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The Menopause Exchange Blog


Ageing is a biological process and should be celebrated. In fact, in many cultures it’s honoured as well, and the knowledge of the elders in the family is highly respected.

This article was included in issue 78 (autumn 2018) of The Menopause Exchange newsletter.

However, not all aspects of ageing can be celebrated. If you suffer from hair loss and/or hair thinning, you will understand the distress, isolation and negative impact that this can have on your self-esteem. Trichologists (hair and scalp specialists) never underestimate the psychological impact of hair loss or hair thinning.

There’s no way to halt your hair’s aging process and you can’t choose which genes you inherit. But you can look after your hair by eating a healthy, balanced diet containing all of the essential food groups, particularly fruits and vegetables and good-quality protein. If you think there’s a problem with your hair, visit a specialist as soon as possible. Three types of hair loss most commonly seen in post-menopausal women by trichologists are female pattern hair loss, acute/chronic telogen effluvium and frontal fibrosing alopecia.

Female pattern hair loss
Female pattern hair loss is one of the most common hair thinning conditions after the menopause. It’s also called androgenetic alopecia (alopecia being the blanket term for any hair loss or hair thinning). Female pattern hair loss has three causative factors:

Genetic predisposition – we inherit the gene for female pattern hair loss most commonly from our maternal grandmother(although the lack of a family history of hair loss doesn’t rule out the diagnosis).

Age – female pattern hair loss can occur at any time of life when there’s hormonal change, such as during puberty, pregnancy or after the menopause. Female pattern hair loss affects more than 50% of women over 50.

Testosterone – increased sensitivity to the normal amount of testosterone present in a woman. After the menopause, decreasing oestrogen levels affect testosterone and the effect this hormone has in your body.

The factors above can lead to mild bi-temporal recession (a receding hairline), with finer, shorter hairs and widespread thinning over the vertex area of your scalp (the top area behind your fringe and before your crown). Diffuse thinning is caused by shrinking of your hair follicles, but doesn’t progress to the baldness seen in men. This shrinking is the effect of a shorter growing stage of your hair growth cycle and an increased resting/fallout stage. Early on, you may notice increased shedding of your hair, although this can be caused by many factors so it’s important to seek a specialist diagnosis before committing to any treatments.

If you have been given a diagnosis of female pattern hair loss, topical minoxidil is the only licensed treatment for this in the UK. Topical minoxidil stimulates a surge of growth but (a word of warning) there’s often increased shedding of ‘resting phase’ hairs over the first month. This will settle down, and often the benefits of using topical minoxidil outweigh any initial shedding. Minoxidil needs to be used continuously and can be used for many years, so you need to consider the cost before committing.

Certain HRT products can help to treat female pattern hair loss. The hair-friendly ones are Premique and Indivina (both of these products contain the antiandrogen medroxyprogesterone acetate) and Angeliq (containing drospirenone). Some women prefer not to commit to a long-term treatment plan and opt for camouflage products instead, such as hair fibres, thickening sprays or scalp creams. These can give the impression of thicker hair without any commitment (the products wash out easily).

Telogen effluvium
Telogen effluvium is a hair shedding condition. During our lifetime, hair grows in cycles. This consist of many stages but trichologists are most interested in the growing stage (anagen) and the resting stage (telogen). After your natural hair growth period, your hair rests for two to four months before falling out.

Sometimes an interruption to your hair cycle can occur, which then causes your hair to enter telogen prematurely. Your hair stays in the resting stage for two to four months as normal. But after this, instead of shedding the normal 40 to 100 hairs per day, the shedding can be four or five times more than normal. This leads to a dramatic amount of hair in the bathroom basin, on your pillow or falling on your clothes. This particular type of hair shedding is called acute telogen effluvium (effluvium means heavy shedding) and should usually only last for a short time. Common triggers for acute telogen effluvium include illnesses, operations, accidents, stressful events or crash dieting. Hair shedding that occurs for longer than nine to 12 months is called chronic telogen effluvium. The hair shedding isn’t normally as dramatic but often needs some form of treatment.

One of the most common causes of chronic telogen effluvium is a low storage iron level (serum ferritin). Although low iron isn’t so commonly seen in women after the menopause, it may be worth speaking to your doctor about this. Stress, long-term illnesses and medications (including some types of HRT) can affect your hair cycle and cause excess shedding, so visit a trained professional to ensure you receive the correct diagnosis for your hair thinning/shedding problem.

Frontal fibrosing alopecia (FFA)
Frontal fibrosing alopecia involves a systematic band of frontal hair loss (affecting the hair margin at the front of your scalp). It’s a relatively newly identified type of hair loss. It was first described and identified by Associate Professor Steven Kossard, a dermatologist in Australia, in 1994.

This hair loss condition occurs most often in post-menopausal Caucasian women. Dr Alison MacDonald and other dermatology researchers in Glasgow have reported a ten-fold increase in the prevalence of FFA in the last decade. Associated signs include full or partial eyebrow loss, orphaned (lone) hairs in the frontal hairline and paler skin where the hair line has receded. Treatments for FFA are limited due to the nature of the condition. But, as with all forms of hair loss/thinning, early intervention is key.

For more information
For information and to find local clinics, visit the website of the Institute of Trichologists (www.trichologists.org.uk)


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