Reviewed by Emily Henderson, B.Sc.Sep 22 2021

Hair loss in middle-aged females is common, affecting up to two-thirds of women after menopause. The exact reasons remain unclear, although evidence suggests a hormonal and genetic predisposition. A presentation at The North American Menopause Society (NAMS) Annual Meeting in Washington, DC, September 22-25, 2021, will address common hair loss problems and review new therapies and treatment approaches to stimulate hair growth and minimize thinning.

There are many different types of hair loss that occur with age. In some (non-scarring), the hair follicle is preserved and hair has the potential to grow back. Others (scarring) are characterized by irreversibly destroyed hair follicles that do not allow hair to be replenished. Today the term most commonly used with women is female pattern hair loss (also known as androgenetic alopecia). Although it's similar to what happens to men, hair loss patterns in women are typically different.

With female pattern hair loss, the hair's growing phase shortens and fewer hairs are in the active growing phase. Hair follicles shrink, leading hair to become thinner and finer with decreased numbers of hairs overall. Women typically report progressive ponytail thinning, increased scalp visibility, and easy sunburn. Usually there is a preservation of the frontal hairline with diffuse central thinning and accentuation of the part-line with a Christmas tree appearance.

Treatment includes daily application of topical 5% minoxidil and may take at least three months before noticeable results. Finasteride is a 5-reductase inhibitor that is FDA-approved for male hair loss. As an off-label indication, it may be effective in females, although higher doses may be required. Additional treatments include drospirenone containing OCP and spironolactone. Newer therapies emerging include platelet-rich plasma injections.