She noticed it first in the shower drain. Then in her hairbrush. Then in the mirror — a widening part, a thinner ponytail, temples that seemed to recede. Perimenopause hair loss is one of the most distressing symptoms of the transition, affecting up to 50% of women. It is rarely discussed and often dismissed — but it is real, it is hormonal, and there are options.
Why Does Perimenopause Cause Hair Loss?
Hair follicles are sensitive to hormonal changes. Oestrogen prolongs the growth phase of the hair cycle, keeping hair on your head longer. As oestrogen declines during perimenopause, this protective effect diminishes. Simultaneously, androgens (male hormones) become relatively more dominant — and in genetically susceptible women, these androgens can miniaturise hair follicles, causing the gradual thinning known as female pattern hair loss (androgenetic alopecia).
💡 💡 Important: Not all perimenopause hair loss is androgenetic. Thyroid dysfunction, iron deficiency anaemia, and nutritional deficiencies are all common in perimenopausal women and can cause hair loss. Always have these investigated before assuming it is purely hormonal.
Types of Hair Loss in Perimenopause
- Female pattern hair loss — diffuse thinning across the crown and top of the scalp, widening part
- Telogen effluvium — sudden shedding triggered by hormonal shifts, illness, or stress. Often temporary.
- Thyroid-related hair loss — diffuse thinning often accompanied by fatigue, weight changes, and cold intolerance
Treatment Options
Medical Treatments
- Minoxidil (Regaine) — the most evidence-based topical treatment for female pattern hair loss. Available over the counter in Australia.
- MHT — oestrogen therapy can slow or halt hormonal hair loss in appropriate candidates
- Spironolactone — an anti-androgen medication used off-label for female pattern hair loss
- Low-level laser therapy — some evidence for stimulating hair growth
Nutritional Support
- Iron — have your ferritin (stored iron) checked; levels below 70 mcg/L can contribute to hair loss even without anaemia
- Zinc — deficiency is associated with hair loss
- Biotin — widely marketed but evidence is weak unless you are deficient
- Protein — adequate protein intake is essential for hair growth