Understanding hair loss
Worried about your hair? Don’t understand what’s changed?
You are not alone if you've noticed your hair is thinning.
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While thinning hair and baldness is most associated with men, it affects around a third of women too 1 . Hair loss tends to be subtler in women with overall thinning (a thinner ponytail, a wider parting, sparse patches around the front hairline) rather than noticeable bald spots.
Through menopause more women can be affected by hair fall - studies report that around 40-50% of menopausal women experience some degree of hair loss.
Before we dig into why this is, let’s remember that some hair loss is normal. Everyone loses hair as part of the hair’s natural growth cycle, which occurs in three stages:
1. The anagen stage - when a hair strand is actively growing (c. 2-8 years).
2. The catagen stage - a short transition phase that lasts up to three weeks. At this point the hair has stopped growing and is preparing to shed.
3. The telogen stage - when the hair is expelled from the follicle.
We also lose more hair at certain times of year. It’s typical to lose more hair during the winter due to dry air leading to hair problems - the hydrogen bonds in your hair strands become weak, resulting in dry hair, breakage and split ends.
And, of course, we also lose hair simply through the ageing process - hair diameter, follicle production and pigmentation all reduce, scalp oil production drops and hair thins.
So, why does hair seem to, almost overnight, thin through perimenopause and menopause? Some of it is hormonal change, but that’s far from the only reason.
Oestrogen and progesterone are two hormones essential for hair growth – they help hair grow faster and stay on the head for longer periods of time. As they become less available through the menopause transition, we see a decline in the number of hair follicles and a shrinking in those that remain plus a drying of the scalp. This can cause the hair to become thinner, weaker, and more prone to breakage and falling out 3 .
A decrease in these hormones also triggers an increase in the production of androgens, which are a group of male hormones. Androgens shrink hair follicles, resulting in hair loss on the head 4 . In some cases, not only this but they can also cause more hair to grow on the face. This is why some menopausal women develop facial “peach fuzz” and small sprouts of hair on the chin.
The thyroid gland produces hormones that play a critical role in regulating the body's metabolism. When the thyroid gland is not functioning properly, it can affect various bodily functions, including hair growth. Both hypothyroidism (an underactive thyroid gland) and hyperthyroidism (an overactive thyroid gland) can cause hair loss 5 .
In hypothyroidism, the body’s metabolism slows down, leading to a reduction in hair growth. Hair can become dry, brittle, and thin, and may fall out more easily than usual. In hyperthyroidism, the body's metabolism speeds up, which can also affect hair growth. The hair may become finer and more fragile and may fall out in large amounts.
Insufficient protein in the diet
Protein is important for hair growth because hair is primarily made up of a protein called keratin. Keratin is a tough, fibrous protein that forms the structural framework of hair, as well as nails and the outer layer of skin. When you consume protein through your diet, it’s broken down into amino acids (the building blocks of protein).
These amino acids are then used by your body to build and repair tissues, including hair.
In general, we need more protein in our diet than we realise (see our Power of Protein wise words article) and if hair-fall is a concern for you, that’s particularly important.
Your body considers hair to be a ‘non-essential tissue’, meaning that it’s not necessary for survival. As a result, your body will prioritise other tissues, such as your organs, over your hair when it comes to distributing nutrients.
So, if you want the protein you eat to benefit your hair, you need to be eating enough that your body, in effect, considers it in excess or more than is needed for its essential tasks.
Hair follicles are among the most metabolically active cells in the body and require a steady supply of nutrients and oxygen to grow and function properly.
Iron is particularly important for hair growth because it is a key component of haemoglobin, which is the protein in your red blood cells that carries oxygen throughout your body. When your body is low on iron, it can lead to a condition called iron-deficiency anaemia, which can cause hair loss.
Iron also plays a role in the production of collagen, which is an important component of the hair follicles. Collagen provides structure and support to the hair, and a lack of iron can lead to weak and brittle hair.
Zinc is also important for hair growth because it plays a vital role in DNA and protein synthesis, which are essential processes for cell growth and division. It also helps to maintain the oil-secreting glands that are attached to the hair follicles. A lack of zinc can lead to the malfunctioning of these glands, which can result in hair loss and dry, brittle hair.
Stress can impact hair loss in two ways. Firstly, its ability to exacerbate hormonal imbalances. When we’re stressed, the availability of oestrogen and progesterone can further decline which impacts hair health.
