Why Is My Hair Thinning? What Every Woman Should Know About Hair Loss in Midlife

Have you noticed more hair in your brush or shower drain? Maybe your ponytail doesn't feel as thick as it used to, or your part seems a little wider. Do you find yourself looking at old pictures and wondering when your hair started changing?

Hair thinning is something I hear about frequently from women in midlife. While this topic of hair loss in midlife may seem like a cosmetic concern, our hair is an aspect of how we view ourselves. Changes in its thickness or appearance can affect how we feel about ourselves too.

Over the course of the past few years, my clinical work has increasingly shifted its focus towards women's midlife health. Throughout this process, I’ve become more aware of just how often women bring up hair thinning and hair loss. And despite my years of experience in medicine, this wasn't something I’d spent time studying in depth. I knew to consider thyroid problems, iron deficiency, and hormonal changes, but I hadn't fully appreciated how many factors could contribute to hair loss or how many treatment options are available. 

So I started digging into the research.

What I learned is that hair thinning isn't always just about the hair itself. Sometimes, it can be a clue that something else is going on in the body. Hair follicles depend on adequate nutrition, healthy thyroid function, sufficient iron, and a range of other factors to grow normally. When something changes, hair growth can be affected [1,2].

At midlife, several of these changes arrive at once. During perimenopause and menopause, hormonal shifts may coincide with disrupted sleep, increased stress, heavy menstrual bleeding, nutritional deficiencies, or rapid weight loss. Any one of these factors may affect hair growth, and sometimes several are at play together.

One study found that approximately half of postmenopausal women had female-pattern hair loss [3]. This is one common cause of hair thinning, but it isn't the only one.

Hair changes are sometimes attributed to stress, aging, or menopause without a closer look at what might be contributing. These factors can matter, but they don't tell us the whole story. Understanding why your hair is changing is an important first step toward finding an approach that makes sense for you.

What Do Hormones Have to Do With Our Hair?

Before we can answer this question, we need to know a little more about how our hair grows. 

Each hair follicle goes through three main phases:

1. Anagen is the growth phase. It lasts approximately two to seven years, and about 85–90% of the hair on our scalp is normally in this phase.

2. Catagen is the transition phase. It lasts about two to three weeks. During this time, growth stops and the follicle begins to shrink.

3. Telogen is the resting phase. It lasts approximately two to four months. The old hair is eventually shed as the follicle begins another growth cycle [2].

   
   

Normally, women shed about 50–100 hairs a day. Because our follicles cycle at different times, we usually don't notice much of this shedding. But when something causes more follicles than usual to enter the resting phase at once, increased shedding can occur two to four months later [1,2]. This is why women often notice increased hair loss a few months after childbirth, a major illness, surgery, or significant stress [4,5].

Estrogen appears to help support the hair growth cycle. During menopause, estrogen levels decline significantly, while testosterone generally declines more gradually. Changes in hormone levels may influence hair growth, but genetics also play an important role. In some women, hair follicles are more sensitive to androgens, including testosterone and dihydrotestosterone (DHT). Over time, these hormones can contribute to follicles shrinking and producing finer, shorter hairs [6–10].

You may notice that your hair isn't as thick as it used to be, especially along the top of your head or where you part your hair. This is called female-pattern hair loss during midlife. Your testosterone levels don't have to be high for this to happen; they can be completely normal. Genetics and the sensitivity of your hair follicles help explain why some women experience this type of hair loss while others don't [10,11].

Female-pattern hair loss typically develops gradually, as individual hairs become finer. This differs from telogen effluvium, which causes increased shedding when more hairs than usual enter the resting phase at the same time. It's also possible to experience both conditions at once [1].

But It's Not Always Hormones

Stress, Illness, Surgery, and Rapid Weight Loss

Before assuming menopause is responsible, I look at several other possible contributors. Significant physical or emotional stress can disrupt the hair growth cycle. This includes major illness, surgery, childbirth, psychological stress, and rapid weight loss. The resulting shedding is called telogen effluvium [1,2]. Unlike the gradual thinning seen with female-pattern hair loss, telogen effluvium often causes noticeable shedding throughout the scalp. Women may suddenly find much more hair in the shower, brush, or on their pillow. It's usually temporary once the underlying trigger is resolved, although restoring normal hair density can take six to twelve months or longer [1,2].

