Menopause and hair loss in women: Exploring the hormonal transition

Menopause, which is defined as the cessation of menstruation, may be preceded by hormonal fluctuations during the transition to menopause, up to 10 years prior. During this time, hormonal changes, including the relative increase in androgens and the cessation of ovarian estrogen production directly impacts the hair follicle, which is an estrogen-sensitive tissue. These hormonal fluctuations can lead to alterations in the hair shaft and hair cycle, including decreased density, decreased caliber, and changes in hair texture. Additionally, loss of estrogen after the onset of menopause may lead to sub-optimal metabolic and vascular functioning of the follicular unit. The overall decline in hair density, appearance and manageability can have significant emotional impact and affect overall mental health, with feelings of stress, anxiety, and diminished self-esteem. In addition to the physiologic changes that can occur in the hair follicle during menopause, certain hair disorders, including female-pattern hair loss, telogen effluvium, and frontal fibrosing alopecia, have been noted with higher frequency in post-menopausal women.