The short answer: hair loss in perimenopause is usually one of two things. Telogen effluvium is heavy shedding after a stress on the body, and it normally grows back within months. Female pattern hair loss is gradual thinning on top that runs in families; it has no cure, but treatment can slow it and regrow some hair, especially when started early.
The NHS lists hair thinning among the symptoms of perimenopause, which our perimenopause symptoms guide covers in full. This article is about what’s behind it and what to do.
What causes hair loss in perimenopause?
Most hair loss at this stage comes from female pattern hair loss, telogen effluvium, or both at once. The American Academy of Dermatology (AAD) calls female pattern hair loss the most common cause of hair loss in women. It’s hereditary, and because it’s more common after menopause, the AAD says hormones may also play a role. DermNet adds that the exact role of estrogen is still uncertain.
Some shedding is normal. The NHS puts it at 50 to 100 hairs a day, and the British Association of Dermatologists (BAD) says anywhere from 30 to 150 is normal. The table shows how the two main types differ:
| Female pattern hair loss | Telogen effluvium | |
|---|---|---|
| What you notice | A widening part and thinner hair on the top and crown; the front hairline usually stays | Sudden extra hair in the shower, brush or on the pillow, from all over the scalp |
| Cause | Genes plus hormones; runs in families | A trigger such as illness, high fever, surgery, major stress, crash dieting or a medicine change |
| Timing | Slow, over years to decades (BAD) | Starts around 3 months after the trigger (BAD) |
| What’s happening | Follicles shrink and make finer, shorter hairs | Resting hairs jump from about 15% of the scalp to 30% or more |
| Outlook | No cure; treatment can slow it and regrow some hair | Usually recovers on its own |
The AAD says female pattern hair loss most often begins in a woman’s 40s, 50s or 60s. The two types can overlap, and the BAD notes that a bout of shedding can be what first reveals pattern thinning.
Is perimenopause hair loss reversible?
Shedding from telogen effluvium usually reverses, and female pattern hair loss can be slowed and partly regrown but not cured. The BAD says the shedding phase of telogen effluvium lasts 3 to 6 months, then new hair grows, though it can take many months to get back to full thickness. The AAD says hair tends to regain its normal fullness within six to nine months, unless the stress continues.
Female pattern hair loss is different. MedlinePlus says that without treatment it’s permanent, and the AAD calls it progressive. The hopeful part, from the AAD: treatment can stop it getting worse and help some women regrow hair, and it works best when started at the first sign.
What blood tests should you ask about for hair loss?
The usual checks are thyroid tests and iron levels, plus hormone tests if you have signs of too many androgens. MedlinePlus says diagnosis means checking for other causes such as thyroid disease or iron deficiency, and the BAD says the same for telogen effluvium. These are worth raising with your doctor:
- Thyroid tests. MedlinePlus lists TSH, T3, T4 and thyroid antibody blood tests. Dry, thinning hair is a symptom of an underactive thyroid, along with tiredness, feeling the cold and constipation. An overactive thyroid can also trigger shedding, says Cleveland Clinic.
- Iron levels. MedlinePlus links pattern thinning with heavy blood loss during periods, which is common in perimenopause. If your periods have become very heavy, mention it.
- Hormone tests. DermNet says blood tests can include sex hormone levels. Most women with pattern thinning have normal levels. A few have high androgens, often with acne, irregular periods and extra facial or body hair, which can point to polycystic ovary syndrome.
- A look at your medicines. Cleveland Clinic lists retinoids, beta-blockers, calcium channel blockers, antidepressants and anti-inflammatory painkillers among the triggers of telogen effluvium. Stopping birth control pills can trigger it too.
If you think a medicine is behind your hair loss, the AAD says to talk with your doctor rather than stopping it, because stopping some medicines suddenly can cause serious side effects. For tiredness alongside the hair loss, our guide on why you might always be tired covers anemia and thyroid problems.
What is the treatment for perimenopause hair loss?
Topical minoxidil is the most-recommended treatment for female pattern hair loss, and telogen effluvium usually needs no treatment at all. The BAD says medicines don’t speed up regrowth after telogen effluvium; finding and fixing the trigger is what matters. For pattern thinning, here’s what dermatology sources say about each option:
| Treatment | What the evidence says | Things to know |
|---|---|---|
| Minoxidil on the scalp | FDA approved for women; the AAD’s top choice. MedlinePlus says it regrows hair in about 1 in 4 or 5 women and slows or stops loss in most | Takes 6 to 12 months to judge. Extra shedding in the early weeks is common. Benefits stop if you stop. Not for pregnancy or breastfeeding |
| Prescription pills, such as spironolactone or low-dose oral minoxidil | The AAD says some have helped women regrow hair; the BAD says oral minoxidil may be at least as effective as topical in certain cases | Not approved for this use, so a doctor prescribes them off label. The NHS says women should not use finasteride. Hair gained is lost within months of stopping |
| At-home laser combs and caps | FDA approved; a few studies show benefit | Long-term safety and results still unknown (AAD) |
| Platelet-rich plasma injections | Early findings show promise | The BAD says research is too limited to know when it works |
| Hair transplant | Can look natural and last | Needs enough healthy donor hair; not suited to thinning all over |
| Wigs, hairpieces and hair fibers | Hide thinning right away | The safest and often cheapest option, says MedlinePlus |
The NHS says no treatment works for everyone, and to see your doctor before paying a commercial hair clinic.
