Perimenopause: Hair thinning or breaking?

My Hormonology

Perimenopause: Hair thinning or breaking?



Notice your hair is thinning or breaking during perimenopause? Here are the common culprits and treatments that can help restore your locks….

The issue

Noticing that the hair on your scalp looks or feels thinner? Do you have more breakage, making your hair strands appear frizzy and damaged? You may have hair-health issues that are common at this stage in your life.


One culprit could be a decrease in estrogen during perimenopause. This can create changes in the scalp and lead to a hormone imbalance that makes testosterone take a leading role in hair growth. The result is excessive shedding or weaker hair strands that easily break.

However, there are other culprits behind thinning hair at this age, such as….

  • Deficiencies in some nutrients
  • Stress
  • Major surgery
  • Health issues
  • Rapid weight loss
  • Extreme dieting
  • Genetics
  • The way you style your hair



Significant or rapid hair loss could be a sign of a medical condition that you should talk about with your healthcare provider. But, for many other issues impacting hair growth—including perimenopausal hormones—there are hair-thickening remedies you can try:

Moisturize hair strands

As your level of estrogen drops during perimenopause, your scalp can become dry due to less active oil glands. This means hair strands aren’t getting coated by as much protective natural oil, which can make them brittle. The fix: Switch to a moisturizing shampoo and conditioner. This helps replace lost oils so strands stay strong. Look for the words “hydrating”, “moisturizing” or “nourishing” on the product label or ask your hair stylist for recommendations.

Up your iron

If you’re getting monthly periods or your flow is heavier than it used to be, and you’re also losing more hair than usual, you could be low in iron. This is a common deficiency in women who menstruate since you lose iron as you bleed. Unfortunately, a dip in this mineral impacts hair growth since hair needs a certain amount of iron to produce healthy new cells in the scalp. If the level falls too low, hair falls out and loses texture and quality.1

Other symptoms of low iron are lethargy, trouble sleeping and mood issues, such as sadness, anxiety or irritability.2 If this sounds like you, then the solution could be as easy as getting the recommended amount of iron, which is 18 mg. daily for menstruating women, through foods or supplements.3

Tip: Take vitamin D3, too. Women with excessive hair shedding who are low in iron also tend to be low in vitamin D, according to a study in the Skin Pharmacology and Physiology.4 That’s key since D promotes healthy hair growth by stimulating hair follicles. Aim for a daily 600 IU to 2,000 IU dose of vitamin D3, the most readily absorbed form of this vitamin.5

Add more protein to your plate

Protein is another nutrient that’s important for healthy hair growth. That’s because hair is made up of 80% to 95% protein (called keratin), so if you’re not eating enough protein in your daily diet, it can interrupt your hair’s growth cycle.6 Just a few high-protein foods include beans, eggs, fish, Greek yogurt, lean beef, lentils, milk, nuts and tofu. You can also add whey protein powder to meals and beverages to increase your protein intake.

Try this nutrient combo

In a study in the Journal of Cosmetic Dermatology, taking 460 mg. of fish oil, 460 mg. of blackcurrant seed oil, 5 mg. of vitamin E, 30 mg. of vitamin C and 1 mg. of lycopene (all available in health food stores) daily reduced excessive hair shedding in 90% of female participants and prompted new hair growth that was thicker and stronger in 62% of participants within six months.7

The researchers explain that the combination of fatty acids and antioxidants in this nutrient blend may improve blood vessel function, which boosts hair cell growth, while reducing inflammation in and around hair follicles that leads to shedding. (Taking more vitamin E, vitamin C and lycopene than required in this mix is fine since you likely won’t find such small pre-portioned amounts in supplements.)

Counter hair-loss genes with 5% minoxidil

When your hair thins on the top of your head and close male or female members of your family also have excessive hair shedding, the culprit could be hereditary hair loss (also called androgenetic alopecia), which is the most common cause of hair loss in women. While you can’t change the hair-loss genes you inherited, numerous studies show you can slow future loss and possibly even regrow some lost hair and with an over-the-counter 5% minoxidil topical treatment.8

Minoxidil increases the amount of energy produced in the hair follicle, keeping it in the growing phase longer so it doesn’t fall out. Keep in mind that this works only for women with hereditary hair loss—not other conditions causing hair loss.

Look for minoxidil products, such as Women’s Rogaine, at drugstores and

Curb stress effects with vitamin C

You may have suspected that stress from work, school, family or other responsibilities can affect your hair. Well, researchers examining stressed-out female medical students discovered it’s true, according to a study in the journal PLOS ONE. Turns out, hormones released when you’re under stress (such as cortisol) drain energy from the hair follicle so it stops growing, which can thin your tresses.

Adopting stress-busting habits—such as regularly exercising, practicing yoga and meditating—is one way to curb stress. Another: Take 500 mg. of vitamin C twice daily. A growing body of research shows that this nutrient can blunt the body’s usual response to stress by reducing output of stress hormones.9

Another option: Take a daily B-complex supplement. In one study in the journal Human Psychopharmacology, stressed-out volunteers who took Bs every day for 90 days reported “significantly lower” tension than the group given a placebo.10 B vitamins (such as B6, B9 and B12) help regulate brain chemicals that impact mood and stress sensitivity. Tip: Make a point to take your B-complex early in the day since taking Bs (which are energizing nutrients) too close to bedtime can trigger wakefulness that keeps you up at night.

