Hair Loss in Menopause and the Role of Estrogen

Hair problems increase before and after menopause. The main reason for hair loss in menopause is the reduction of the female hormone estrogen, which enriches and protects hair.

Although many women do not consider hair loss related to menopause, 40% of women experience hair loss in menopause. The increase in hair loss may start after age 45, which is defined as pre-menopause, or it can be seen 1-2 years after menopause. It can also occur at an early age in people who have entered menopause at an early age.

In the menopause period, the lack of production of estrogen and progesterone hormones, called female hormones, is not the same as it can affect whole-body metabolism, as well as hair growth. As a result of the decrease in estrogen, the male hormone Testosterone in the bloodstream does not increase, but it becomes the more dominant hormone and plays the leading role in the weakening of the hair.

The primary factor triggering hair loss in menopause is genetic predisposition. People with hair weakness in family history can see that this predisposition was triggered during menopause. Factors such as thyroid dysfunction, blood pressure problem, diabetes, insulin resistance, weight problem, intestinal problems and side effects of the drugs used can increase the degree of hair loss.

Symptoms of hair loss in menopause are as follows:

  • The hair does not grow as before,
  • Intense shedding,
  • Volumetric reduction without spillage,
  • Opening in hair separation,
  • A decline in hair inlets.

How Estrogen Affects Hair During Menopause

It is inevitable that the anxieties increase in women who have entered the menopause period. There are many questions about menopause, which has a very important place in women’s life. Apart from hot flashes, weight gain decreased sexual desire and loss of thinning and elasticity of the skin, one of the things women are most concerned about is hair loss. In the female body that produces both estrogen and testosterone before menopause, hair loss is faced because the level of estrogen hormone together with menopause is less effective against testosterone hormone. With the continuation of the menopause process, hair loss can also increase.

The hair loss mechanism of women in this period is similar to that of men. Therefore, treatments for male pattern hair loss can be applied in its treatment. Menopause increases hair loss, but not every woman who enters the menopause will necessarily lose her hair. Because, in addition to hormones, genes also have an effect on hair loss during women’s menopause. Approximately two-thirds of women who enter menopause have hair loss. Others only have thinning hair.

The normal hormone ratio in a woman’s body is 1 measure of androgen hormone versus 8 measures of estrogen (female hormone). However, when this ratio changes, hair loss begins in women. The hormone estrogen directly affects the texture of the skin and the elasticity of the hair. In fact, women’s hair begins to fall out a few months after birth. Because the estrogen level, which is very high during pregnancy, drops suddenly after birth, which affects the hair badly. However, this is a temporary situation so there is no need to worry. In addition, women taking birth control pills may experience hair loss after they stop using the pill.

In the majority of polycystic ovarian patients, the “male-type” hair loss that develops as a result of the effect of increased androgen (male) hormones and the hormone balance that deteriorates in women is a significant complaint, and with the treatment of the disease, hair loss stops and the hair grows again.

Hair loss problem is less common in women than in men. Nevertheless, women who use hair with snaps are increasing because they find their hair lifeless and scarce. However, it is necessary to know how and why it is shed to protect hair health. Environmental factors can be mentioned if the hair that is well-fed and has a strong root is still falling out. There may be a loss of hair that is collected tightly, blow-dry, washed and dyed at long and short intervals. However, if there is a loss in short hair, there may be a problem with the hair root. In such cases, it is necessary to consult a doctor. The hair of women is shed for hormonal reasons besides environmental factors. These hormonal causes include adolescence, pregnancy, menopause. The dilution at the top is called “male pattern” hair loss and occurs for hormonal reasons. Apart from environmental factors and hormonal causes, traumatic burns may also cause problems in the hair due to accidents.

How to Prevent Estrogen Related Hair Loss in Menopause

Hair development is influenced by factors such as diet, health status, medications used, stress level and degree of genetic predisposition. Therefore, while it is aimed to reduce hair loss and displace the loss in some people, results are obtained in the form of protecting the hair in some people. Sometimes hair growth can be restored. Results vary according to the methods to be preferred. The following methods can be applied:

  • Knowing Blood Values: During this period, eating habits may change, the amount may decrease, or healthy absorption may not occur due to the stomach and intestinal problems. With a detailed blood test, it should be defined whether there is a lack of vitamins or minerals. Supplements should be taken for missing values. Food supplements that contain hair amino acids tyrosine, L-cystine and methionine are particularly useful.

