Perimenopause Hair Loss: Why It Happens and How to Stop It

If you’ve been noticing more hair than usual left on your pillow or clothes, more in the shower drain, or more in your brush, you’re not alone.

Am I losing my hair, or is this normal shedding?" If you're finding significantly more hair in your brush, shower drain, or on your pillow than you used to, and you're in your late 30s to early 50s, you may be experiencing perimenopause hair loss.

Perimenopause hair loss doesn’t always get as much attention as other perimenopause symptoms, but it’s very common. Experts estimate that up to 2 out of 3 women experience perimenopause hair loss before the age of 60 [1].

What causes hair loss, and how can you slow thinning? In this article, we’ll help you understand perimenopause hair changes, and provide daily strategies for hair-friendly care to stop perimenopause hair loss.

What causes perimenopause hair loss?

Perimenopause hair loss stems from many different factors, all in play during the transition to menopause, including:

• Hormone shifts
• Increased cortisol and stress
• Possible nutrient deficiencies
• Genetics and age

When Does Perimenopause Hair Loss Start?

Perimenopause hair loss can begin anytime during the perimenopause transition, but most women notice changes in their early to mid-40s. Some women experience hair thinning as one of their first perimenopause symptoms in their late 30s, while others don't notice changes until their late 40s. 

Early signs to watch for:

• More hair than usual on your pillow when you wake up
• Increased shedding in the shower or when brushing
• Your ponytail feeling thinner or your hair tie wrapping around an extra time
• More visible scalp when you part your hair

How hormones affect perimenopause hair loss?

Each strand of hair on your head has a life cycle, starting with the anagen phase when hairs grow, and ending with the telogen phase when hairs rest then shed. Your hormones help regulate the hair life cycle, keeping your hair follicles healthy and promoting hair growth.

Estrogen and progesterone stimulate the anagen phase to make hair grow longer and support new growth, while keeping androgen levels in check to protect hair. Androgens, a group of male sex hormones that includes testosterone, can make head hair thin and facial and body hair grow [2,3].

During perimenopause, estrogen and progesterone decline more quickly than androgens. This causes a few different hair changes to happen [2,4]:

• The hair growth phase shortens: Individual strands of hair get to the end of their life cycle and shed more quickly.
• New hair growth slows: Hair that sheds is replaced much more slowly.
• Hairs shrink in diameter: Individual strands become thinner.
• Androgen levels are higher than other hormone levels: Androgens can impact hair growth more.

Some experience these changes as perimenopause hair loss. You might notice that you shed more hair than before, your hair seems thinner, and new hair doesn’t seem to be growing in as quickly.

How cortisol affects perimenopause hair loss?

Have you ever felt like you shed more hair than usual during periods of high stress? There’s a biological reason for this: cortisol, the stress hormone, increases hair loss [5]. Since cortisol rises during perimenopause, it can interfere with hair growth and cause thinning [2].

Do nutrient deficiencies cause perimenopause hair loss?

Yes, nutrient deficiencies that people may develop in perimenopause can contribute to perimenopause hair loss, including [1,6]:

• Protein deficiency: Makes hair brittle and more prone to breakage
• Vitamin D deficiency: Impedes hair follicle growth
• Iron deficiency: Makes hair thin, brittle, and more prone to shedding
• Zinc deficiency: Slows hair growth 

How genetics and age affect perimenopause hair loss?

Genetics and age are also factors in perimenopause hair loss. Everyone’s hair changes as they get older, but some people are genetically predisposed to experience more hair loss than others. Keep in mind, though, that genes are only part of the picture and don’t necessarily predict the future.

What does perimenopause hair loss look like?

It’s normal for hair to shed, that’s a natural part of the hair life cycle. Typically, around 19% of head hair is in the rest then shed phase (telogen phase) at any given moment, and people generally shed around 100 hairs each day [1].

When a person experiences perimenopause hair loss, though, shedding and thinning increase without an increase in growth. This can lead to noticeable perimenopause hair changes, such as:

• Thinning: Hair thins out, often at the crown of the head or along the hairline at the temples (although developing noticeable bald spots is rare).
• Increased shedding: More hairs come out when brushing or washing hair.
• Wider part: The part widens as strands of hair become thinner.
• Slower regrowth: Hair grows in more slowly, or not at all.
• Dry, brittle hair: Hair loses its shine and appears dry and brittle.Increased scalp visibility: The scalp becomes more visible through the hair.

Not everyone experiences significant perimenopause hair loss. Some may just notice a bit more shedding, while others may see visible thinning.

You may also notice more facial hair, particularly around the upper lip and chin. Up to 50% of perimenopausal people experience an increase in facial hair [3].