Secondly, our body’s response to particularly stressful situations such as surgery or an adverse life event such as a bereavement. Stress can cause a type of hair loss called telogen effluvium, which occurs when a significant number of hair follicles enter the resting (telogen) phase of the hair growth cycle at the same time.
This can cause hair to fall out in large clumps several months after the stressful event. Stress can also trigger an autoimmune condition called alopecia areata, which causes the immune system to attack hair follicles, resulting in hair loss.
Inflammation is another one of the possible underlying factors that can contribute to hair fall 6 .
Inflammation can cause damage to the hair follicles by promoting the release of free radicals, which can damage the follicle cells and impair their ability to produce healthy hair. Inflammation can also trigger an autoimmune response, where the body’s immune system attacks the hair follicles (known as alopecia). It can also affect the scalp – for example in the form of eczema or psoriasis – which impacts hair health.
Hair loss can be genetic. The most common genetic condition is known as female-pattern hair loss, or androgenic alopecia. Women with this condition might notice a widening of the part at the top of the head. It often begins when a woman is in her 40s or 50s.
Some medications include side effects that can affect hair quality. If you think this could be a consideration for you, please discuss with your healthcare provider. Cancer treatment, chemotherapy, is well understood to cause hair loss.
Some women find that HRT, rather than helping with hair loss, can be counter-productive. This is because oestrogen can disrupt the hair growth cycle, leading to more hair entering the telogen (resting) phase and falling out. If you are also replacing testosterone, some women can experience hair loss linked to this, especially if they are genetically predisposed to male-pattern baldness. If this is a concern for you, please have a conversation with your healthcare provider.
As you can see, there are a range of possible contributing factors to hair loss. Without testing and analysis, it’s difficult to pinpoint the key contributing factors in your case, but below are some general start-points that can help.
Get the right nutrition
- Eat more protein. It really is that simple.
There’s been a lot of noise about collagen recently and there are many collagen supplement brands one can buy.
Collagen is an amino acid (a building block of protein) that’s an essential component of the skin, hair, and nails, playing a role in maintaining their strength and elasticity. Consuming sufficient collagen will help your hair but, please remember, only in the same way as eating protein – you don’t need a specialist product.
2. What can be helpful, however, is ensuring you have sufficient Vitamin C as this is necessary for the synthesis of collagen fibres. Vitamin C also has antioxidant properties, which help to protect collagen from damage by free radicals. Vitamin C is found in a variety of foods, including citrus fruits, berries, tomatoes, peppers, broccoli, and kale.
3. Ensure your iron levels are optimal. Good dietary sources of iron include red meat, poultry, fish, beans, lentils, spinach, and dried apricots
4. B vitamins are considered to help restore hair growth. You may have read about biotin (B7) which can contribute to healthy hair as it functions in the synthesis of hair proteins like keratin. It’s found in foods such as eggs, milk, avocado, beef liver and salmon.
5. Essential fatty acids also play a crucial role in maintaining hair health and can be found in salmon, tuna, walnuts and almonds.
An easy way to combat dry hair is to drink more water – make sure you’re drinking 2 litres of caffeine free and non- alcoholic liquid per day. Avoid sweet drinks (including fruit juices) and artificial sweeteners (eg. sugar free squash, diet sodas).
Look after your thyroid
WomenWise can help you understand if you are suffering from an imbalanced thyroid and your best options to resolve any imbalance. If it’s medically out of range, this will need to be discussed with your doctor. If you are looking to optimise thyroid function, this can be achieved with targeted supplements as advised by your nutritional therapist. Following the nutrition recommendations as above will also help plus particularly ensuring optimal iron levels.
Manage your stress
Something we should all be doing, every day, but remember that managing your stress can help with hair loss. There are many approaches to building your stress resilience, including breathwork, mindfulness, yoga, exercise and spending time in nature. Find the one that works for you and build it into your life.
Treat your hair kindly
In order to prevent drying and breakage, it’s best to stay away from heat tools, such as hair dryers and straightening irons 9 . Extensions and other styling methods can also weaken your hair and cause hair loss.
If you dye your hair, choose an all-natural hair colour. Artificial chemicals found in dyes and perms can put undue strain on your hair.
Keep your hair clean (wash it every 2 to 3 days) with a gentle sulphate-free shampoo and always use a nourishing conditioner to keep your scalp healthy and promote healthy hair growth.
A soft bristled hairbrush is a good idea and don’t brush your hair when it’s wet – loosely detangle with your fingers instead. Avoid hairstyles that cause substantial strain on your follicles – eg. a tight, high ponytail or bun.
