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I’ve written an article about hair loss some time ago, but it’s a topic I’ve seen popping up a lot lately, so I revised my article for you to shed a bit more light on hair loss in perimenopause and what strategies you can use to manage it.
The 3 main causes for hair loss are:
Hormone imbalance
Nutrient deficiencies
Stress (and that includes all kinds of stressors that impact your body, mainly emotional stress and toxins)
And unfortunately all of them are more difficult to maintain as we age: our hormone levels go down, we absorb less of our nutrients and our bodies are more impacted by stress.
Perimenopausal hair loss often manifests as increased shedding, widening part lines, or a noticeable reduction in hair volume.
While hormonal changes play a primary role, other lifestyle factors can exacerbate hair loss during perimenopause. Chronic stress, an imbalanced diet, and a sedentary lifestyle can all contribute to compromised hair health.
In reality, it’s usually a combination of different causes and therefore, there’s also not ONE solution, but often it’s a combination of things that will help.
The main hormone imbalances leading to hair loss and hair thinning are elevated testosterone, insulin resistance and hypothyroidism.
Hair loss linked to high testosterone tends to be on the crown and front of the head – above the forehead. High testosterone in women is much more common than you might think! It occurs when your blood sugar levels stay high (insulin resistance) or when you have high inflammation levels in general. This leads to suppression of Sex Hormone Binding Globulin (SHBG), and when SHBG is low, testosterone is allowed to build up in the blood, as it isn’t being bound by SHBG and gets converted to dihydrotestosterone (DHT). Dihydrotestosterone (DHT) plays a role in male pattern baldness as well as frontal hair loss in women. In women who have a genetic predisposition to hair loss, an enzyme within the hair follicle (5-alpha reductase) binds to testosterone and converts it to DHT, which then binds to additional receptors deeper within the hair follicle, causing less growth.
Insulin resistance is affecting many women especially in perimenoapuse when our insulin receptors are naturally getting more resistant to insulin and estrogen levels are going down. It’s causing a number of hormone conditions. It increases free testosterone, which, as you’ve seen above, can lead to hair loss. Insulin resistance also causes reduced blood flow and oxygen levels, contributing to hair follicle constriction, which makes it harder for hair to grow. This means that the follicle, which once produced healthy hairs, starts making thinner hairs with a fragile shaft that can easily fall out.
Also declining estrogen levels have an impact on your blood sugar: estrogen is protecting your blood sugar levels in follicular phase, but when levels decline in perimenopause and menopause, women are more prone to insulin resistance and blood sugar issues.
How do you know if you have imbalance blood sugar or insulin resistance? The easiest is to have a look at a recent blood draw result and check out the following markers:
fasting glucose should be below 90 mg/dL,
HbA1c should be between 4.1 & 5.4%
Insulin should be between 2 – 8 IU/mL
You can also go by symptoms of course that can be a good indicator - these are all signs of imbalanced blood sugar:
Not being able to go 3-4 hours without a snack, coffee or pick me up
Feeling irritable (hangry) if you don’t eat
Fatigue, especially afternoon energy slump
Insomnia
Cravings
Feeling hungry just after meals
Need something sweet after your meal
Increased appetite or thirst
Tingling sensations in hands or feet
Polycystic Ovarian Syndrome (PCOS) is a hormonal condition that occurs more and more frequently in women of childbearing age. It is characterized by high levels of androgen (male) hormones, high blood sugar levels, insulin resistance, and obesity. It is called PCOS because of the cysts that may grow on the ovaries (although many women with PCOS don’t have ovarian cysts). The excess circulating androgens convert to DHT, as explained above.
Estrogen dominance is another common imbalance that can lead to hair loss. When estrone (E1) and estradiol (E2), get out of whack, they will impact and imbalance your other hormones and also your thyroid and therefore impact hair loss.
Thyroid-related hair loss tends to manifest in hair thinning all over the head or hair loss on the sides of the head.
Thyroid conditions are often overlooked, partly because conventional lab ranges are too broad, but also because most doctors only check for TSH and not T3 and T4. Thyroid function can be too low (hypothyroid) or too high (hyperthyroid). To learn more about thyroid symptoms and important markers, check out this article.
