Perimenopause Hair Changes: Thinning, Shedding, and What You Can Do

When Your Hair Starts to Change

Hair changes during perimenopause catch most women off guard. You might notice more hair on your brush, a thinner ponytail, a wider part, or a general loss of the density and body your hair once had. For some women, the texture changes too, becoming drier, more brittle, or coarser. Some notice fine facial hair appearing on the chin or upper lip while head hair is thinning. All of these changes can happen simultaneously, driven by the same underlying hormonal shifts.

Hair changes can feel particularly distressing because hair is so closely tied to identity and appearance. It can be hard to bring up in a medical appointment because it seems less urgent than other symptoms, and yet it is consistently among the concerns that most affect quality of life for women in this transition. The good news is that perimenopause hair changes are not a permanent life sentence. Many of the changes are responsive to treatment, and even understanding the mechanism helps you choose the right interventions rather than spending time and money on ones that don't address the actual cause.

The hormonal drivers of perimenopause hair changes are multiple and overlapping, which is why the picture can feel complex. Understanding each driver separately makes the overall picture clearer.

The Hormonal Drivers: Estrogen, Androgens, and Thyroid

Estrogen promotes the growth phase of the hair cycle (called anagen) and extends how long each hair follicle stays in active growth before resting. When estrogen declines in perimenopause, hairs spend less time in the growth phase and more time in the shedding phase (telogen). The result is that more hairs are shed at any given time than are replaced, leading to a gradual reduction in overall density. This pattern of diffuse thinning, particularly at the crown and top of the scalp with preservation of the frontal hairline, is called female pattern hair loss (FPHL), and it is predominantly driven by hormonal changes in midlife women.

Androgen activity becomes relatively more prominent as estrogen declines, even if your androgen levels themselves haven't changed dramatically. Dihydrotestosterone (DHT), a potent form of testosterone, binds to receptors in hair follicles and causes them to miniaturize over time, producing finer, shorter hairs with each growth cycle. This is the same mechanism that drives male-pattern baldness, though the pattern in women is diffuse rather than resulting in complete baldness in specific zones. Women with a genetic predisposition to androgen-sensitive follicles are more susceptible to this effect.

The thyroid gland is a third significant player. Both hypothyroidism and hyperthyroidism can cause significant hair shedding and texture changes. Thyroid-related hair loss often presents as diffuse shedding all over the scalp, sometimes with loss of the outer third of the eyebrows. Because thyroid dysfunction is significantly more common in midlife women and its symptoms overlap so heavily with perimenopause, it is one of the first things worth checking when hair loss becomes significant.

Female Pattern Hair Loss vs. Telogen Effluvium vs. Alopecia

Not all hair loss in perimenopause is the same type, and the type matters for treatment. The three most common patterns seen in this age group have distinct mechanisms and management approaches.

Female pattern hair loss (FPHL) is the most common. It develops gradually over years and produces diffuse thinning on the top and crown of the scalp. The frontal hairline usually remains intact. Hair follicles don't disappear entirely but miniaturize, producing finer hairs. FPHL has a genetic component and is driven by hormonal changes, particularly the androgen-to-estrogen ratio shift of perimenopause.

Telogen effluvium is a different kind of hair loss characterized by diffuse shedding that typically begins two to three months after a triggering event. Common triggers include physical or emotional stress, illness, rapid weight loss, nutritional deficiencies (particularly iron deficiency), major surgery, or significant hormonal change. The hair shedding can be alarming in volume, sometimes with handfuls coming out in the shower. The good news is that telogen effluvium is usually temporary. Once the trigger is identified and addressed, hair typically regrows within three to six months, though full recovery can take longer.

Alopecia areata is an autoimmune condition that causes patchy, circular areas of hair loss rather than diffuse thinning. It can affect any area of the scalp and sometimes the beard, eyebrows, or body hair. It tends to present differently from perimenopause-related hair loss and requires dermatological evaluation for appropriate management. Any sudden, patchy, or geometrically distinct hair loss pattern warrants evaluation by a dermatologist.

What Lab Tests Actually Matter

If you're experiencing significant hair thinning or shedding, a targeted set of blood tests can identify treatable causes that are distinct from or compounding the hormonal changes of perimenopause. Knowing what to ask for means you can have a more productive conversation with your doctor.

Ferritin is the most important single test for hair loss. Ferritin measures your body's iron stores rather than iron in circulation, and it is the measure most directly relevant to hair follicle health. The normal laboratory range for ferritin is set very conservatively and starts around 12-15 ng/mL. For optimal hair growth, most dermatologists and trichologists consider levels above 50-70 ng/mL to be necessary. Women who are still having heavy periods during perimenopause are particularly at risk for low ferritin, and it is one of the most common and most overlooked causes of hair shedding in this age group.

Thyroid function should be checked with TSH at minimum, and ideally also free T3 and free T4, because both hypothyroidism and hyperthyroidism cause hair loss and because TSH alone can sometimes be within range when free thyroid hormone levels are suboptimal. Vitamin D deficiency is also associated with hair loss, and levels can be low even in people who think they get adequate sun exposure. Zinc deficiency and B12 deficiency are less common but worth including in a comprehensive panel if initial tests are unrevealing.

