Hormonal changes in menopause: do they contribute to a ‘midlife hair crisis’ in women?

Abstract

Female pattern hair loss is a common problem affecting a large number of women worldwide but beset by a paucity of research. The study of androgens has hitherto dominated the field of hair biology but there is increasing scientific and clinical data to suggest that nonandrogen signals can also affect the folliculosebaceous unit, especially in women. The discovery of oestrogen receptor beta has renewed and redefined prior concepts of oestrogen activity and signalling in hair biology. It is postulated that oestrogens modulate hair growth by their influence on a number of other hormones, growth factors, transcription factors and cytokines. The menopause is a period in which significant changes in oestrogen levels are recorded, and this review discusses studies that help to clarify the link between menopause and the perception of thinning hair. In a study of pre- and postmenopausal women without alopecia, menopausal status significantly influenced hair parameters, specifically hair growth rate, percentage anagen and hair diameter distributions, most notably in the frontal scalp. Hair density decreased with age, but was not correlated with menopausal status. Analyses of hair amount using a model of hair density and hair diameters suggest that the impact of changing hair parameters is most notable in the mid-forties for women.

Hair: What is New in Diagnosis and Management?

“…14 Conversely, lower systemic estrogen levels have been implicated in the increase of FPHL after menopause. 15 FPHL has been correlated with low systemic estrogen levels when aromatase inhibitors are used in cancer therapy. Topical estrogen preparations are used to treat FPHL in some countries, but their efficacy is questionable.…”

28 Hair Restoration

“…Microscopic evaluation in FPHL shows patterns that mimic MPA with progressive follicular miniaturization and decreased anagen phase. 13,14,15 Some women with hair loss may present more similarly to the classical male patterns of hair loss. It is reported that 40% of women have FPHL by age 70.…”

Hair Loss in Women

“…There is not a clearly defined division between the more mild findings of normal aging and the more pronounced findings of FPHL. 6,8 When evaluating women complaining of hair thinning, it is important to remember that decreases in hair density are often not publicly perceived until the density has decreased by half. The anagen phase, or growth phase, is the longest phase of the hair cycle.…”

“…6 A schematic of normal hair cycling is presented in Figure 2. 6,8 These changes of decreased hair density and hair diameter lead to physiological hair thinning in all aging women. Following anagen is a short regression phase termed catagen, during which the hair follicle regresses via apoptosis.…”