Penny Lancaster went to see a GP to help with the menopause
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Hair loss can be very upsetting, impacting your self-esteem and confidence to an extreme level. While hair loss is often considered a male problem, it’s very common among women around the menopause. The NHS estimates that around 50 percent of women over 65 experience female-pattern baldness. Express.co.uk chatted to Dr Deborah Lee from Dr Fox Online Pharmacy to find out why hair loss happens as women age and what you can do about it. Does HRT really fix menopausal hair loss?
As women age, it’s all too common to find they are losing their hair.
There are many different types of hair loss, but most of the time hair loss is due to female pattern hair loss (FPHL).
Dr Lee explained: “Hair loss causes untold misery for women, and some become so distressed that they develop an unhealthy obsession with their body image and appearance.
“Many women start to avoid social gatherings and find this has a negative effect on their social life.
“In one survey 40 percent of women with hair loss complained of marital problems, bratz yasmin fashion designer and 63 percent had work-related issues.
“In another study, 55 percent of women with FPHL were diagnosed with clinical depression, and in a further study.
“However, in the same study 89 percent of these women showed improvements in their depressive symptoms when their hair loss was treated.”
What is female pattern hair loss?
You’ve probably heard of male pattern baldness, but what about female pattern hair loss? This is the most common cause of hair loss in women, but you may have heard it referred to as androgenic alopecia (androgenic because of the probable association with male hormones known as androgens).
Dr Lee explained: “FPHL is described as thinning of the hair on and around the vertex and/or at the sides of the scalp, but the frontal hairline is preserved.
“Hair normally grows in a hair growth cycle – normal hair is actively growing in the anagen phase, which In healthy hair, can last up to six years.
“At the end of the anagen phase, the hair passes into a resting phase called the telogen phase.
“New hair grows underneath the telogen-phase hair and pushes the old hairs out.
“In healthy hair, 85 percent is in the anagen phase but in FPHL, the anagen phase is shortened, meaning the hair does not grow so thick or so long before it is extruded from the scalp.”
Female pattern hair loss is a particularly common finding in perimenopausal, menopausal and postmenopausal women.
Dr Lee said: “Declining levels of estrogen lead to a marked lowering of SHBG, with a consequent increase in levels of free testosterone.
“Hence women often complain of thinning hair on the head but increased, unwanted, facial hair.
“At this time, there is a natural redistribution of body weight, with an increased tendency to accumulate visceral fat, associated with worsening insulin resistance. This can lead to worsening oxidative stress in the hair follicles.”
The exact nature of hormones and hair growth and the cause of FPHL is still not fully understood, but it is thought that FPHL might be caused by high levels of the male hormones – testosterone and androstenedione.
However, the situation is complex, because most women with FPHL do not have raised blood levels of androgens or suffer from hyperandrogenic symptoms.
Dr Lee said: “In men, male pattern baldness has been clearly linked to testosterone metabolism.
“This responds to antiandrogen therapy, using the drug finasteride – a 5-alpha-reductase type two inhibitor, but this is not licensed for use in women to treat FPHL.
“However, some antiandrogens do appear to be effective in FPHL, for example, the diuretic, spironolactone, and the progesterone, cyproterone acetate.”
In one research study, 75 percent of women treated with spironolactone reported improvements in the thickness of their hair.
Dr Lee said: “The usual dose is 100 mg – 200 mg per day. Unfortunately, this is not the answer for many women, as it can cause side effects such as nausea, vomiting, dizziness and low blood pressure.”
Other options are spironolactone, cyproterone, a combined oral contraceptive pill containing estrogen and cyproterone acetate or hormone replacement therapy.
Alternatively, hormone replacement therapy (HRT) can help reduce hair loss, as estrogen is believed to promote hair growth.
Does HRT fix menopausal hair loss?
Hormone replacement therapy can help reduce hair loss, as estrogen is believed to promote hair growth.
Women choose to take HRT at menopause for a variety of reasons, most often to try and control unpleasant hot flushes and night sweats.
However, HRT helps many other menopausal symptoms too, including insomnia, tiredness, joint pains, irritability, low mood, and vaginal dryness and soreness.
One of the lesser-known benefits of HRT is that it stimulates the production of collagen – the main matrix protein (scaffolding) in skin, bone, cartilage, hair and nails.
There is little published research on which HRT preparation to recommend for treating hair loss, however.
Dr Lee added: “The most antiandrogenic progesterones are likely to have the best effects at reducing hair loss.
“These include medroxyprogesterone acetate – for example, found in Indivina, and drospirenone, for example, found in Angelique.”
The risks and benefits of HRT must always be carefully assessed with your GP or menopause specialist, but for most women, the benefits of taking HRT will outweigh the risks.
Dr Lee warned: “Women need to be fully informed about the possible small increased risk of breast cancer from taking combined HRT, versus the protective benefits from HRT on the cardiovascular system, bone health, and the other possible protective aspects against other medical conditions such as dementia and colon cancer.
However, wanting to take HRT to improve their hair is a good enough reason to take HRT if hair loss is causing distress and affecting their quality of life. Taking HRT is always a personal decision.”
If you’re concerned about hair loss during menopause, see your doctor for an accurate diagnosis.
They are likely to request some blood tests to check for iron deficiency, anaemia and thyroid hormone levels, Dr Lee said.
She added: “Make sure you are eating a proper, varied, balanced, diet full of fruit and vegetables as these contain high levels of antioxidants, and make sure you are getting enough protein, healthy (unsaturated) fats, and fibre. Check with your GP whether you need calcium and vitamin D supplements.”
On top of that, you can make sure you’re being gentle with your hair and using the right products.
Dr Lee said: “Be gentle with your hair. Avoid any direct heat. Use pH-balanced shampoo and conditioner – SLS-free.
“Look out for anything on the label that could cause scalp dermatitis – for example, methylisothiazolinone.
“You should see your GP for a menopause consultation and use it as an opportunity to discuss any symptoms and the relative benefits and risks of HRT.
“You may decide you want to try HRT, which although there are no guarantees, could be a good option for your hair.”
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