Treatments With Actual Evidence

Several treatments for perimenopause-related hair loss have meaningful clinical evidence behind them. None of them work overnight, and most require consistent use for at least three to six months before results are visible. Managing expectations is part of the process.

Minoxidil is currently the most evidence-supported topical treatment for female pattern hair loss. It works by prolonging the anagen (growth) phase of the hair cycle and increasing blood flow to follicles. It comes in 2% and 5% topical solutions or foam, and a once-daily oral low-dose formulation has become increasingly popular and may have even better results for some women. Results require four to six months to appear, and the treatment must be continued for the effects to persist. Minoxidil is available without a prescription in most countries.

Spironolactone is an oral medication that acts as an androgen blocker, reducing the effect of DHT on hair follicles. It is commonly used by dermatologists for FPHL in women, particularly those who also have other signs of androgen excess like acne or facial hair growth. It requires a prescription and has some contraindications, but it is generally well tolerated in healthy women and has good evidence for slowing or reversing FPHL. Low-level laser therapy (LLLT), delivered through laser combs, helmets, or caps cleared by regulatory agencies for this purpose, has evidence for stimulating follicle activity and improving hair density in FPHL. It works best as an adjunct to other treatments rather than as a standalone therapy.

The Biotin Reality Check and Other Nutritional Support

Biotin is one of the most heavily marketed supplements for hair loss, and the marketing significantly outpaces the clinical evidence. Biotin deficiency does cause hair loss and brittle nails, but true biotin deficiency is rare in people eating a varied diet. If your biotin levels are already adequate, taking additional biotin will not improve hair growth. The studies that showed hair improvement with biotin supplementation were almost all conducted in people who were actually deficient.

Iron, on the other hand, has strong evidence for being important for hair growth, and getting ferritin levels optimized if they're low can produce meaningful improvement in hair shedding over several months. If your ferritin is below 50 ng/mL, working with your doctor to raise it through dietary iron (red meat, organ meat, beans, lentils, and dark leafy greens consumed with vitamin C to improve absorption) or supplementation is a high-value intervention for hair health.

Protein intake is genuinely important. Hair is made almost entirely of a protein called keratin, and inadequate dietary protein means the body doesn't have the building blocks for new hair. Many midlife women are consuming less protein than optimal due to caloric restriction or reduced meat consumption. Aiming for 1.2 to 1.6 grams of protein per kilogram of body weight daily supports both hair health and the muscle maintenance that becomes increasingly important during perimenopause.

Scalp Care and Hair Habits That Support Regrowth

The scalp is skin, and it responds to the same hormonal changes that affect skin elsewhere. A congested or inflamed scalp can impair the hair follicle environment. Regular scalp massage, done with the fingertips for five to ten minutes daily or several times per week, increases blood flow to the follicles and has some evidence in small studies for improving hair density over time. It's also pleasant and low-risk, making it a worthwhile addition to any hair care routine.

Heat styling tools, chemical treatments, and tight hairstyles all cause mechanical damage to the hair shaft and can worsen the appearance of thinning by increasing breakage. During a period of active shedding or thinning, reducing heat exposure and avoiding tight styles like ponytails, braids, or extensions helps prevent additional loss that isn't hormonal in origin. Using a gentle, sulfate-free shampoo reduces barrier disruption to the scalp and helps maintain the scalp environment.

Volumizing products and dry shampoo can help with the appearance of thinning hair while you're working on the underlying causes. Strategic haircuts, including shorter lengths and layers, often create the appearance of more volume and fullness. A skilled hairstylist who has experience with fine or thinning hair can be a helpful resource for cosmetic management while you address the underlying drivers.

Facial Hair: The Other Side of the Androgen Story

The same androgen-to-estrogen shift that contributes to scalp hair thinning can also cause the growth of coarser, darker facial hair, particularly on the chin, upper lip, and sides of the face. This feels particularly unfair when happening simultaneously with scalp thinning, but it reflects the same underlying hormonal change: relatively increased androgen activity on hormone-sensitive follicles.

Facial hair in perimenopause is not dangerous and does not indicate a medical problem in most cases. However, if facial hair appears suddenly and thickly, particularly alongside other signs of androgen excess like significant acne, clitoral enlargement, or a deepened voice, it's worth having your androgen levels checked to rule out an androgen-secreting tumor or polycystic ovarian syndrome (PCOS), which can persist or worsen through perimenopause in some women.

For management of unwanted facial hair, methods with longer-lasting results include laser hair removal (which works best on darker hair against lighter skin, though newer devices have broader efficacy) and electrolysis (which works on all hair colors and skin tones and provides permanent removal). Topical eflornithine cream slows the rate of facial hair growth when applied regularly. Spironolactone, mentioned above for scalp hair loss, can also reduce facial hair as part of its androgen-blocking effect.

PeriPlan's symptom tracker can help you document both scalp shedding patterns and facial hair changes over time, which is useful information for a dermatology or endocrinology appointment.

Medical Disclaimer

This article is provided for general informational purposes and does not constitute medical advice. Hair loss can have multiple causes, some of which require professional diagnosis and treatment. If your hair loss is rapid, patchy, or accompanied by other significant symptoms such as fatigue, weight changes, or skin changes, please consult a dermatologist or your primary care provider. Do not self-diagnose or self-treat without appropriate medical evaluation.