GLP-1’s

I also want to mention GLP-1 medications such as semaglutide and tirzepatide. Hair shedding has been reported with these medications, particularly during rapid weight loss [12,13]. Reduced calorie and protein intake, along with the physiological stress of weight loss, may contribute. Whether these medications have any direct effect on hair follicles is still being studied [14,15,16].

Low Iron and Other Nutritional Deficiencies

Iron deficiency is one thing I pay particular attention to, especially in women who have experienced years of heavy periods. Our hair follicles rely on iron to function normally and grow healthy hair [17].

You can have low iron stores even if you aren't anemic. A blood test may show normal hemoglobin levels but low ferritin, which measures the iron your body has stored. That's why a normal blood count doesn't always rule out iron deficiency [18].

Low levels of vitamin D, vitamin B12, and zinc can also contribute to hair problems in some cases. I consider whether to test for these based on a woman's symptoms, diet, medical history, and other risk factors rather than ordering every test for everyone [1,2].

If a deficiency is contributing to hair loss, correcting it can help. However, it may not fully restore hair growth if female-pattern hair loss is also present.

Thyroid Disorders

Thyroid hormones regulate metabolism throughout the body, including within hair follicles [19]. Both hypothyroidism (when your body can’t produce enough thyroid hormones to regulate your metabolism) and hyperthyroidism (when your body is over-producing thyroid hormones) can contribute to hair thinning [20]. With hypothyroidism, women may also experience fatigue, dry skin, constipation, feeling cold, or thinning of the outer eyebrows [21]. Because many of these symptoms overlap with perimenopause, its crucial that your provider doesn’t overlook thyroid disease. 

Medications and Hormonal Changes

Some medications can contribute to hair shedding, including certain beta-blockers, anticoagulants, antidepressants, anticonvulsants [1,2], and breast cancer endocrine therapies [22]. Starting or stopping hormonal contraception or menopausal hormone therapy can also trigger temporary shedding [1,2]. This doesn't mean you should stop taking your prescribed medication. It means we need to consider whether it may be contributing.

Higher Androgen Activity

If hair thinning occurs alongside new acne, oilier skin, or increased coarse facial hair, it may be a sign of higher androgen levels and warrants further evaluation [23,11]. Depending on your symptoms, your clinician may check testosterone levels and sex hormone-binding globulin (SHBG), a protein that binds to sex hormones and affects how much testosterone is available for your body to use [10].

Autoimmune and Scarring Hair Loss

Hair thinning isn't always related to hormones or nutrition. Some conditions affect the hair follicles themselves. Alopecia areata, for example, is an autoimmune condition that often causes smooth, round patches of hair loss [4]. Frontal fibrosing alopecia, which is more common after menopause, can cause the hairline to gradually recede and may also lead to eyebrow thinning [9,7,24].

If you notice scalp pain or burning, redness, scaling, or a hairline that's gradually receding, it's worth seeing a dermatologist. Some inflammatory conditions can permanently damage hair follicles, so identifying and treating them early is important.

How Do We Evaluate Hair Loss?

When I evaluate hair thinning, I start by looking at the pattern and asking a few key questions. Is your part gradually widening, or are you suddenly shedding much more hair than usual? If the shedding is sudden, what was happening in the few months before it began?

I also look at whether hair is falling out from the follicle or breaking along the shaft. Heat styling, chemical treatments, and tight hairstyles can all cause breakage, which can make hair look thinner but requires a different approach.

From there, I consider your menstrual history, recent illnesses, weight changes, nutrition, medications, supplements, family history, and any other symptoms. Together, these details help me narrow down the possible causes and decide what to investigate next.

Depending on what I find, I may recommend blood tests to check for issues such as anemia, low iron stores, or thyroid problems. Additional tests may be useful in certain circumstances [1,2]. There isn't one set of tests that every woman with hair thinning needs. The goal is to understand what's most likely contributing to your hair changes and focus on the next steps that make sense for you.

If the cause remains unclear, or I see signs of a scalp condition that needs closer attention, I may recommend a dermatologist for further evaluation.

So What Can We Actually Do About It?

Treatment depends on the cause. If iron deficiency, thyroid disease, or inadequate nutrition is contributing, we need to address that. If it's female-pattern hair loss, treatment focuses on slowing further thinning and encouraging follicles to produce thicker hair.