  • Suppressing DHT: The basis of controlling hair loss in menopause is to prevent the conversion of the more dominant and active male hormone, Testosterone, into DHT in a weakening and destructive form in the hair sheaths. There are topical lotions produced for this purpose. It contains active ingredients that can suppress DHT. It is necessary to use this type of lotion for 6-8 months regularly by applying it to the scalp.
  • Increasing Blood Flow: With the advancement of age, the rate of self-renewal of the body and cells decreases. The keratin synthesis of the skin also slows down. In order to keep the hair in the growth phase for a longer period, lotions that increase blood circulation in the scalp should be used. Today, the most commonly used lotion agent medically is “Minoxidil”. However, it may not be appropriate for every person, you should definitely talk to a healthcare professional and evaluate its suitability.
  • Laser – Light Therapy: Laser Therapy stimulates cell metabolism and accelerates blood circulation. Thus, it activates the new hair formation by reviving the weakened and thinning hair.

  • Hormone Replacement Therapy: People who take HRT support with the advice of a doctor experience hair loss in menopause less.
  • Using Herbal Estrogen Supplements: There are plants (Phyto-estrogens) that show estrogen-like effects in nature. Wild Indian Locality (Wild Yam), Black cohosh, Red clover (Trifolium Pratense), Primrose Oil, Black serpentine (Cimicifuga Racemosa), Soybean, and so on. Isoflavones provided by these plants have been used for years to reduce menopausal complaints. You can also use preparations or topical lotions containing these herbs for hair loss in menopause. Herbal estrogen food supplements are products that should be consulted and used for people with a family history of cancer. For this reason, lotions used on the scalp are preferred.

  • Getting Support From Different Methods of Cell Renewal: Although procedures such as PRP, Mesotherapy, Micro Dermal Therapy are of different qualities, the main purpose is to trigger more collagen, hyaluronic acid, elastin fibril formation by secretion of growth hormones around the hair follicle. Thus, the hair roots become stronger and the development of the hair can be faster.

To get results from all these methods, it is necessary to use the recommended method for hair loss in menopause for 4-6 months regularly.

A Scientific View: Estrogen, Contraceptives and Hair Loss

The common belief in the society is that estrogen, progesterone duo, namely birth control drugs, are good for hair loss – preventing loss. For this reason, hair loss is considered to increase after menopause. Because when the menstrual period ends and the woman enters menopause, blood estrogen and progesterone levels decrease over time. This period is often accompanied by hair loss. The same situation is observed in the postpartum period and for other reasons in patients using estrogen receptor blockers. However, scientific data that birth control drugs prevent hair loss are insufficient.

However, we still have evidence that estrogen nourishes the hair. For example, women have more estrogen receptors in the front of the head (frontal) and aromatase enzyme activity that converts testosterone to estrogen. For this reason, the forehead lines of women are generally preserved, that is, male pattern shedding is not observed or occurs at very advanced ages. Testosterone in this region is converted to estrogen instead of converting to DHT and thus, it gets rid of hair loss. Based on this feature, estrogen was used even in some male cases and it was reported that effective results were obtained. According to these data, it can be thought that estrogen and contraceptive drugs will work in women before and after menopause.

Oral contraceptives increase the amount of circulating free hormones by increasing the amount of globulin that binds sex hormones in the blood. This protects hair indirectly from the effect of testosterone and DHT. It also suppresses the mechanisms that cause more testosterone to be produced. Sex hormones are converted to each other with enzymes. The name of the enzyme complex that converts androstenedione and testosterone to estrogen in women is aromatase. Although estrogen is the guardian angel of women in many cases, the hormone that feeds hormone-sensitive breast cancer is also estrogen. Therefore, the most commonly used drugs in the treatment of breast cancer are aromatase inhibitors.

Depending on the condition of the patient, we usually get very good results from a combination of estrogen + progesterone + spironolactone… The preparations are prepared orally or topically for the patient. This treatment protocol has been approved by the FDA for the treatment of acne but has not yet been approved for hair loss. The hardest part is: inviting our female patients to have 6 months of patience for the first results of the treatment. It really sounds long for women. The nice and encouraging part of the job is that they absolutely agree to wait 6 months when hair loss stops around the tenth day (Hormonal therapy in female pattern hair loss).

