MenopauseMenu guest blog post by Erin Moore, MD of The Polyclinic’s Dermatology Department, and also from her personal website Seattle Skin MD.
Hair loss, a distressing issue. Thick and shiny hair is a sign of health and youth in our culture, and thinning and loss are surprising and distressing, even if they are a normal part of aging. There are certain discomforts and annoyances that we expect as we approach menopause, but hair thinning and loss is not something that is commonly discussed.
Diagnosing and treating hair loss can be very challenging. Often there are multiple factors, age and hormonal fluctuations being common. Even if you are in menopause (and assume hair loss is a crappy side effect) hair loss should be reported to your doctor to ensure it isn’t a sign of an underlying condition that can be treated.
In this article I will review the most common causes of hair loss and briefly discuss treatment. This article should not be used to replace a visit to your doctor because every case of hair loss is unique.
Female Pattern Hair Loss
- This is the type of hair loss associated with menopause. It is usually easy to diagnose but not as easy to treat. It is the most common cause of hair loss that I see in my clinic. Most women experience hair loss as they mature. The hair gets less full and the texture of the hair changes (becoming more dry and brittle). These changes can be very distressing. In most cases it presents during perimenopause or menopause and in the majority of cases all hormones are normal. Some women have elevated testosterone, but most often not. Female pattern hair loss is challenging to treat and usually not completely reversible. Rogaine, spironolactone (a blood pressure pill that can block the hormones contributing to hair loss) and finasteride are all used with variable success. Finasteride is not used by all doctors as it is not FDA approved in women. A newer treatment option that helps stimulate hair growth is platelet rich plasma injections. This treatment is very successful in helping hair grow, but it is expensive as it is not covered by insurance.
Alopecia Areata
- This type of hair loss causes patches of hair to fall out, leaving a completely bald spot. It usually happens in small areas but can affect any hair follicle including facial hair, eyebrows and eyelashes. This is an easy diagnosis for most doctors. It is caused by your immune system attacking the hair follicles. We don’t know why this occurs. In most cases it is not associated with any other autoimmune conditions, but in a few cases it can be associated with diabetes or a thyroid problem. In the majority of cases it will resolve without treatment in 12 months. Certain locations can be treated with topical steroids or steroid injections but these treatments just suppress the inflammation and allow the hair to grow back. They need to be repeated every 4-8 weeks or the hair will fall out again. On a personal note, I experienced alopecia areata of my eyelashes on one eye in college. It was not treatable with steroids, but they grew back and it hasn’t recurred (yet).
Telogen Effluvium
- This is a generalized sudden loss of scalp hair. Usually people notice lots of hair in the drain or on the floor and hair seems overall thinner. This can be caused by a long list of conditions. The most common are: childbirth, surgery or illness, weight loss or weight gain, nutritional deficiency, life stress and medications. Often there are multiple factors playing a role. Telogen effluvium occurs 3-4 months after the inciting event. It can continue for 3-4 months after the body “stressor” has ended. Often people never regain the fullness they had, though the shedding usually stops. A doctor may test your iron reserves (called ferritin) and thyroid levels to ensure this is not playing a role.
Other Type of Hair Loss
- This category is the least common (in my practice) but potentially the most serious. Autoimmune conditions such as lupus and lichen planus can present with hair loss. Psoriasis and eczema can cause hair loss. Infections such as ringworm and syphilis can cause hair loss. These conditions obviously need treatment and are beyond the scope of this discussion, but just reinforces that hair loss should be reported to your doctor.
The bottom line: hair loss is common in menopause and most often not serious, but you should see your doctor if you are having hair loss to ensure you are diagnosed and treated appropriately.
Dr. Erin Moore