1. Minoxidil

   
   

Minoxidil is the mainstay of treatment for female-pattern hair loss and is available over the counter as a topical liquid or foam [25,11]. It helps prolong the growth phase and can improve hair density [26,10]. Some women notice increased shedding during the first several weeks of treatment as follicles transition into a new growth cycle, which can be unsettling, but it doesn't necessarily mean the medication isn't working [26]! 

Dermatologists may also prescribe topical treatments that combine minoxidil with other medications, such as finasteride, although these aren't necessarily more effective than standard minoxidil, and the research is still limited. Overall, results generally take at least four to six months, with fuller improvement often taking closer to a year. It’s important to note that continued use is necessary to maintain the benefit [27,1]. 

Low-dose oral minoxidil is another option, although it's prescribed off-label for hair loss. It can be effective, but possible side effects include unwanted facial hair, fluid retention, lower blood pressure, and an increased heart rate, so it requires an individualized discussion, particularly in women with cardiovascular conditions [28,29,11,30]. 

For pet owners: Topical minoxidil is extremely toxic to cats and can also harm dogs. Keep the product and anything contaminated with it away from pets.

2. Anti-Androgen Medications

   
   

Two other medications, spironolactone and finasteride, are sometimes used off-label to treat female-pattern hair loss. Spironolactone helps block the effects of androgens and may be especially helpful for women who also experience acne or unwanted facial hair. It can affect blood pressure and potassium levels, so your clinician will consider your kidney function, other medications, and whether you need monitoring [29,11,10].

Finasteride works differently: it reduces the conversion of testosterone to DHT, a hormone that can cause hair follicles to gradually shrink [27,22]. Neither medication is appropriate during pregnancy, so preventing pregnancy is an important consideration for women who could become pregnant [27,25].

3. Nutrition and Protein

   
   

Hair is made mostly of a protein called keratin, so getting enough calories and protein is important for healthy hair growth. When you're not eating enough, your body prioritizes essential functions over hair growth, which can lead to increased shedding. This can be especially relevant if you're losing weight rapidly or taking GLP-1 medications that reduce your appetite [16].

4. Hair and Scalp Care

   
   

These habits can help everyone, regardless of the cause of their hair thinning. Be gentle with your hair, especially when it's wet, and avoid excessive heat styling or hairstyles that pull tightly on your scalp. If you have dandruff or scalp irritation, treating it with specific products and with guidance from your healthcare provider can help keep your scalp healthy. Hair fibers and volumizing products can also help your hair look fuller while you wait for treatments to take effect.

5. Red-Light Therapy, Microneedling, and PRP

There are a few other treatments worth knowing about. Low-level light therapy, which uses light to stimulate hair follicles, has shown modest improvements in hair density in some studies [11]. Microneedling may also help minoxidil work better when the two are used together, although the best approach is still being studied [1].

Another option is PRP, or platelet-rich plasma. This treatment uses platelets from your own blood, which are injected into your scalp. Some women see improvements, but results can vary, and it's not yet clear which treatment approaches work best [11].

These treatments may be worth considering in certain situations, but I'd generally start with more established options. For women with more advanced hair loss, a hair transplant may also be an option. It's not right for everyone, so it's important to have a dermatologist who specializes in hair loss assess whether it's likely to help.

6. Menopausal Hormone Therapy?

   
   

Unfortunately, we don't have enough research to say that menopausal hormone therapy will consistently prevent hair loss or help regrow hair that's already been lost [24]. That's why I don't recommend hormone therapy specifically for hair loss. However, if you're already taking hormone therapy for menopausal symptoms, I do look at the type of progesterone or progestin you're using. Some synthetic progestins can have androgen-like effects, meaning they act somewhat like testosterone, which may contribute to hair thinning in women who are sensitive to these hormones. I want to make it known that micronized progesterone doesn't have those same androgenic effects. 

While hormone therapy may be an important part of treating menopausal symptoms, I wouldn't rely on it as the primary treatment for hair loss.

Hair Loss After Breast Cancer

Hair thinning can also happen in women taking medications such as tamoxifen or aromatase inhibitors for breast cancer. And after everything a woman has already been through with cancer treatment, dealing with hair loss can be especially difficult [22]. 