Female Pattern Hair Loss (FPHL) in General

Hair loss in women is usually caused by hormonal causes or mineral deficiency in the body. This situation may not be prevented with methods such as zinc, vitamin B supplements, and mesotherapy. Hair loss may occur if there is a problem in the absorption of these minerals due to zinc or selenium deficiency and chronic intestinal disease. Rheumatic diseases can also cause this problem. In these cases, the problem of baldness or hair loss improves when the missing mineral is replaced or the disease is treated.

Androgenetic hair loss, which is caused by a lack of minerals in the body, is observed in 90 percent of men and 45-50 percent of women. Androgen hormone in men and women plays a variable role in the emergence of this condition, such as genetic predisposition and aging and stress that will trigger these two causes. If the person is genetically predisposed and has the androgen hormone in his body, his hair will be lost at some point in his life. Hair loss can occur in approximately 30 percent of men aged 30 and 40 percent of those aged 40.

This type of hair loss is defined as the progressive miniaturization of the hair follicle, which shows a different pattern of hair loss in women and is more common in women who are genetically predisposed. Miniaturization is defined as the transformation of thick hair into thin hair. It is a common condition. It causes higher aesthetic concerns in women than men, which is important because it creates serious stress. It is seen in 12% of women around the age of 30 and 30-40% between the ages of 60-69. Although it usually progresses at variable clinical severity and at a certain pace after adolescence, it can also start at any age. As the age of onset decreases, the tendency of clinical violence increases.

The Reasons of Female Pattern Hair Loss

The frequency and severity of androgenetic alopecia in women, as in men, increases with age. The role of androgens in hair loss is not exactly as clear as in men. Therefore, the concept of female pattern hair loss (FPHL) is considered to be more accurate in defining the disease. FPHL is observed in women with high androgen levels. Other findings of androgen excess, such as hirsutism, menstrual irregularity, are also observed in these patients. Androgen excess is defined as hyperandrogenism. However, it may not always be seen with elevated serum androgen levels.

Most of the female patients with FPHL do not have any signs of clinical and biochemical androgen excess. The increased sensitivity of hair follicles to normal androgen levels in these women may explain this situation. More interestingly, male pattern hair loss is observed in people with androgen sensitivity or alpha-reductase deficiency. This female type proves that androgenetic alopecia can occur even in the absence of androgens. Decreased levels of hormone-binding globulin (SHBG) in women compared to the control group have been shown in many studies. These findings show that there is a correlation between free androgen levels in the blood and severity of hair loss.

Genes that cause genetic transmission have not been detected in studies. Polymorphism of the androgen receptor gene EBA2R on the x chromosome, which is one of the genes specific for male pattern hair loss, has also been demonstrated in early-onset female patients. In male relatives of women with FPHL, more androgenetic alopecia findings were detected than in the normal population.

The Treatment of Female Pattern Hair Loss

Drug treatments can be divided into the androgen-dependent and androgen-independent in terms of their mechanisms of action.

Androgen-Independent Treatments

  • Minoxidil

Today, the only approved androgen-independent treatment is minoxidil topical solution. It is thought to affect the hair life cycle and provide an early termination of the telogen period and prolong the anagen phase. It has a potassium channel opening effect and its mechanism of action is still not very clear. It has been found that they stimulate new vessel development around the hair follicle and hair growth factors (vascular endothelial and hepatocytic growth factors). It has properties to increase the number and weight of the hair. Only 2% of the form has approval in FPHL. The 5% solution is effective but side effects such as local and facial hair growth are observed.

Minoxidil 2% is applied 1 ml twice a day. It should be used for at least 12 months to evaluate its effect. After the activity is provided, it should be continued without cutting. It should be known that telogen effluvium, ie shedding, can be triggered after discontinuation. There may also be a temporary increase in shedding in the first months of treatment. Its side effects are often allergic to propylene glycol and contact dermatitis. Since the 5% foam form does not contain this content, there is less possibility of side effects. It has been shown that the use of 0.025% retinoic acid and 0.05% betamethasone Dipropionate together with minoxidil is more effective in FPHL.

