Hair thinning in perimenopause and menopause

Somewhere in your 40s the ponytail gets thinner, the parting gets wider, and the brush has more in it than it used to. It’s one of the most common menopause symptoms and one of the least talked about, because nobody puts it on the list next to hot flushes.

Why it happens

Oestrogen keeps hair in its growing phase. As it falls, the balance tips towards androgens, which shrink follicles on the top of the head. Each hair grows back a little finer until some stop. Stress, poor sleep, low iron and thyroid changes — all common in the same years — make it worse. It’s gradual and it doesn’t reverse on its own.

What it looks like

Overall thinning rather than patches. The crown and parting go first, the front hairline usually stays. Hair feels finer, dries faster, won’t hold a style. Shedding may rise for a while then settle into a slow thin.

What actually helps

HRT helps some women, particularly if started early, and a GP can discuss it. Topical minoxidil is the best-evidenced treatment and works regardless of cause if used for six months or more. Dermatologists can add anti-androgen tablets. Get iron, ferritin, thyroid and vitamin D checked, because fixing a low result often makes the biggest difference. Supplements and “menopause hair” shampoos are mostly hope.

Why tracking matters

Every treatment here takes months to show anything, and you’re changing several things at once — HRT, iron, minoxidil, sleep. Without a record you can’t tell what’s working and you’ll stop the right thing at the wrong time. A monthly photo of your parting and crown, same light, same angle, gives you a clear answer and gives your GP something to act on.