Ask your doctor about your thyroid

Hair that thins, especially around the outer band of the scalp, is a common symptom of an underactive thyroid (hypothyroidism), and so are fatigue, sensitivity to cold, the blues, weight gain, memory loss, brittle nails and constipation. If this sounds like you, your doctor can measure your thyroid hormone levels, then give you medicine to perk up your thyroid if it’s sluggish.

A slow thyroid doesn’t just slow down your body’s metabolism, it also slows the metabolism of your hair, plus it thickens the skin on your scalp, making it more difficult for the follicle to grow and push through new shafts. Once you reach the correct thyroid levels, your metabolism will speed up and your scalp skin will get thinner, helping to regrow lost hair.

Slow your weight loss

Dieters who lose more than 10 pounds (4.5 kg.) in a month are at a higher risk of excessive hair shedding. Why? For hair to grow, you need to a minimum number of calories to supply enough energy to the follicles. That’s because hair is a “non-essential tissue”, meaning it receives nutrients last—so when you get too little food, the body cuts back on supplying nutrients to the hair first. On top of that, skipping meals or not eating regularly means the steady energy supply to the follicles gets interrupted.

A better way to shed excess pounds while not shedding hair: Eat four small meals throughout the day (such as breakfast, lunch, a snack and dinner), which provides a steady stream of energy that promotes healthy hair growth. And aim to lose no more than the recommended one to two pounds per week.

Massage your scalp

Giving yourself a scalp massage—which includes gently kneading, stretching, pinching and pressing your scalp—for four to 20 minutes per day may spur hair growth, suggests preliminary research.11 It makes sense since massaging your scalp increases blood flow to the hair follicle, which promotes healthy hair growth.

In addition, a study in the journal Eplasty show that scalp massage may activate genes that encourage hair growth and reduce activity in genes that lead to hair loss.12

Change your hairstyle

If your hair is breaking or falling out in certain areas of your scalp, your hairstyle may be the culprit. Hairstyles that require regularly applying heat on hair strands (such as blow drying and flat ironing) and using harsh chemicals (such as bleach or relaxers) can make hair fragile and prone to breakage. And, too much tension from braids, ponytails and extensions can pull out hair at the root. Even continually parting your hair in the same spot can put extra tension on hair, causing it to break. If you’re not ready to change your style, talk with your stylist about gentler ways to get the look you want.

Consult with a doctor before trying any new vitamin, supplement or herb. And look up interactions, risks, allergy symptoms and storage instructions of all vitamins, supplements and herbs on, National Institutes of Health ( or WebMD (

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(1) Song Youn Park, et al., “Iron plays a certain role in patterned hair loss”, Journal of Korean Medical Science, 28 (2013): 934-938
(4) Hoda Rasheed, et. al., “Serum Ferritin and Vitamin D in Female Hair Loss: Do They Play a Role?” Skin Pharmacology and Physiology, 26 (2013): 101-107
(6)  Zuzanna Sabina Goluch-Koniuszy, “Nutrition of women with hair loss problem during the period of menopause”, Menopause Review, 15 (2016): 56-61
(7) Caroline Le Floc’h, et al., “Effect of a nutritional supplement on hair loss in women”, Journal of Cosmetic Dermatology, 14 (2015): 76-82
(8) Aditya K. Gupta, Kelly A. Foley, “5% Minoxidil: treatment for female pattern hair loss”, Skin Therapy Letter, 19 (2014): 5-7;  Ulrike Blume-Peytavi, et al., “A randomized, single-blind trial of 5% minoxidil foam once daily versus 2% minoxidil solution twice daily in the treatment of androgenetic alopecia in women”, Journal of the American Academy of Dermatology, 65 (2011): 1126-1134.e2
(9) Stuart Brody, et al., “A randomized controlled trial of high dose ascorbic acid for reduction of blood pressure, cortisol, and subjective responses to psychological stress”, Psychopharmacology, 159 (2002): 319-324; Delia McCabe, et al., “The impact of essential fatty acid, B vitamins, vitamin C, magnesium and zinc supplementation on stress levels in women: a systematic review”, JBI Database of Systematic Reviews and Implementation Reports, 15 (2017): 402-453
(10)  Con Stough, et al., “The effect of 90 day administration of a high dose vitamin B-complex on work stress”, Human Psychopharmacology, 26 (2011): 470-476
(11)  Robert S. English Jr., James M. Barazesh, “Self-Assessments of Standardized Scalp Massages for Androgenic Alopecia: Survey Results”, Dermatology and Therapy, 9 (2019): 167-178;
(12) Taro Koyama, et al., “Standardized Scalp Massage Results in Increased Hair Thickness by Inducing Stretching Forces to Dermal Papilla Cells in the Subcutaneous Tissue”, Eplasty, published online, January 25, 2016

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