Why Does Hair Loss Happen in Perimenopause and Menopause?
- Clare Bellini
- 16 hours ago
- 4 min read
Hair loss in perimenopause and menopause is one of the most common and distressing symptoms women experience. Hormonal changes, iron deficiency, thyroid imbalance, stress and blood sugar fluctuations can all contribute to menopausal hair thinning.
Between 40 and 60 percent of women aged 50 to 60 experience hair thinning or loss, this presents as increased shedding, widening of the parting or reduced volume.
What Causes Hair Loss in Perimenopause and Menopause?
Hair loss in perimenopause is usually caused by a combination of factors rather than one single issue.
Hormonal Changes
During perimenopause, oestrogen levels decline and fluctuate. At the same time, there is a relative rise in androgen activity.
This can lead to:
Thinning through the central parting
Reduced volume at the crown
Finer, weaker strands
Unlike male pattern baldness, hair loss in menopause typically presents as overall thinning rather than bald patches.
Iron Deficiency
One of the most common causes of hair loss in perimenopause is low iron.
Hair follicles are very sensitive to low iron stores, and shedding is often one of the earliest signs of deficiency. Common causes include:
Heavy periods in early perimenopause
Vegetarian or vegan diets
Digestive issues
Long-term use of proton pump inhibitors (PPIs)
Without adequate iron, hair growth slows.
Underactive or Suboptimal Thyroid
Thyroid dysfunction is common in midlife women and frequently contributes to thinning hair in women over 40.
The thyroid regulates metabolism and affects the speed of hair cell turnover. Symptoms may include:
Fatigue
Constipation
Anxiety
Weight changes
It is important to test a full thyroid panel, not just TSH, and to check thyroid antibodies.
Physical and Emotional Stress
Stress is a major trigger for perimenopause hair shedding.
Stressful events, illness or trauma can push hair into its resting phase. Shedding often occurs 3 to 6 months later, as the hair must fall out before new growth begins.
Research suggests stress can make a woman 11 times more likely to experience increased shedding. During prolonged stress, the body prioritises essential organs over hair growth.
Dieting and Under-Eating
Hair requires consistent nutrition to grow well.
Common triggers for menopausal hair thinning include:
Chronic dieting
Low carbohydrate or strict keto diets
Rapid weight loss
Weight loss injections
Skipping meals
When the body perceives under-fuelling as stress, hair growth slows.
Hair grows around 1.3 cm per month, so improvements take time once nutrition is restored.
Nutrient Deficiencies
Hair needs specific nutrients for strength and growth. Low levels of the following can contribute to hair loss in menopause:
Protein
Iron
Zinc
Essential fatty acids
Selenium
Biotin
Vitamins B12 and D
Without the right building blocks, hair quality and thickness decline.
Blood Sugar Imbalance and Insulin Resistance
Around 1 in 2 women in perimenopause and menopause are insulin resistant. This is linked to type 2 diabetes, metabolic syndrome and conditions such as Polycystic Ovary Syndrome.
High insulin levels and blood sugar fluctuations can slow hair growth and increase shedding. Diets high in ultra-processed foods, alcohol and refined carbohydrates can worsen this.
For some women, hair loss in menopause can be an early warning sign of blood sugar dysregulation.
Gut Health and Nutrient Absorption
Even with a good diet, poor gut health can limit nutrient absorption.
Low stomach acid, microbiome imbalance, chronic diarrhoea, food intolerances and ongoing stress can all reduce your ability to absorb iron, zinc and protein effectively.
Inflammation from gut imbalance can also affect hair follicles indirectly.
How Can Your GP Help With Hair Loss in Menopause?
Your GP is an important first step if hair loss is sudden, severe or accompanied by other symptoms.
They may:
Check iron levels
Test thyroid function
Screen for diabetes
Assess for underlying medical causes
Discuss HRT where appropriate
If anaemia, thyroid dysfunction or diabetes is identified, medical treatment can significantly improve hair loss.
However, results are often reported as “normal” within wide reference ranges. If symptoms persist, a more detailed investigation may be helpful.
How Can a Nutritional Therapist Help?
Hair loss in perimenopause and menopause is rarely about one nutrient or one hormone. It is usually a combination of the above.
A Nutritional Therapist looks at the whole picture rather than treating hair in isolation.
My Approach
In clinic, I focus on identifying root causes and rebuilding foundations.
This includes:
Ensuring adequate protein at each meal
Supporting optimal iron levels through diet and supplementation, where needed
Balancing blood sugar
Reducing inflammation
Supporting stress resilience and improving sleep
Improving gut health and nutrient absorption
Hair reflects what has been happening internally for months. Consistency and patience are essential.
Functional Testing
Where appropriate, functional testing can help clarify the picture. This may include:
Full thyroid panel including antibodies (TSH, Free T3, Free T4, TPO Ab, TG Ab)
Full blood count and iron panel
Vitamin D testing
Blood glucose and insulin markers
Comprehensive gut testing
Cortisol testing
Take the First Step Toward Improvement
Hair loss in perimenopause and menopause is common, but it is not something you simply have to put up with. With the right investigation and targeted support, improvement is often possible. If you are concerned about thinning hair alongside fatigue, weight changes or other midlife symptoms, looking beneath the surface is key.
I’d love to help. Reach out for a chat, and let’s explore how I could support you.
