Is Perimenopause Making my Hair Fall Out? (Spoiler: Probably)
No it’s not in your head (or on top of your head either). Your hair is thinning, and you can blame your hormones. Before you cry into a bowl of biotin supplements that are doing nothing, let’s talk about what to do about Perimenopausal Hair Loss.
December 12, 2024
You’re juggling work, kids, a house that never stays clean, and perimenopausal fits of rage. Now, on top of it all, your hair is falling out. Great. If you’re a mom in the throes of perimenopause, you’ve got enough on your plate without worrying about why your ponytail looks like it’s gone through a breakup. Let’s get to the root (pun intended) of why this is happening and what you can do about it.
Why am I losing hair in Perimenopause?
Perimenopause is the hormonal pregame to menopause, and it’s not messing around. Here’s how it impacts your hair:
1. Estrogen and Progesterone Take a Nosedive
These two hormones are like the babysitters of your hair follicles—they keep everything calm and growing. During perimenopause:
Estrogen levels drop, shortening the growth phase of your hair cycle. The result? More shedding, less regrowth. Remember the postpartum shed? Basically samesies, though that one may have been more dramatic because during pregnancy you held onto most of your hair for 9 months, then kapow!
Progesterone levels also decline, which like estrogen also means a shortened anagen cycle.
Testosterone. In some women, testosterone levels rise during perimenopause. When testosterone doesn’t have enough progesterone to counter it, this leaves your hair follicles vulnerable to the chaos of androgen hair loss (similar to what happens in PCOS).
Testosterone, again. But wait—don’t assume you’ve got too much testosterone just because you’re shedding. Many women in perimenopause actually have lower testosterone levels (hi, it’s me. I’m some women 👋), which can also lead to weaker, thinner hair. It’s a Goldilocks situation: too much androgen, and you get thinning; too little, and your hair doesn’t have the oomph to grow back strong.
2. Heavy Periods Are Bleeding You Dry
If your periods have gone from “manageable” to “crime scene” - this may be indirectly related to hair loss as well.
Estrogen Dominance: Without enough progesterone to keep it in check, estrogen causes the lining of your uterus to thicken too much. When your period rolls around, your body has to expel all that extra tissue, leading to heavy or prolonged bleeding.
Iron Loss: Those heavy periods can deplete your iron levels, and low iron = weak, brittle hair. It also disrupts the hair growth cycle, pushing more strands into the shedding phase.
Is it my thyroid?
Your thyroid gland, the control center for metabolism, is highly sensitive to perimenopause’s hormonal drama. Here’s what’s going on:
Want more like this?
Subscribe to my newsletter for weekly(ish) hormone and nutrition tips
Progesterone’s Decline: Progesterone supports thyroid function by calming inflammation and helping cells use thyroid hormones. When progesterone drops, your thyroid can slow down, leading to symptoms like thinning hair, fatigue, and weight gain. If your hair loss is not just on your head (think eyebrows), it’s definitely appropriate to seek out a thyroid panel.
Estrogen’s Shifty Behavior: Estrogen affects the proteins that transport thyroid hormones in your bloodstream. Fluctuating estrogen levels can make thyroid hormones less available to your cells, even if your TSH (thyroid-stimulating hormone) looks fine on a basic test.
Autoimmune Triggers: Perimenopause is a prime time for Hashimoto’s thyroiditis, an autoimmune condition that attacks your thyroid. Symptoms include thinning hair, brittle nails, and constipation that gets you more backed up than the recycle bin the week before Christmas.
Could gut health be sabotaging my hair?
Speaking of poop, let’s talk about your digestion’s role in hair loss. Not really something you consider when trying to figure out why your ponytail looks like it’s on ozempic. Hormonal changes during perimenopause can disrupt your microbiome—the delicate balance of bacteria in your gut—and that has downstream effects on your hair:
Poor Nutrient Absorption: If your gut isn’t in great shape, you might not be absorbing enough iron, zinc, or biotin, all of which are essential for hair growth.
Estrogen Metabolism: Your gut plays a big role in clearing out excess estrogen. If this process gets sluggish, it can worsen estrogen dominance, making periods heavier and lead to more iron (and thus hair) loss.
Inflammation: An inflamed gut can trigger systemic inflammation, which damages hair follicles and disrupts the hair growth cycle.