Perimenopause vs. Other Types of Hair Loss

Perimenopause Hair Loss:

• Gradual, overall thinning
• Starts in your 40s during hormone transition
•  Affects crown and temples most
• May slow or stabilize after menopause

Postpartum Hair Loss:

• Sudden, dramatic shedding 2-4 months after birth
• Temporary (grows back within 6-12 months)
• Related to sudden hormone drop after pregnancy

Thyroid-Related Hair Loss:

• Can occur at any age
• Often accompanied by weight changes, fatigue, temperature sensitivity
• Requires thyroid medication treatment

Alopecia Areata:

• Autoimmune condition causing patchy bald spots
• Can occur at any age
• Distinct circular bald patches (not just thinning)

"Will I Go Bald?" Understanding What to Expect

One of the most common fears about perimenopause hair loss is: "Will I go bald?"  The short answer: It's extremely rare for perimenopause to cause complete baldness. Unlike male pattern baldness, perimenopause hair loss typically presents as overall thinning, particularly at the crown and temples, rather than bald patches. Most women experience gradual thinning that can be managed with treatment and styling, not dramatic, sudden baldness.

How to stop or reduce hair loss in perimenopause?

Perimenopause hair loss is a common symptom, and it can be very distressing. It’s completely understandable to feel upset and anxious. Try to remember that you’re not alone, and you have support.

Since lifestyle factors play a key role in hair health, supportive strategies may help you reduce or even stop hair loss. Let’s take a closer look at ways to combat perimenopause hair loss.

What Actually Works: Real Results Timeline

Weeks 1-4: Focus on gentle hair care, start supplements

• What to expect: Less breakage, but no new growth yet

Months 2-3: Maintain nutrition, reduce heat styling

• What to expect: Shedding may slow; baby hairs may start appearing

Months 4-6: Consider medical treatments if lifestyle changes aren't enough

• What to expect: Visible improvement in thickness and regrowth (if treatments are working)

Reality check: Complete reversal isn't always possible, but most women see 30-50% improvement with consistent treatment over 6-12 months.

Nutrition for hair health

A healthy, balanced diet is absolutely essential for supporting perimenopause hair health [6]. 

Try including these food groups in your diet to help increase your nutrient levels and reduce perimenopause hair loss [1]:

• Protein: poultry, lentils, beans, dairy, eggs, pumpkin seeds, sunflower seeds
• Whole grains and complex carbohydrates: brown rice, whole wheat pasta, quinoa, bulgur, whole oats, whole grain breads
• Healthy fats: oily fish (salmon, trout, sardines), flaxseeds, chia seeds, soybeans, walnuts, olive oil
• Fruits and vegetables high in vitamin C (vitamin C increases iron absorption): kale, bell peppers, broccoli, cauliflower, strawberries, kiwis, citrus fruits

You can also talk to your doctor about increasing your nutrient intake with perimenopause vitamins and supplements for hair loss. Options include vitamin D, iron, vitamin C, and B vitamins.

Gentle scalp and hair care

Practicing gentle scalp and hair care may also help reduce perimenopause hair loss and thinning:

• Brush your hair gently with calm, even strokes, starting from the ends then working up
• Avoid damaging hair practices as possible, including:
  
  • Heat tools, like blow dryers, straighteners, and curling irons
  • Chemical treatments
  • Bleaching and dyeing (or use all-natural dyes only, and always go to a salon)
• Ask your dermatologist about gentle hair care products that are right for your scalp
• Wear loose hairstyles that don’t pull tightly on your scalp

To create a fuller look in thinning areas, try:

• Changing where you part your hair
• Styling with scarves and headbands
• Using scalp concealers
• Getting a layered haircut to boost volume and movement

Wigs are also a great option offering more support!

Stress management and sleep for hair health

Lowering stress and cortisol levels may help support hair health and growth [7].

Great stress relieving activities include:

• Meditation
• Mindfulness exercises
• Deep breathing techniques
• Yoga
• Time spent with friends and loved ones

Getting good sleep can also help lower stress to address perimenopause hair loss. Plus, sleep is essential for your overall wellbeing. Aim for 7 to 9 hours of sleep each night.

Medical treatments for hair loss

Some medical treatments may also help combat perimenopause hair loss. Talk to your doctor and dermatologist about whether these hair loss treatments could be right for you:

• Minoxidil (Rogaine)
• Hormone replacement therapy (HRT)
• Antiandrogens (testosterone blockers)
• Procedures to stimulate hair growth, like laser treatments and microneedling

When to see a doctor about hair loss?

Generally, hair loss in perimenopause stems from a combination of hormone-related factors. In some cases, though, hair loss could be a sign of a health condition that needs medical treatment.

