Since going through menopause, I have noticed changes to my scalp and hair texture. My scalp is dry and flaky, and my hair is dry and falling out. Is there anything I can do to address it?

These things are familiar to women going through menopause, said Dr Shilpi Khetarpal, a dermatologist at Cleveland Clinic.

About half of menopausal women notice accelerated hair loss and changes in texture at this life stage, according to a recent study.

The years leading up to and after menopause are characterised by dramatic shifts in levels of female sex hormones. Hormonal changes are believed to contribute to changes in hair growth and texture as well as in scalp texture, she said.

Hair follicles, which are tiny organs under the skin that contain the root of the hair, contain receptors for sex hormones such as oestrogen, testosterone and other androgens.

There is not much conclusive research on how female sex hormones affect hair. Preliminary studies in mice and on skin cells suggest that oestrogen affects hair growth, possibly stimulating it, and may also be responsible for maintaining the diameter of each strand of hair.

“There’s probably more that oestrogen is doing that we don’t know of, but a lot of women tell me, ‘My hair is not as shiny or radiant as it once was’, and the only change is that they’ve been through menopause,” she said.

Other hormones, particularly testosterone, are responsible for sebum production, which are oils that nourish and moisturise the scalp and hair shaft (the part of the hair that is visible above the skin).

During menopause, those hormones can be thrown out of whack, possibly leading to an increasingly dry and flaky scalp and more brittle hair.

What other factors might change hair?

In many cases, menopause-related hormonal changes may be exacerbating an existing hair issue, said Dr Emma Guttman-Yassky, chair of the dermatology department at the Icahn School of Medicine at Mount Sinai, whose research focuses on alopecia.

Other factors might chip away at hair quality and growth before a woman enters perimenopause, like chronic inflammatory conditions (which are often tied to hair loss) and other stressors, which can lead to temporary hair loss, she said.

Age is also associated with changes in hair growth, thickness and texture in both men and women, said Dr Paradi Mirmirani, a dermatologist at Kaiser Permanente, who specialises in hair disorders and loss.

Even a lack of nutrients can play a big role in hair changes, Dr Khetarpal said, particularly of vitamin D and iron.

“We know vitamin D acts more like a hormone in the hair than a vitamin. So with all of my patients, we test for vitamin D.”

Another major factor in hair change is genetics, Dr Guttman-Yassky said.

“I always ask my patients about family history and, many times, somebody with female-pattern hair loss will say, ‘Oh, yeah, my mother in her 40s or 50s had the same pattern of hair loss.’”

Are there ways to manage these hair changes?

The sooner you seek help for hair changes, the better the results of interventions will be, said Dr Guttman-Yassky.

When you notice hair loss or changes in scalp texture, ask a dermatologist for a full examination and blood work to find out whether the changes are hormonal or if there are other factors, she said.

Hormone therapy – which is used to manage menopause symptoms, like hot flashes and brain fog – may help with hair changes, but there is no real data on the effectiveness, Dr Mirmirani said.

The tried-and-tested methods to curb hair loss are effective, even if the hair loss is related to menopause, experts said.

Steroid injections into the scalp are an effective method for stimulating hair growth, Dr Guttman-Yassky said.

Vitamin supplements may work if you are deficient in them, Dr Khetarpal said. Some dermatologists offer scalp injections of vitamins to help with patches of hair loss, but vitamins will never outperform drugs like minoxidil.

More brittle hair means that it may no longer be able to withstand styling methods like straightening irons or hair dyes. Dr Mirmirani said: “I have women come in and say, ‘This is not my hair. I’ve always coloured my hair’, or ‘I’ve always used heat on my hair and now it’s not behaving the same.’”

It might be worth considering changing practices, like minimising the use of heat and chemicals or reducing how often you wash your hair, she said.
NYTIMES