Read More on the Blog:
Blood sugar, inflammation, and hair loss
If your kids’ tantrums aren’t enough to raise your stress levels, perimenopause has you covered. Here’s how blood sugar and inflammation mess with your hair:
Blood Sugar Swings: Hormonal shifts make your cells less responsive to insulin, leading to highs and lows in blood sugar. High insulin levels stimulate androgens, which can shrink hair follicles (yay…).
Cortisol Chaos: Stress and unstable blood sugar raise cortisol, which disrupts your hair growth cycle and increases shedding.
Chronic Inflammation: This damages the hair follicle environment, making it harder for hair to grow. Think of inflammation as the grumpy neighbor who ruins the whole block.
What can I do about Perimenopause hair loss?
Okay, enough bad news. Here’s what you can do to get your hair back on track:
1. Get the Right Tests
Stop guessing and start testing:
Iron and Ferritin: Ferritin levels below 70 ng/mL are a red flag for hair health.
Thyroid Panel: Ask for TSH, Free T3, Free T4, Reverse T3, and thyroid antibodies.
Hormone Levels: We need to know what’s up with your estrogen, progesterone, testosterone and cortisol levels. Keep in mind that timing matters for these tests (both time of your cycle and time of day). Serum, saliva, or urine testing (like the DUTCH test) are all good choices here.
Nutrient Levels: Check zinc, vitamin D, and B vitamins at a minimum.
2. Eat a hair thickening diet
Iron-Rich Foods: Beef, dark meat, and even liver can help bring your iron up. Plant sources like spinach, lentils and fortified cereals are generally not enough to rebuild stores and counteract a heavy flow. Supplementation is often necessary if levels are tanked.
Protein: Your hair is made of keratin, a protein. If you’re undereating protein though, your scalp isn’t your body’s first priority. Aim for 1.5 g of protein per kg of body weight daily to meet basic needs and have enough leftovers for your mane.
Healthy Fats: Omega-3s from salmon, walnuts, and flaxseeds reduce inflammation and support scalp health and prevent breakage.
Biotin and Zinc: Found in eggs, seeds, and shellfish, these nutrients strengthen hair follicles.
3. extra hormonal help
Phytoestrogens: Foods like flaxseeds and soy can help balance estrogen levels.
Stress Reduction: Try yoga, mindfulness, or even a good Netflix binge to lower cortisol.
4. Fix Your Gut
Deal with any microbial imbalance, digestive insufficiency or bad bug hitching a ride in your intestines. Testing is important here.
Take a high-quality probiotic to restore balance.
Eat fiber-rich foods like vegetables, legumes, and whole grains to support healthy estrogen metabolism.
5. Address Thyroid Dysfunction
If your thyroid is struggling:
Add selenium (Brazil nuts) and iodine (seaweed) to your diet.
Work with a provider to explore thyroid medication if needed.
6. Consider Hormone Replacement Therapy (HRT)
HRT can stabilize estrogen and progesterone levels, giving your hair (and sanity) a fighting chance. Work with a knowledgeable practitioner to see if it’s right for you. HRT is particularly effective on top of a really solid foundation of a hormone supporting diet, replenished nutrient stores and after addressing root cause issues like inflammation and blood sugar.
What if I’m both Postpartum and Perimenopausal at the same time?
Ahhh having babies in your late 30s and 40s can be a special slice of hell. If you’re navigating both postpartum recovery and perimenopause at the same time, you’re basically running a hormonal marathon with no water breaks. The combo of nutrient depletion from pregnancy and breastfeeding, plus perimenopause’s chaos, can make hair loss worse. Focus on:
Replenishing Nutrients: Iron, zinc, and vitamin D are usually depleted postpartum.
Getting Help: Work with a dietitian who understands the unique challenges of postpartum and perimenopausal health.
When should I call in for reinforcements?
If your hair loss feels out of control, don’t wait to seek help. A dietitian specializing in perimenopause can interpret your lab results, create a personalized nutrition plan, and help you restore your hair’s health.
The big picture
Hair loss during perimenopause might feel like one more thing piling onto your already full plate, but there’s a lot you can do to address it. With the right tests, targeted nutrition, and support, you can tackle the root causes of hair loss and maybe even reclaim your ponytail’s glory days.
——————————-
Interested in learning more about working with Alison, a functional dietitian specializing in hormonal help for mothers?
Check out my Mother Reboot program to cntrl + alt + delete your mom bod.
Want the good stuff?
sign up to get weekly nutrition and hormone tips via email.