Dermatology · Menopause

Menopause hair loss: causes, workup, and what actually regrows hair

Thinning at the crown. Wider part line. More hair in the shower drain. Female pattern hair loss affects up to 40% of women by age 60 and accelerates in menopause when estrogen (which prolongs hair growth phase) drops while androgens remain relatively unopposed. It's treatable — but requires the right workup.

The mechanism

Hair follicles cycle through growth (anagen), regression (catagen), and shedding (telogen). Estrogen prolongs anagen. When estrogen falls, more follicles enter telogen, shedding increases, and regrowth slows. In genetically susceptible women, androgens further miniaturize follicles at the crown and temples.

The workup

Ferritin (target >70 ng/mL, not just "normal").
TSH, free T4, TPO.
Vitamin D 25-OH, B12, zinc.
DHEA-S, total & free testosterone.
Scalp exam by dermatologist if diffuse or scarring.

Treatment stack

Minoxidil — topical 5% or oral 1.25–2.5 mg.
Spironolactone 100–200 mg for androgen-driven pattern.
HRT — helps hormone-driven thinning.
Iron repletion if ferritin low.
Low-level laser therapy — modest evidence, worth trying.

Frequently asked questions

Why is my hair falling out in menopause?

Estrogen extends the anagen (growth) phase of hair. As it falls, more follicles enter telogen (shedding). Relative androgen excess also miniaturizes follicles in genetically susceptible women.

Does HRT prevent hair loss?

It helps in women with hormone-driven thinning, but is not a first-line hair loss treatment. Minoxidil (topical or oral) has stronger direct evidence.

What labs should I get?

Ferritin (target 70+), TSH, vitamin D, B12, complete iron panel, DHEA-S, testosterone. Low ferritin is the most commonly missed cause.

Is minoxidil safe for women?

Yes. Topical 5% once daily or oral low-dose (1.25–2.5 mg) both work. Oral is often more convenient and equally effective.

Should I take spironolactone?

For androgen-driven pattern hair loss, yes — 100–200 mg daily is standard. Not for postmenopausal women planning HRT with progesterone without clinician oversight.

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Medically reviewed by Kindr Health Clinical Team · Last reviewed 2026-06-19. Compounded medications are prepared by FDA-registered 503A pharmacies and are not FDA-approved drug products.