Hair loss and thinning affects the majority (65%) of women after menopause, as well as 20% of younger women. Despite this, hair loss remains shrouded in shame and is often left untreated. We ask consultant trichologist Anabel Kingsley why we lose our locks and what can be done to restore both hair density and confidence.
Why do so many experience hair loss during menopause?
Our hair-growth cycle is regulated to a great degree by hormones – most notably estrogen and testosterone. Estrogen is a hair-supportive hormone which helps to keep strands in their anagen (growth) phase. On the other hand, testosterone is the catalyst for androgenetic alopecia, which is also known as female and male pattern hair loss. Androgenetic alopecia occurs when hair follicles are sensitive to normal levels of circulating testosterone. Specifically, testosterone is converted to dihydrotestosterone (DHT), which binds to androgen receptors in the hair follicle, causing a reduced growth phase and miniaturisation of hair follicles. When follicles become smaller they produce fewer, finer and shorter hairs.
Any time there is a flux in estrogen and testosterone, or a disruption to the balance of these hormones, we’re likely to see changes in our hair. This can happen at puberty (when testosterone and estrogen are first produced), pregnancy (when estrogen levels are very high) and menopause (when our ovaries stop producing estrogen). Soaring estrogen during pregnancy is the main reason why women often have thicker hair when pregnant, and the rapid decline in estrogen post-partum is responsible, in part, for the shedding many women have six to 12 weeks after giving birth. A surge in androgens, such as testosterone, at puberty is responsible for the development of coarser hair in areas like our under-arms, upper-lip and pubic region – and this is also the earliest time that women with a strong genetic tendency can experience androgenetic alopecia.
Leading up to and upon entering menopause, our estrogen levels lower, and this can result in recurrent bouts of hair shedding, known as telogen effluvium. While testosterone levels don’t rise, the percentage of testosterone in relation to estrogen increases – which means our follicles have a more testosterone-dominant environment to contend with, and we also lose the protective effect of estrogen. If we have a genetic predisposition to follicle sensitivity, we will likely notice hair diameter changes on our scalp, whereby strands become finer, shorter and more fragile, and our parting becomes wider. Some women also have increased facial hair growth.
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