Our hair follicles actually have receptor sites for thyroid hormones. The thyroid hormone binds to these receptor sites and stimulates hair growth (or not), and both -insufficient and excess thyroid hormone can cause your hair to fall out. Adequate levels of T3 and T4 thyroid hormones are needed for normal hair growth and they also encourage pigmentation of the hair.
Nutrient Deficiencies:
You’ve probably heard of biotin (Vitamin B7 or B8) which is broadly promoted as a hair beauty supplement and also in many shampoos. But there are other nutrients you might not think of, that are associated with thinning hair like lack of vitamin B12, iron, zinc, silica, and essential fatty acids – particularly Gamma Linolenic Acid (GLA).
We need biotin for the production of keratin, which is a structural protein that makes up our hair, skin, and nails. Cells that are lacking biotin are more susceptible to damage from stress, but they also need it to produce collagen and grow hair.
Biotin deficiency can be caused by gut dysbiosis, drug-nutrient interactions, bariatric surgery (leading to decreased absorption), smoking, excessive alcohol consumption, and over-consumption of raw egg whites (if you haven’t heard yet that eating egg whites only is completely overhauled ;-).
Vitamin B12 is needed for the production and maturation of healthy red blood cells, which are needed for delivering oxygen and nutrients to the base of our hair follicle. It also promotes the growth of new cells, including hair.
Iron deficiency is, next to thyroid disorders, one of the most common conditions associated with hair loss – I see it especially low in vegetarians and vegans, but also in clients who are lacking the stomach acid to absorb iron and/or have a compromised gut lining to store it.
Zinc is not only crucial for our immune system, but also for most of our hormones to function properly. A lack of zinc has clearly been linked to hair loss.
Silica is a trace mineral that is present throughout the body but mostly in our connective tissue, including hair. A deficiency in silica can also lead to poor production of collagen, an important component of hair.
Gamma Linolenic Acid (GLA) is an anti-inflammatory omega-6 fatty acid that is found primarily in plant seed oils, such as evening primrose oil and black cumin seed oil. GLA is supposed to improve hair texture and makes it stronger and less brittle. GLA is also a powerful DHT inhibitor and therefore prevents its destructive effect on our hair follicles.
A lack of protein can also contribute to hair loss. A key protein that is important for healthy hair is collagen (that’s the jelly-like stuff that comes from bone broth): it is very important for maintaining healthy hair follicles and hair growth.
Our natural collagen production declines as the body ages, the damaged DNA causes the collagen in hair follicle stem cells to break down.
And lastly, stress can cause hair loss too! But this is probably not new to you...
Stress will elevate your Cortisol levels and accelerate hair loss - even a short, but intense stress period can cause this.
If you’re not sure if you have high cortisol levels, you can get in touch to get them tested.
Ok so now that you’re aware of all the different things that can influence hair loss, let’s talk about what you can do to keep your hair healthy and beautiful as you age:
Stop torturing your hair with too much and/or too harsh products: what kind of chemical treatments like perming, bleaching or coloring have you had done on your hair over the years? Even the sulfates in shampoo can break down the protective oils that coat the hair, leading to drying and more breakage. You can easily find sulfate-free shampoos to eliminate this potential cause of hair loss. Shampoos with rosemary and grape seed extract are great for thinning hair.
Get your blood checked for nutrient deficiencies: Hba1C, insulin, iron, ferritin, zinc, Vitamin B12 - these can all be done with your GP and are not expensive
Seek out professional advice to get your hormones back on track: seek out a practitioner who is specialized in hormone therapy and who can help you rebalance your hormones and/or nutrient deficiencies (like me or someone else 🙂).
Set boundaries - saying NO is the most important step to less stress! Also incorporate stress management techniques like yoga nidra, mediation, breath work or whatever works for you
Consider buying my cookbook for blood sugar and hormone balance to get started with blood sugar balance on your own.
If you want to tackle all of the above, consider my 1:1 program Hormone Harmony or the group option Perimenopause like a Boss.