Hair is a complex topic for women and individuals of all genders. It holds significant meaning and associations with youth, beauty, and fertility. During pregnancy, many women experience thick and lustrous hair due to hormonal changes, but postpartum hair loss is also common. On the other hand, thinning hair is often associated with old age and illness, which can evoke feelings of mortality and shame.
Thinning hair is not uncommon for women in their 40s, and while it doesn’t necessarily indicate a medical emergency, it is worth discussing with a doctor as it can have various causes. Perimenopause, the phase preceding menopause, is a time when hormone levels fluctuate, and women may experience a range of symptoms, including irregular periods, vaginal dryness, chills, night sweats, difficulty sleeping, mood changes, weight gain, dry skin, loss of breast fullness, and yes, thinning hair.
Perimenopause is not a disease but a natural process, similar to puberty and pregnancy. However, there is limited awareness about the symptoms of perimenopause and available treatments. It’s important to note that perimenopause can only be confirmed retrospectively after the cessation of menstruation for 12 months. Hormone levels during perimenopause can vary widely, making it challenging to diagnose based on bloodwork alone.
Hair loss during perimenopause differs from male pattern baldness. In women, it typically involves a gradual thinning of hair around the scalp, while the frontal hairline remains intact. The change in hormone ratios, specifically androgenic to estrogen hormones, likely contributes to perimenopausal hair loss. By the age of 70, 38% of women experience hormone-driven hair loss. However, determining the exact cause of perimenopausal hair loss is difficult since hormone levels vary greatly among individuals.
There are other potential causes of hair loss, including genetic predisposition, stress, chronic illness, thyroid disease, medications, nutritional deficiencies, and certain hairstyles. Traction alopecia, a condition resulting from tight hairstyles, can lead to hair loss at the temples and hairline. Certain hair products can also dry out follicles and limit hair growth. Deficiencies in vitamin D, iron, folic acid, and B vitamins can contribute to shedding and slow hair growth. Fibrosis alopecia, an inflammatory reaction seen in postmenopausal women, causes loss of hair on the front and sides of the scalp.
Hair growth follows a natural cycle where hair falls out and is continuously replaced by new growth. Losing up to 100 strands of hair per day is considered normal. It’s essential to consult with a medical provider to determine the cause of hair loss since there isn’t a one-size-fits-all solution. Minoxidil is the only FDA-approved treatment for female pattern hair loss, but it must be used consistently for results. Hormone therapy is not widely supported as a hair loss treatment. Other options include finasteride (off-label use for women with male-pattern hair loss) and ketoconazole (an anti-dandruff shampoo).
While hair loss may be a cosmetic concern, it can have significant psychological consequences and affect emotional well-being. It is important to address the issue with a doctor and explore available treatments and support. Hair loss should not be dismissed or seen as something to live with, as there are potential causes and solutions to explore.
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