If you swim, make sure to wear a swimming cap, as chlorine can contribute to hair breakage. When out in the sun or the wind for extended periods of time, it’s important to wear a hat to protect your hair from drying and breakage.
Look after your scalp
Scalp health can be overlooked but nearly half of women experience an itchy scalp through perimenopause. As scalp health and hair health are closely linked, looking out for your scalp is important. Wearing hats, bandanas, or covering your head from the sun protects against UV rays and will help prevent sunburn.
Scalp treatments or serums containing aloe vera help soothe dry skin and improve overall scalp health. In addition, treating any pre-existing conditions such as dandruff or psoriasis will improve scalp health and is likely to have a positive impact on your hair. One study suggests topical coconut oil on the scalp helps to reduce dandruff and promote healthy scalp bacteria 10 .
Minoxidil (found in Regaine) is a treatment recommended for Female Pattern Hair Loss and research suggests it encourages hair density 11 . Whilst Minoxidil doesn’t require a prescription, check with your GP before using as it may adversely affect pre-existing scalp conditions or interact with other medications you are taking.
There are also some newer options being used to treat hair loss. One is platelet-rich plasma (PRP) injections, another is the use of low-level LED laser lights. These have yet to be fully researched and results are principally anecdotal.
Avoid chronic inflammation
To help reduce inflammation in the body - follow an anti-inflammatory diet (focus on foods that are rich in antioxidants and avoid processed and high-sugar foods), exercise regularly, manage stress and get enough sleep, avoid smoking and limit alcohol consumption.
If your levels of oestrogen and progesterone are low, you can consider discussing the option of HRT with your doctor or investigate natural alternatives.
For many women, their hair is their crowning glory and suffering hair loss can be a knock to their confidence. But, please be assured, there are many options to help strengthen your hair (many of which will also benefit your overall mid-life health).
Learn more about the menopause:
Want to understand more about the menopause and how WomenWise can help you beat your symptoms? Check out the rest of our website and you can also book a free discovery call with one of our friendly experts.
2 (Brito, Brüggen, Ildiz, Fausto, 2022; Chaikittisilpa et al., 2022; Mirmirani, 2011; Pimenta, Leal, Maroco, Ramos, 2012) .
3 Tosti, A., Schwartz, J. R., Frost, P., James Schwartz, C. R. (2021). Role of scalp health in achieving optimal hair growth and retention. International Journal of Cosmetic Science, 43(S1), S1–S8. https://doi.org/10.1111/ICS.12708
4 Zouboulis, C. C., Blume-Peytavi, U., Kosmadaki, M., Roó, E., Vexiau-Robert, D., Kerob, D., Goldstein, S. R. (2022). Skin, hair and beyond: the impact of menopause.
7 Thomas Stephens, by J., Berkowitz, S., Marshall, T., Kogan, S., Raymond, I. (2022). A Prospective Six-month Single-blind Study Evaluating Changes in Hair Growth and Quality Using a Nutraceutical Supplement in Men and Women of Diverse Ethnicities. The Journal of Clinical and Aesthetic Dermatology, 15(1), 21. Retrieved from /pmc/articles/PMC8903234/
8 Ablon, G., Kogan, S., Raymond, I. (2022). A Long-Term Study of the Safety and Efficacy of a Nutraceutical Supplement for Promoting Hair Growth in Perimenopausal, Menopausal, and Postmenopausal Women. Journal of Drugs in Dermatology, 21(7), 776–783.
9 Alessandrini, A., Starace, M., Bruni, F., Piraccini, B. M. (2020). Bubble Hair and the Usefulness of Trichoscopy. Dermatology Practical Conceptual, e2020081–e2020081.
10 Saxena, R., Mittal, P., Clavaud, C., Dhakan, D. B., Roy, N., Breton, L., … Sharma, V. K. (2021). Longitudinal study of the scalp microbiome suggests coconut oil to enrich healthy scalp commensals. Scientific Reports 2021 11:1, 11(1), 1–14.
11 Lucky, A. W., Piacquadio, D. J., Ditre, C. M., Dunlap, F., Kantor, I., Pandya, A. G., … Kohut, B. E. (2004). A randomized, placebo-controlled trial of 5% and 2% topical minoxidil solutions in the treatment of female pattern hair loss. Journal of the American Academy of Dermatology, 50(4), 541–553.
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