Androgen-Dependent Treatments

  • Cyproterone Acetate

Cyproterone acetate is a synthetic steroid with antiandrogen and antigonadotropic properties with weak progesterone activity. Androgen receptor competes as a binder with dihydrotestosterone. Although there are contradictory results about its effectiveness in FPHL, it is successful in women with hyperandrogenism and high ferritin levels. Side effects are weight gain, menstrual irregularities, decreased libido, breast tenderness. It is definitely not used in pregnancy.

  • Spironolactone

It is widely used in the treatment of FPHL and hirsutism. It acts as an androgen antagonist by blocking androgen receptors as a competitor, but also by inhibiting the production of androgens from the ovaries. It is used in 100-200mg / day doses. Since it also acts as an aldosterone antagonist, it has different side effects than other antiandrogens such as postural hypotension, electrolyte disorders. Menstrual disorders, weakness, urticaria, breast tenderness, and hematological disorders are other possible side effects. Regular blood pressure and electrolyte levels are recommended for the first few months of treatment. It should be used much more carefully in people with kidney disease.

  • Finasteride

Finasteride is a type 2 α-reductase enzyme inhibitor, inhibiting the conversion of testosterone to dihydrotestosterone. Reduces hair loss and stimulates hair growth at doses of 1mg / day for male pattern hair loss. Its effectiveness has been demonstrated in menopausal women with a contraceptive pill containing drospirenone and Ethinylestradiol at a dose of 2.5-5 mg/day. It is not used in pregnancy. There may be a slight increase in estrogen levels due to the conversion of testosterone to estradiol, so it is not recommended for those with a personal or family history of breast cancer.

  • Dutasteride

Types 1 and 2 are 5 α-reductase enzyme inhibitors. In 2002, it was approved to use 0.5 mg/day for benign prostate enlargement in men. Compared to finasteride, it is known that it has 100 times the effect on type 2 5 alpha-reductase enzyme and 3 times on type 1 enzyme. It inhibits the conversion of testosterone to dihydrotestosterone. Effective results have been observed with 0.25 mg/day dutasteride. A combination of 0.5 mg / day dutasteride and 2.5 mg / day finasteride is recommended. Dutasteride can be applied to the top of the hair with mesotherapy and a combination of biotin, pyridoxine, and D-panthenol.

  • Flutamide

Flutamide is a nonsteroidal selective antiandrogen that inhibits the receptor connections of androgens. Studies have highlighted the effectiveness of female pattern hair loss at a dose of 250 mg/day. The only restrictive aspect is the presence of a dose-dependent liver toxic effect. Therefore, it is necessary to carefully monitor liver functions.

Other Treatment Options

  • Prostaglandin Analogs

Prostaglandin analogs such as latanoprost, travoprost, and bimatoprost are used in the treatment of glaucoma and ocular hypertension. It has been observed that it accelerates eyelash growth during these treatments. It is the only FDA approved mediation for bimatoprost eyelash hypotrichosis. There are studies with a limited number of patients only in male-pattern androgenetic alopecia.

  • Ketoconazole

Studies suggesting that shampoos containing ketoconazole increase hair density and the size and rate of anagen follicles in male pattern hair loss, and the systemic antiandrogen effect of ketoconazole may be effective in FPHL, but there is no comprehensive study in this direction.

  • Low-Level Light Therapy

There are opinions that the photons in the beam regulate the production of adenosine triphosphate on the cytochrome oxidase in the mitochondria in the hair follicles, activate the hair follicles and increase the blood flow in the hair follicles. For this purpose, systems containing light-emitting diodes of 630-680 nm wavelength have been developed. These are applied as hats or combs. They are applied several times a week for 10 to 15 minutes. Reported side effects are scalp irritation and redness. It can be an ideal alternative to support medical or surgical treatment or for patients who are resistant to treatment.

Best Products to Prevent Hair Loss in Women

Savaş Ateş

I'm a hair loss expert. The picture was taken 10 years ago :) I have been losing my hair. So I started to learn everything about hair loss and hair transplants. I contacted a lot of hair transplant doctors. We shared our experiences. I'm writing blog posts for people who have the potential of losing their hair. I give some tips about hair transplants and medical issues too.

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