There are treatment options that don't involve hormones. Topical minoxidil is one of them, and in some cases, low-dose oral minoxidil can also be considered [10]. Spironolactone is another medication that may be an option, and large observational studies haven't found an increased risk of breast cancer with its use. It's always important to coordinate treatment with your oncology team to coordinate treatment [22].

Do Hair Supplements Actually Work?

There are countless supplements marketed for thicker, fuller hair, but evidence for most is limited, particularly when you don’t have a pre-existing nutritional deficiency. 

Biotin is a good example: true biotin deficiency is uncommon, and taking extra biotin hasn't been shown to reliably improve hair growth in women who aren't already deficient. High-dose biotin can also interfere with laboratory tests, including thyroid testing and certain cardiac troponin assays. 

For the same reason, I don't recommend starting iron supplements without testing your levels first. Too much iron can be harmful [27], and excessive amounts of vitamin A or zinc can actually contribute to hair loss. Before spending money on supplements, let's first figure out what your body needs and whether a deficiency is actually contributing to the problem.

Why Early Treatment Matters

With female-pattern hair loss, follicles become progressively smaller over time. The longer this continues, the more difficult it may be to restore hair density. We're generally better at preserving existing hair than bringing back hair after years of progressive thinning. I recommend taking photographs of your part, the top of your scalp, and your hairline in consistent lighting every few months. Gradual changes can be difficult to recognize when you're looking in the mirror.

What I Want Women to Know About Hair Loss

Hair thinning is common during perimenopause and menopause, but we shouldn't automatically assume it's just hormones or aging. Low iron, thyroid problems, stress, medications, and rapid weight loss can all play a role, and sometimes several factors overlap. And now you know this too! 

The key is to understand what's causing the changes so we can find the right approach for you. There are options, and early evaluation may help slow further hair loss and, in some cases, improve hair growth.

Hair Loss Checklist: Bring This to Your Visit

Before your visit: Gather a list of medications and supplements, note any recent illnesses or weight changes, and bring photos of your hair if you have them.

Check any that apply:

• My part is getting wider or my ponytail feels smaller.

• I'm shedding more hair than usual.

• I've experienced significant stress, illness, surgery, or rapid weight loss in the past six months.

• I've recently started or stopped medications, hormones, or a GLP-1.

• I have heavy periods or a history of low iron.

• I've noticed fatigue, feeling cold, constipation, or dry skin.

• I've developed new acne or increased facial hair.

• Hair thinning runs in my family.

• I'm taking biotin or other hair supplements.

  
  

Symptoms that need prompt evaluation:

• Round or patchy areas of hair loss.

• Scalp burning, pain, redness, or significant scaling.

• A receding front hairline or eyebrow loss.

• Rapid hair loss with a deeper voice or sudden increases in coarse facial or body hair.

  
  

Thank you for reading the Midlife Memo. My goal is to help you better understand your body, feel informed about your options, and make confident decisions about your health through every stage of midlife.

If you're concerned about hair thinning and would like help understanding what might be contributing, I'd be happy to work with you to explore the possible causes and discuss a plan tailored to your health and needs. You can book an appointment at Dreavahealth.com 

About Me

I’m passionate about helping women navigate midlife with clarity, confidence and evidence-based information and care. After witnessing firsthand how often women’s symptoms are dismissed and questions go unanswered, I dedicated myself to advancing women’s midlife health. I continue to care for patients through my practice: Dreava Health, where I focus on women’s midlife and menopause care.

My clinical perspective is shaped by 23 years as a family nurse practitioner and adult-gerontology acute care nurse practitioner caring for cardio-thoracic surgery patients through acute recovery. Those years taught me to look beyond a single symptom or diagnosis and treat the whole person. The heart, blood vessels, blood sugar, bones, brain, and hormones are all connected. With an undergraduate minor in nutrition, I’ve long believed that nutrition, lifestyle, and prevention are foundational to long-term health. I’m a Menopause Society Certified Practitioner (MSCP), reflecting my specialized training and commitment to evidence-based menopause care.

Today, I write about and care for women across the hormonal lifespan, from the first menstrual period to the last. Every stage deserves to be taken seriously, explained clearly, and supported by real evidence. Through my clinical practice and educational work, my goal is to help women understand their changing bodies, ask informed questions, and advocate for their health.

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