Hair Loss & Thinning

Written by Andrea Mazzocchi, PhD | Medically reviewed by Mandy Armitage, MD

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If you're noticing more hair in your brush or a widening part line, you’re not alone. About 40% of women experience noticeable hair loss by age 50, and this can increase significantly during perimenopause (1).

Hair loss or thinning may be one of perimenopause’s most under-discussed symptoms. But menopause-related hair changes may look different for each woman: increased shedding during washing, visible scalp at the crown, a thinner ponytail, or changes in hair texture. So how can you take control of your hair health during perimenopause? The first step is understanding the science behind these changes.

How common is hair loss during perimenopause or menopause?

Hair changes during perimenopause are very common. Studies suggest that around half of women in perimenopause identify hair thinning as a bothersome. This makes it almost as common as many of the more widely recognized symptoms (2).

What makes this challenging is the lack of awareness and tracking tools. Many women don't realize their hair changes are hormonally driven and therefore potentially treatable. If we understand hair loss as a quantifiable, hormone-related symptom rather than an inevitable part of aging, we can intervene with data-driven solutions.

How do hormone changes in perimenopause cause hair loss and thinning?

The science behind perimenopausal hair loss is complex. It involves hormonal shifts that directly impact hair follicle function. During early perimenopause, fluctuating hormone levels trigger increased shedding, textural shifts, or decreased manageability. As the transition progresses, these changes accelerate, particularly in the years immediately surrounding the final menstrual period (3).

Hair follicles contain specific estrogen receptors. So there is a direct biological pathway through which hormonal changes influence hair health (4). Specifically, estrogen and progesterone act to extend the growth phase of hair follicles. This results in thicker, more robust hair growth (5). When these hormone levels decline in menopause, the result is shortened growth phases and thinning hair (6).

Importantly, the ratio of estrogen-to-androgen (such as testosterone) changes in menopause. This creates a new follicular environment. As estrogen decreases, the relative influence of androgens increases, even though absolute androgen levels may remain stable. This ratio change triggers follicle miniaturization in genetically susceptible women. In some cases, hormone changes can be measured with hormone tests (7).

What can I do about hair loss in perimenopause?

Understanding these mechanisms is important and actionable. With symptom tracking and early intervention, we can identify individual patterns, predict progression, and work with a clinician to implement targeted interventions before significant hair loss occurs. This data-first approach transforms hair loss from a mysterious inevitability into a manageable aspect of the perimenopause journey.

Tracking your symptoms and hormones with Play Health can help you make sense of the symptoms you’re experiencing during perimenopause.

• References

  1. Mirmirani P. Managing hair loss in midlife women. Maturitas. 2013;74(2):119-122. doi:10.1016/j.maturitas.2012.10.020

  2. Williams R, Levine KB, Kalilani L, Lewis J, Clark RV. Menopause-specific questionnaire assessment in US population-based study shows negative impact on health-related quality of life. Maturitas. 2009;62(2):153-159. doi:10.1016/j.maturitas.2008.12.006

  3. Zouboulis CC, Blume-Peytavi U, Kosmadaki M, et al. Skin, hair and beyond: the impact of menopause. Climacteric. 2022;25(5):434-442. doi:10.1080/13697137.2022.2050206

  4. Ohnemus U, Uenalan M, Inzunza J, Gustafsson JA, Paus R. The hair follicle as an estrogen target and source. Endocr Rev. 2006;27(6):677-706. doi:10.1210/er.2006-0020

  5. Conrad F, Paus R. Estrogens and the hair follicle. J Dtsch Dermatol Ges. 2004;2(6):412-423. doi:10.1046/j.1439-0353.2004.04037.x

  6. Grymowicz M, Rudnicka E, Podfigurna A, et al. Hormonal effects on hair follicles. Int J Mol Sci. 2020;21(15):5342. doi:10.3390/ijms21155342

  7. Herskovitz I, Tosti A. Female pattern hair loss. Int J Endocrinol Metab. 2013;11(4):e9860. doi:10.5812/ijem.9860