In the smorgasbord of menopausal signs and symptoms, alopecia is extremely common yet often overlooked. Maybe because it can occur at the onset of perimenopause, or more often it occurs 5-10 years into menopause. This delay often stumps patients and practitioners alike.
Menopausal alopecia is a type of late-onset female-pattern hair loss (FPHL) which occurs in 50% of women by the time they reach 50. Early onset FPHL occurs in 20-30 yr olds, and late onset occurs in 40-60 yr olds.
There are several underlying causes of menopause-induced alopecia, but early intervention is key in preventing miniaturization of the hair follicles. The longer the condition continues, the more invasive the treatment typically has to be. I encourage all women to act as soon as they think they are losing more hair than is normal.
Two well-known causes of abrupt hair loss are exposure to acute stress and surgery, which can trigger a type of hair loss called telogen effluvium. It can be 2-4 months after an event before a woman may experience hair loss. This delay between the stressor and the onset of symptoms makes it difficult to connect the dots as to the cause.
Hair growth occurs in 3 phases, the resting phases (catagen and telogen), and the growth phase (anagen). With age, anagen phase-time decreases, while the resting phases increases. When age-related changes are combined with hormone-induced changes, hair loss tends to intensify. Let us not forget, Alopecia can be triggered by genetics also.
Common areas of loss include temples and frontal area, crown of head, or a more diffuse pattern of generalized loss throughout the scalp. Look for a thinning of the hair follicles (minimization or miniaturization) and increased scalp exposure (decreased density of follicles).Normal hair loss is 50-100 hairs/day. Women with hair disorders can lose 200-400 strands per day.
Both estrogen and progesterone play a role in hair follicle health. Estrogen increases hair growth in the growth phase, making the hair thicker, healthier and grow out faster. Progesterone blocks the negative effect of testosterone on the hair follicles.
Conversely, there may be a gradual increase of testosterone and adrenal hormones (cortisol/ androgens), which promote an androgen-induced alopecia. Androgens bind to hair follicles, making them to go into the resting phase sooner than normal. Androgens shrink hair follicles, which causes new hairs to grow back thinner each time, and over time lead to follicle death.
Many physiologic states can be evaluated with a cortisol rhythm. Elevated cortisol is suggestive of ongoing stress and a progesterone steal situation whereby progesterone is converted into cortisol. Both stress and low progesterone contribute to hair loss.
There are several ways to test a women to confirm this is the issue. Conventional blood tests, or ZRT labs offers very specific tests, that you do at home, and then send off for results.
If menopausal alopecia is the cause, there are many specific ways to go about slowing down the process, strengthening the hair, and even promoting hair growth again. Balancing hormones, a healthier diet, managing stress better, and even compounded Rx formulations for the scalp / hair can be prepared. So stop stressing about it (you’ll just lose even more hair), and just get started on the path that will improve the condition.