Talk to your doctor if you have:

• Rapid hair loss (like losing large clumps)
• Hair loss accompanied by sudden weight gain, fatigue, weakness, or other unusual symptoms
• Scalp pain, itching, inflammation, or infections

Your doctor may draw blood and run tests to rule out causes like thyroid issues or severe nutrient deficiencies. Together, you can get to the bottom of what’s going on and determine next steps. 

Perimenopause hair loss: The bottom line

If you're feeling devastated about hair loss, you're not alone. Hair is deeply tied to identity and femininity for many women, and watching it thin can be genuinely traumatic. It's okay to grieve this change while also taking action to address it.

Perimenopause hair loss and thinning is often caused by a combination of hormonal factors, stress, nutrient deficiencies, and age.

To slow or reduce perimenopause hair loss, try eating a nutritious diet with foods that boost hair health, building hair and scalp-friendly habits, lowering stress, and talking to your doctor about medical treatments.

Perimenopause hair loss can be very distressing. As you navigate perimenopause and all the symptoms that come with it, lean on your community for support and reach out to mental health professionals as needed.

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Frequently Asked Questions About Perimenopause Hair Loss

Will my hair grow back after perimenopause?

In many cases, yes, hair can regrow or at least stabilize after perimenopause, especially with proper treatment and care. Once you reach menopause and hormone levels stabilize (even at lower levels), some women find that excessive shedding slows down and their hair thickness improves. However, complete restoration to pre-perimenopause density isn't always possible, as aging itself affects hair growth. The good news: with lifestyle changes, supplements, and potentially medical treatments like minoxidil or HRT, most women see noticeable improvement. Starting treatment early in perimenopause gives you the best chance of preserving and regrowing hair.

How long does perimenopause hair loss last?

Perimenopause hair loss can occur throughout your entire perimenopause transition, which typically lasts 4-10 years. Some women experience hair thinning for just a year or two, while others notice it throughout the entire journey until they reach menopause (defined as 12 months without a period). The intensity and duration vary widely. Hair loss may worsen during periods of particularly dramatic hormone fluctuations, then improve during more stable phases. After menopause, many women find their hair loss stabilizes or slows, though some thinning may persist due to the permanently lower estrogen levels.

Is perimenopause hair loss permanent?

Not always, but it depends on several factors. Some perimenopause hair loss can be reversed or improved with treatment, especially if you address it early with lifestyle changes, proper nutrition, stress management, and medical interventions. However, some degree of hair thinning may be permanent because aging and prolonged lower estrogen levels do cause lasting changes to hair follicles. The key is: perimenopause hair loss is often partially reversible. Most women won't return to their 20s-era hair thickness, but with consistent care, you can significantly improve hair health, slow further loss, and stimulate regrowth of thinner areas.

How much hair loss is normal in perimenopause?

It's normal to lose about 100 hairs per day throughout your life, that's just the natural hair growth cycle. During perimenopause, you might notice you're losing more than this, perhaps 150-200 hairs daily during peak shedding periods. What makes perimenopause hair loss concerning isn't just the number of hairs shed, but the fact that they're not being replaced as quickly, leading to overall thinning. If you're noticing significantly more hair in your brush, shower drain, or on your pillow than you did before perimenopause, or if you can see more of your scalp through your hair, this is common perimenopause hair loss. However, if you're losing large clumps of hair or developing bald patches, see your doctor immediately.

What vitamins should I take for perimenopause hair loss?

The most important vitamins and minerals for perimenopause hair health include vitamin D (supports hair follicle growth), iron (prevents brittle, thinning hair), vitamin C (helps iron absorption and collagen production), B vitamins especially biotin and B12 (support hair strength and growth), zinc (promotes hair growth), and protein (essential for hair structure). Before starting any supplements, talk to your doctor about testing your nutrient levels taking supplements you don't need won't help, and some can be harmful in excess. Your doctor can recommend appropriate dosages based on your specific deficiencies. A high-quality multivitamin designed for women over 40 can be a good starting point, combined with targeted supplements if you have confirmed deficiencies.

Does biotin really help with perimenopause hair loss?

Biotin (vitamin B7) can help with hair loss, but primarily if you have a biotin deficiency. Most people get enough biotin from their diet (eggs, nuts, seeds, sweet potatoes), so supplementing may not make a dramatic difference if your levels are already adequate. That said, biotin supplements are generally safe, and some women report modest improvements in hair strength and growth when taking 2,500-5,000 mcg daily. Just know that biotin isn't a miracle cure it works best as part of a comprehensive approach that includes proper nutrition, hormone management, and gentle hair care. Also important: biotin can interfere with certain lab tests, so tell your doctor if you're taking it before having bloodwork done.

When does perimenopause hair loss start?

