As the body goes through the menopause, various hormonal changes occur to include the reduction in the production of oestrogen. These hormonal changes can alter the natural growth cycle of the hair follicle which can result in finer, shorter hair and sometimes even hair loss.
Female pattern hair loss (FPHL) is considered to be the equivalent of male pattern baldness. It usually peaks during the reproductive years and after the menopause which suggests a strong hormonal link.
In FPHL there is an increase in the transformation of the hormone testosterone to a chemical called DHT and it’s this DHT that has been shown to contribute to hair loss. This process is helped along by an enzyme called 5-alpha reductase, this is important to note as some treatments of hair loss act on this enzyme.
Women with FPHL usually notice a very gradual thinning of the hair, mostly at the top of the head but also at the sides. Some women may notice thinning of the ponytail or a change in the texture and length of the hair. Interestingly, about 50% of women with FPHL have a family history of female hair loss, which suggests that there is also a genetic component.
Hair care practices such as colouring, perming or relaxing and the use of heat can cause damage – this alongside going through the menopause can have significant effects on hair quality. Therefore, avoid chemical treatments wherever possible and keep the use of heat to a minimum!
People often ask me about what I can do as a GP for hair loss and what medications can be prescribed, well, the answer is as follows.
FPHL tends to be very gradual and follows a very particular pattern, therefore if hair loss is sudden or if the features of hair loss are unusual – other causes should be considered.
Thyroid problems, low iron and low vitamin D can all contribute to FPHL. All of which are easily treatable by your GP. In some cases topical treatments such as minoxidil can be considered to see if they help, however they can sometimes cause scalp irritation and increased hair growth in unwanted areas.
As GP’s we can also talk to you about getting psychological support for the emotional effects of hair loss, which can sometimes be just as hard to manage as the hair loss itself – don’t suffer in silence.
You may have heard about the use of ‘blood pressure tablets’ (spironolactone) and tablets traditionally used to treat large prostates in men (finasteride) for hair loss – these are usually started after specialist referral to a Dermatologist as they too can have some unwanted side effects.
So can we make any lifestyle changes to prevent hair loss? My advice would be to look after the hair follicle and shaft from day one, eat well and look after your body – exercise, minimise stress, drink alcohol in moderation and try not to smoke!
In recent years there has been lots of interest in newer, more innovative treatments for hair loss such as laser, micro-needling, hair transplantation and fat transfer – the results of which are very promising.
Many women ask me if the use of hormone replacement therapy (HRT) is beneficial in reducing hair loss after menopause. Unfortunately HRT has not been adequately studied or licensed for the treatment of FPHL in post-menopausal women; therefore it should only be considered if it’s indicated for other reasons. Nonetheless, it most likely will contribute to good hair health.
Another question I get asked often is, how much hair loss is ‘normal’ and at what point should someone go to their GP for advice? It’s normal to shed between 50-100 hairs per day. However in reality, hair loss can vary tremendously from person to person. As a general rule of thumb – if you notice thin or bald patches, a visible scalp, a sudden increase in hair fall, or a gradual decline in the thickness of the hair, seek help from your GP.
Finally something topical, can Covid-19 cause hair loss? The answer is in fact yes. Telogen effluvium (TE) is a common type of hair loss. It presents as diffuse hair loss following a significant stress on the body. This can occur as a result of stressful life events, drugs, following major surgery, hormonal abnormalities and even some nutritional deficiencies. TE typically occurs around 1-3 months after a major stress to the body and most people with it notice a general thinning of the hair. Unlike some other types of hair loss, TE is almost always temporary and for most people the hair does grow back. Most people notice that the hair is ‘back to normal’ around 6 months after the hair loss. In some cases the hair unfortunately doesn’t grow back but this is very rare.