Understanding Hair Changes in Perimenopause and Menopause
Article written by Dr Rachael Kay, Hair Restoration Doctor, March 2026
This information is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your healthcare provider for personal guidance.
Hair plays a deeply personal role in how many women see themselves. It is often tied to identity, confidence, and a sense of vitality. It can affect how people engage with the world and how they see themselves.
When hair begins to change, it can feel unsettling, particularly during a life stage already characterised by physical and emotional transition.
Perimenopause and menopause bring significant hormonal changes that influence many systems within the body, including the hair follicles. Often the shift is gradual, with hair becoming finer, less dense, or more difficult to style. Hair related specifically to menopause and peri menopause tends to be the development or unmasking of Female pattern hair loss. However, there are a multitude of other forms of hair loss which can occur at this stage of life which need different investigations and treatment.
Although menopausal hair changes are common, they can still feel distressing. Many women describe becoming increasingly aware of the amount of hair they see when brushing or washing or noticing subtle changes to their parting or ponytail thickness. It is not unusual for hair loss to trigger anxiety or concern about how much worse things might become.
Why hair changes during midlife
Perimenopause and menopause involve significant hormonal changes, particularly fluctuations and eventual decline in oestrogen levels.
Oestrogen plays an important role in supporting the normal hair growth cycle. As oestrogen levels decline during perimenopause and menopause, several changes can occur within the hair follicles.
The growth phase of the hair cycle may become shorter, meaning hairs do not grow for as long as they once did. At the same time, the balance of hormones in the body shifts. With lower oestrogen levels, the effects of other hormones, particularly androgens such as testosterone can become more noticeable.
Some testosterone is converted into another hormone called dihydrotestosterone (DHT). In women who are genetically sensitive to this hormone, DHT can gradually affect the hair follicles. Over time the follicles may become smaller and produce finer, shorter hairs.
This process is known as follicular miniaturisation and is the underlying mechanism behind female pattern hair loss.
Female pattern hair loss typically develops slowly and often appears as widening of the parting or thinning over the crown of the scalp, while the frontal hairline usually remains relatively preserved. The ponytail can start to feel thin too.
Understanding the hair growth cycle
Hair grows in a natural cycle made up of three stages.
The anagen phase is the active growth stage and can last between two and seven years. At any one time, the majority of scalp hairs are in this phase.
This is followed by the catagen phase, a short transitional period lasting a few weeks, when the follicle begins to shrink.
The hair then enters the telogen phase, a resting stage lasting several months before the hair sheds and a new hair begins to grow.
It is normal to shed around fifty to one hundred hairs each day as part of this cycle. However, when a larger number of hairs enter the resting phase at the same time, noticeable shedding can occur.
This normal cycle can sometimes be disrupted by physical or emotional stress, illness, hormonal changes, such as thyroid changes, or nutritional factors. When this happens, a larger number of hairs may enter the resting phase together, leading to increased shedding a condition known as telogen effluvium. This can occur alongside the peri menopausal or menopausal period but is not always directly related to it.
Women may notice a sudden increase in hair shedding, particularly when washing or brushing their hair. Despite the alarming amount of shedding, the hair follicles themselves usually remain healthy and capable of regrowth. If this cycle continues without the trigger being identified, it can evolve into an ongoing hair loss cycle known as Chronic Telogen Effluvium.
Because several different hair loss conditions can present with similar early signs, accurate diagnosis becomes particularly important.
The importance of accurate diagnosis
When the underlying reason is clearly understood, treatment can be targeted appropriately and unnecessary worry, or ineffective and often costly interventions can be avoided.
A specialist consultation for hair loss usually begins with a detailed discussion about medical history, recent life events, medications, hormonal changes, and nutritional health. Blood tests are often arranged to help identify potential contributing factors.
Examination of the scalp is also an important part of the assessment. This should include trichoscopy, a magnified evaluation of the scalp that allows subtle differences between hair loss conditions to be identified
Holistic Approach
Hair loss rarely happens in isolation. It often reflects a combination of hormonal changes, life circumstances, and overall health. Understanding the wider picture of a woman’s life is therefore an important part of making sense of what is happening.
For many women, the years surrounding perimenopause and menopause are also a time of significant responsibility and transition, balancing careers, family life, caring for ageing relatives, or navigating other personal challenges. These factors can all influence our physical wellbeing, including the health of our hair.
Taking the time to consider these wider influences helps ensure that hair loss is approached with both clinical understanding and compassion.
What can I do to help?
For women who are noticing changes in their hair, there are some practical steps that may help support hair health while seeking clarity about the underlying cause.
Paying attention to the pattern of hair changes can provide useful information. Some women notice increased shedding, while others observe gradual thinning over time. Reflecting on recent life events or health changes may also offer clues, as hair shedding frequently follows triggers that occurred several months earlier.
Supporting overall health can also be beneficial. Hair follicles are highly active structures that require adequate nutrition, particularly sufficient protein, iron stores, and key micronutrients.
Maintaining scalp health through gentle hair care practices and avoiding excessive heat or harsh chemical treatments may also help protect the hair shaft.
It is also worth recognising that when shedding increases, it is natural to become hyper-aware of every hair that falls. Many women find themselves checking the brush, shower drain, or pillow with growing concern. While this reaction is understandable, constantly monitoring hair loss can increase anxiety and rarely provides meaningful information.
Some types of HRT are more hair friendly than others and so if hair loss is a concern, it is important to mention it during these discussions.
Finally, blood testing, what needs investigating is dependent on the type of hair loss suspected, but would typically include Full blood count, Iron, B12, Vitamin D, Thyroid, SHBG, Testosterone (to calculate FAI or free androgen Index). Explore blood test options at Lemala Health.
When to seek specialist advice
Although some temporary shedding resolves naturally over time, it can be helpful to see a hair specialist to ascertain correct diagnosis.
Early assessment allows an experienced clinician to distinguish between the various causes of hair loss and develop an appropriate treatment strategy. In some cases, timely intervention may help prevent further follicle miniaturisation and preserve hair density
Final thoughts
Hair loss during perimenopause and menopause can feel overwhelming, but it is rarely without explanation. With careful clinical assessment and a holistic understanding of each woman’s health and life stage, it is often possible to identify the contributing factors and develop a personalised plan for improvement.
Ultimately, understanding the true cause of hair loss requires both clinical expertise and a holistic view of each woman’s unique health journey, ensuring that care is thoughtful, personalised, and grounded in both science and compassion.
For many women, gaining clarity about their hair loss is the first step towards feeling more confident and supported again.
Explore more of Dr Rachael Kay’s work, The Hair Restoration Doctor: