Midlife Hair Loss: What Causes It and Expert Tips on How to Deal

Almost half of women have hair loss by age 50?— here’s what you need to know about what’s causing it and the type of treatment options available.

hair loss for women at mid life
With female pattern hair loss, thinning can occur on the crown of the head.Grace Cary/Getty Images

Do you ever look in your shower drain or hairbrush and wonder how you still have any hair left on your head? Is your scalp easily sunburned, or are you noticing thinning where you part your hair? You may be experiencing female pattern hair loss, a problem that’s much more common than you might think.

Hair Loss Happens as We Age

“About half of all women will have some element of hair loss by age 50, and by the age of 60, approximately 80 percent of women will experience some hair loss,” says Glynis Ablon, MD, an associate clinical professor at the University of California in Los Angeles and a dermatologist at Ablon Skin Institute and Research Center.

We all know hair loss or balding can happen to men in midlife, but we don’t talk about it as much when it comes to women, she says. “It usually impacts women in a different way, especially their self-confidence. Someone like Bruce Willis can just shave their head and look fine, but it tends to be a bigger deal for women,” says Dr. Ablon.

How Is Female Pattern Hair Loss Different From Baldness in Men?

The most common type of hair loss in women is called androgenetic alopecia, or female pattern hair loss (FPHL). Hair follicles shrink, causing the hair to become thinner and finer, with decreased numbers of hairs overall. The hair’s growing phase also gets shorter, which means fewer hairs are in the active growing phase at any one time.

“Usually in female pattern hair loss, the frontal hairline stays about the same, but there can be a widening of the part and a central thinning of the hair,” explains Alison Bruce, MBChB, professor of dermatology, a researcher, and a practicing dermatologist at Mayo Clinic in Jacksonville, Florida.

In contrast, male baldness often starts with a receding hairline, according to?Mayo Clinic.

What Causes Female Pattern Hair Loss?

Hair loss is largely influenced by genetics and the aging process, says Bruce. A genetic cause doesn’t mean that it’s necessarily something you’ve inherited directly from your mom or dad, she adds.

“There are multiple different genes related to hair loss, and this is a very complex interplay of many genes. You shouldn’t assume you’ve done anything to cause your hair loss, especially if you are otherwise healthy,” says Dr. Bruce.

Hair loss might also be related to a shift in hormones, says Stephanie S. Faubion, MD, the director of the Center for Women’s Health at the Mayo Clinic in Jacksonville, Florida. Androgens, a group of hormones that include testosterone and androstenedione, don’t increase during the menopause transition, but the ratio between estrogen and androgen changes, so you have less estrogen and relatively more androgens, including testosterone, she explains.

Why does that matter? DHT, a metabolite of testosterone, has been linked to male baldness in research. “There’s a theory that changing ratios may be related to hair loss in women,” says Dr. Faubion.

Find Out the Reason Behind the Hair Loss

If you’re bothered by your thinning hair or hair loss, a visit to your dermatologist is a great place to start. Although it’s likely that female pattern hair loss is the culprit, we shouldn’t assume that is always the reason for hair loss; sometimes there are underlying issues causing the condition, explains Faubion.

If your hair loss doesn’t follow the typical appearance of female pattern hair loss, your doctor will likely perform a few tests to explore potential causes.

  • A complete blood count (CBC) test is used to evaluate overall health and can detect many conditions, including anemia, which can cause hair loss.
  • Thyroid function tests can reveal thyroid issues that may be related to thinning hair.
  • A dietary assessment, or a discussion of what you eat, can determine whether you’re following a healthy diet or if you’re not getting enough essential?vitamins.
  • Autoimmune inflammation Your doctor may investigate conditions related to inflammation in the scalp, including autoimmune diseases, which can be associated with hair loss, says Bruce.
  • A hormone test may be performed, though a hormone imbalance is rarely the culprit in hair loss, says Faubion.

High Stress Can Cause Hair Loss

“Extreme stress can be a problem and cause hair loss,” says Faubion. The condition is called telogen effluvium, and fortunately, the hair loss it causes is temporary, she notes.

All hair follicles are on a cycle, and significant physical or emotional stress can push more follicles than usual into a resting phase, which can lead to a significant amount of hair loss at one time, says Faubion. “It can take a while after that stress for the cycle to go back to normal,” she says.

A recent example: The pandemic seemed to increase stress levels and subsequent hair loss for a lot of women, says Ablon. The number of patients seeking my help for hair loss grew significantly during that time compared with before the arrival of COVID-19, she adds.

Over-the-Counter and Prescription Medications May Help

The good news: There are many options for hair loss in menopausal women, says Bruce.

Topical?minoxidil?The simplest solution is to start using 5 percent minoxidil, which is available without a prescription, says Bruce. “The trade name is Rogaine, but there are also generic versions available. This topical treatment is effective in about two out of three people who use it,” she says.

Compliance can be an issue, because you have to use it twice daily every day to retain the benefits, she says. “There are medications marketed to both men and women, but women can use the men’s formulation and it is often less expensive.”

Oral prescription drugs that have been approved for use in other conditions are sometimes used by doctors “off-label” with female pattern hair loss, according to the American Academy of Dermatology Association (AAD).

Spironolactone?This blood pressure medication is a diuretic (a drug that increases the production of urine) that can prevent hair loss from worsening and restore hair growth, according to the AAD.

Hormone medications Drugs that block the effects of circulating androgens or lower androgen levels, such as finasteride, flutamide, or dutasteride may be prescribed for women with hair loss, per the AAD. These oral medications should not be used by women who are pregnant or planning to become pregnant.

Oral minoxidil?Oral minoxidil to treat hair loss in both men and women has gained popularity recently, notes Bruce. Although topical minoxidil is effective, many people don’t always use it as directed because of the twice-daily regimen and side effects like poor hair texture and scalp irritation. A review published in March 2021 in the Journal of the American Academy of Dermatology stated that “oral minoxidil was found to be an effective and well-tolerated treatment alternative for healthy patients having difficulty with topical formulations.”

Other Forms of Treatment

Although there is no “miracle cure,” says Bruce, other options can help with FPHL.

Platelet rich plasma (PRP) injection is a procedure in which the patient’s blood is drawn and the blood is spun in a centrifuge so that the platelets are concentrated; then they are injected into the scalp, says Bruce. “The theory is that the platelets have growth factors and they will stimulate hair growth,” she says.

A review published in March 2022 in Drug Design, Development, and Therapy found that PRP injections were safe, had minimal side effects, and could be used as a therapeutic option for female pattern hair loss.

Low-level light lasers These laser combs, helmets, and other devices can be used at home without a prescription. The laser light has been shown to stimulate hair growth in a few studies, according to the AAD.

Low-level light therapy is a noninvasive and safe way to treat hair loss, either on its own or with topical minoxidil, according to a review published in the October 2021?Journal of Cutaneous and Aesthetic Surgery.

Hair Transplantation May Be an Option for Some Women

Women who are more distressed by their hair loss or have more significant hair loss may consider hair transplantation, says Bruce. “This is an expensive and somewhat invasive procedure. You’re taking hair from a donor site, typically at the back of the scalp, and then redistributing those hair follicles to areas where the hair is thinner,” she says.

If you’re interested in hair transplantation, first talk with your doctor to see if you’re a good candidate. For many people, the procedure is an effective way to restore hair that’s been lost, according to StatPearls.

Lifestyle and Home Remedies for Thinning Hair

If you feel self-conscious about thinning hair, there are options beyond treatments and procedures that may make hair loss less noticeable, says Bruce.

  • Wear a wig, extension, or hairpiece. Some women find this to be a suitable option.
  • Style your hair differently. This can make a widening part less noticeable.
  • Try hair powders. These contain tiny fibers; you sprinkle the powder in your hair and the fibers cling to the hair shaft, giving the appearance of fuller hair and hiding where the scalp is visible.
  • Consult a hairstylist. Some stylists specialize in thinning hair.
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