Perimenopause hair loss most commonly begins in your early to mid-40s, often as one of the earlier perimenopause symptoms. However, some women notice increased shedding or thinning in their late 30s, while others don't experience it until their late 40s or early 50s. Early warning signs include finding more hair on your pillow in the morning, increased shedding in the shower, more hair in your brush than usual, or your ponytail feeling noticeably thinner. If you're suddenly experiencing these changes and you're between 35-52, perimenopause is a likely culprit. There's no single "normal" timeline, hair loss can begin at any point during the perimenopause transition and may come and go as your hormones fluctuate.

Can you stop perimenopause hair loss completely?

It's difficult to stop perimenopause hair loss completely because the underlying cause, hormone fluctuation, is a natural biological process. However, you can significantly slow hair loss, prevent further damage, and promote regrowth with the right combination of treatments. The most effective approach includes eating a nutrient-rich diet, taking targeted supplements for any deficiencies, using gentle hair care practices, managing stress, getting adequate sleep, and considering medical treatments like minoxidil (Rogaine) or hormone replacement therapy (HRT). Most women who take a comprehensive approach see noticeable improvement, think slowing loss by 50-70% and achieving some regrowth, even if they don't completely halt all thinning. The earlier you start treatment, the better your results.

Does hormone replacement therapy (HRT) help with hair loss?

Yes, hormone replacement therapy (HRT) can help reduce perimenopause hair loss for some women by stabilizing declining estrogen and progesterone levels. When these hormones are supplemented, they can help extend the hair growth phase, reduce shedding, and counterbalance the effects of androgens that contribute to thinning. However, HRT isn't guaranteed to work for everyone's hair loss, and it's typically prescribed to treat multiple perimenopause symptoms rather than hair loss alone. The decision to start HRT involves weighing various health factors with your doctor. If you're already considering HRT for other symptoms like hot flashes or mood changes, improved hair health could be an additional benefit worth discussing with your healthcare provider.

How long does it take to see results from hair loss treatments?

Hair growth is slow, so patience is essential. With lifestyle changes alone (improved nutrition, gentle hair care, stress management), you might notice reduced shedding within 2-3 months, but visible regrowth typically takes 4-6 months or longer. If you're using minoxidil (Rogaine), expect to wait at least 3-4 months before seeing results, with more significant improvement at 6-12 months of consistent use. For HRT, hair improvements may take 3-6 months to become noticeable. Supplements can take 3-4 months to show effects. Many women see their best results after 6-12 months of comprehensive, consistent treatment. Important: you may experience initial increased shedding in the first 2-8 weeks of starting minoxidil. This is normal and temporary as old hairs make way for new growth.

What's the best shampoo for perimenopause hair loss?

There's no single "best" shampoo, but look for products that are gentle, sulfate-free, and designed to support thinning hair. Helpful ingredients include biotin, caffeine (stimulates hair follicles), ketoconazole (reduces scalp inflammation), and saw palmetto (may block androgens). Avoid harsh sulfates, heavy silicones, and products with lots of fragrance or alcohol, which can dry out aging hair. Popular options include shampoos specifically marketed for thinning hair or hair loss. That said, shampoo alone won't solve perimenopause hair loss, it's just one supportive tool. Focus more on internal health (nutrition, hormones, stress) and avoid damaging practices (heat styling, tight hairstyles, chemical treatments). Your dermatologist can recommend specific products suited to your scalp type.

Can stress make perimenopause hair loss worse?

Absolutely. Stress significantly worsens perimenopause hair loss through multiple mechanisms. When you're stressed, your body produces more cortisol (the stress hormone), which can push more hair follicles into the shedding phase and disrupt the normal hair growth cycle. Since cortisol already rises during perimenopause, additional stress compounds the problem. Chronic stress can also lead to behaviors that damage hair health: poor sleep, inadequate nutrition, neglecting self-care. The good news: managing stress through meditation, yoga, exercise, therapy, good sleep, and joyful activities can genuinely help reduce hair loss. While you can't eliminate perimenopause-related hormonal changes, reducing stress gives your body the best chance to maintain healthy hair growth.

Is it normal to have more facial hair during perimenopause while losing head hair?

Yes, this frustrating paradox is completely normal during perimenopause. As estrogen and progesterone decline faster than androgens (male hormones like testosterone), the relative androgen levels in your body increase. This hormonal imbalance causes two simultaneous effects: head hair thins because androgens can shrink hair follicles on your scalp, while facial hair increases (particularly on the upper lip, chin, and jawline) because androgens stimulate facial hair growth. Up to 50% of perimenopausal women experience increased facial hair. While it feels cruel to lose hair where you want it and gain it where you don't, this is a normal hormonal response. Treatments like HRT, antiandrogens, or laser hair removal can help manage unwanted facial hair.