair loss, but, she said, vitamins will never work better than medications like minoxidil.
More brittle hair may no longer be able to withstand things like flat ironing or dyeing, Mirmirani said. “I get women coming in saying, ‘This doesn’t look like my hair — I’ve always dyed my hair,’ or ‘I’ve always used a flat iron, but now my hair isn’t reacting like it used to.’ In those cases, she said, it’s worth considering changing your habits by minimizing the flat iron and chemicals or washing your hair less often.
Translated by Clara Allain