Do perimenopause hair loss supplements work?
Most hair supplements haven’t been shown to work. The AAD says studies of biotin, folic acid and similar products have had mixed results, and in most of them the supplements had no effect on growth or thickness. Too much selenium, vitamin A or vitamin E has been linked to hair loss, so a high-dose hair formula can backfire.
What does help is filling a real gap. The AAD says low iron or protein, or eating too few calories, can lead to hair loss, and it suggests a blood test to see if you’re short of anything before buying a supplement. To check your intake, see how much protein you need and our guide to what to eat during menopause.
How can you protect thinning hair at home?
You can’t stop pattern thinning with home care alone, but gentle habits reduce breakage so the hair you have looks fuller. These come from the AAD and the BAD:
- Wash gently. Use a mild shampoo and a moisturizing conditioner every time. A leave-in conditioner or detangler cuts breakage further.
- Go easy on heat. Pat hair dry with a microfiber towel, use the lowest dryer setting, and save flat irons and curling irons for special days.
- Skip harsh chemicals at home. The AAD advises against home coloring, perms, relaxers and hot-oil treatments for fragile hair.
- Loosen your style. Tight buns, ponytails and braids can cause traction alopecia, which can become permanent.
- Brush only to style. Tugging pulls out hair. Try not to twist or pull at it.
- Protect bare scalp. The BAD suggests sunscreen or a hat on thin areas.
Volumizing shampoos can make hair look thicker, but the AAD says they can’t regrow hair.
When should you see a doctor about hair loss?
See a doctor if hair loss worries you or keeps going, especially with an itchy, sore or irritated scalp. MedlinePlus says there may be a treatable cause. Book sooner if you have:
- Round bald patches, which the AAD links to alopecia areata
- New facial hair, acne or irregular periods, which can signal high androgens
- Very heavy periods, tiredness or feeling cold all the time
- Shedding that hasn’t settled after 6 months
A dermatologist can usually tell the types apart by looking at your scalp and asking about your history. The NHS also says to tell your doctor if hair loss is affecting your wellbeing, since counseling and support groups can help. Hair loss often travels with other changes, and our guide to menopause brain fog covers another common one.
Your next step
This week, take a photo of your part in good light and note any illness, stress or medicine change in the last three months. Bring both to your doctor and ask about thyroid and iron tests. If you want to eat well for your hair without guesswork, The Menopause Meal Plan gives you four weeks of high-protein meals.
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Quick questions
Does perimenopause hair loss stop?
Shedding from telogen effluvium usually stops on its own once the trigger passes, often within 3 to 6 months. Female pattern hair loss tends to continue slowly without treatment. The AAD says treatment can keep it from getting worse, and it works best when you start at the first sign of thinning.
Will perimenopause hair loss make me bald?
It’s very unlikely. MedlinePlus says female pattern hair loss rarely leads to total or near-total baldness the way it can in men. Most women see a wider part and thinner hair on top while the front hairline stays. Without treatment, some women do develop thinning all over the top of the scalp.
What hormone causes hair loss in perimenopause?
No single hormone has been proven to cause it. Female pattern hair loss is mainly inherited, and the AAD says hormones may play a role because it’s more common after menopause. DermNet says the role of estrogen is uncertain and most affected women have normal androgen levels, though a few have high androgens.
Is perimenopause hair loss temporary?
It can be. Telogen effluvium, the heavy shedding that follows illness, stress or a medicine change, is usually temporary, and the AAD says hair tends to regain its fullness within six to nine months. Female pattern hair loss is long term, though treatment can slow it and regrow some hair.
Do hair loss shampoos work for perimenopause hair loss?
They can make hair look fuller, but they don’t treat the cause. The AAD says hair loss shampoos help hair hold moisture and reduce breakage, but they cannot regrow hair or stop hair loss from getting worse. A mild shampoo and a moisturizing conditioner after every wash are what dermatologists suggest.
Can perimenopause cause an itchy scalp with hair loss?
Female pattern hair loss doesn’t usually cause scalp symptoms, though the BAD says some women report itch. Telogen effluvium can sometimes cause tenderness or odd sensations in the scalp. MedlinePlus says to see your doctor if hair loss comes with itching or irritation, because there may be a treatable cause.
This article is general information, not medical advice. Hair loss has many causes, and some need a doctor’s diagnosis. If you’re pregnant, breastfeeding, take regular medicines or have a health condition, ask your doctor or a dermatologist before trying any hair loss treatment or supplement.
Sources
- American Academy of Dermatology. Thinning hair and hair loss: Could it be female pattern hair loss?
- American Academy of Dermatology. Hair loss or shedding?
- American Academy of Dermatology. Hair loss: Tips for managing
- British Association of Dermatologists. Female pattern hair loss: patient information leaflet
- British Association of Dermatologists. Telogen effluvium: patient information leaflet, October 2025
- NHS. Hair loss
- NHS. Symptoms of menopause and perimenopause
- MedlinePlus Medical Encyclopedia. Female pattern baldness
- MedlinePlus. Hypothyroidism
- DermNet. Female pattern hair loss
- Cleveland Clinic. Telogen effluvium