Midlife hair crisis – Perimenopause and hair loss
Among the various symptoms experienced during the menopausal years, one of the most distressing is hair loss in perimenopause and post menopause. Some women notice a gradual hair loss, particularly more hair falling out than usual, and others may notice thinning hair, particularly a widening part and a visible scalp. Hair loss and thinning hair can cause significant emotional and psychological stress for women affecting their self esteem and confidence.
The most common type of hair loss in menopause in Female Pattern Hair Loss (FPHL) or Androgenic Alopecia. Around 20-60% of women will experience hair loss before the age of 60 years, with the main cause being the change in hormone levels. There are other factors that can contribute to hair loss such as ageing, medications, some diseases, environmental factors and genetics. Medical conditions include chronic iron deficiency and thyroid disorders among others, so it is important to have any significant hair loss investigated by your doctor to rule out any underlying medical conditions that may be causing your hair loss.
Understanding hair loss in menopause
It is normal to lose some hair every day, between 70-100 hairs will not cause a problem, however, it can become problematic when more than 100 hairs per day are lost over a period of time. In perimenopause, women may notice more hair falling out due to fluctuating hormones, notably, lowered oestrogen levels with an increase in androgens. When women have higher levels of androgens, they will experience hair loss.
Let’s look into this a little further…….
FPHL is otherwise known as Androgenic Alopecia because of the role that increased androgen plays in hair loss. Androgens are hormones that are produced in the ovaries, adrenal glands, fat and skin cells. They are often thought of as male hormones, but females produce small amounts. The main androgens are testosterone, androstenedione, DHT, DHEA and DHEA-S. In females, androgens such as testosterone convert to oestrogen. As oestrogen levels drop during menopause, testosterone levels remain unchanged, resulting in a natural increase in testosterone, or collectively, an increase in androgens. It is this natural increase in androgens that lead to hair loss in perimenopause. If you are interested in the science behind androgens and women’s health, this article here talks about the effects of low and high androgen levels.
Androgens are important in the regulation of the hair growth cycle. There are 3 stages in the lifecycle of a hair:
- Anagen phase – hair grows continiously lasting between 3-6 years
- Catagen phase – completion of the anagen (growth) phase, cutting the hair from it’s blood supply, lasts about 2-3 weeks
- Telogen phase – hairs don’t grow or fall out, 15-20% of scalp hairs are in the telegenic phase, lasting up to 3 months. The hair then falls out allowing for new growth and the cycle begins again
FPHL involves a shorter anlagen (growth) phase and a decline in scalp hair, from thick, pigmented hair, into short, thin, non-pigmented hair that is barely noticeable, known as vellus hair.
Nutrition and hair loss
Nutrition plays an important role in our overall health, and often nutritional deficiencies can cause hair loss in menopause, impacting on hair structure and growth. Let’s look at the top 5 nutritional deficiencies.
1. Iron
Iron is the world’s most common deficiency across the lifespan, and a well known cause of hair loss. When in perimenopause, erratic, longer and heavier periods can lead to increased iron losses, and in post menopause, iron loss may occur via intestinal losses. Those that follow vegan or vegetarian diets are at increased risk of iron deficiency due to non-haem iron (plant foods) having a lower bioavailability than haem iron (animal foods). Malabsorption disorders such as celiac disease and those that cause the acidity of the stomach to become more alkaline, can also affect iron absorption, as iron requires an acidic environment to be absorbed. Medications that decrease stomach pH can also contribute to this. Making sure that you are eating enough iron rich foods in your diet will help combat against deficiency.
Good sources of iron include:
Haem iron: red meat – beef, pork, poultry, liver, fish
Non-haem iron: soya, pinto beans and other legumes, peanut butter, sunflower seeds, nuts, dried fruit, broccoli and parsley leaves. Absorption is enhanced when combined with foods high in Vitamin C, such as citrus.
2. Zinc
Zinc is involved in the hair cycle by influencing hair follicles and growth. When zinc deficiency is present, it can make hair brittle, slow growth and increase loss. Similar to iron deficiency, zinc deficiency will occur if malabsorption diseases are present such as inflammatory bowel disease or following gastric bypass surgery. Vegan and vegetarian diets also will contribute to deficiency due to the lower bioavailability from plant foods. Vegetarians also tend to eat more legumes and wholegrains which contain phytates that bind to zinc and inhibit absorption.
Zinc is highest in protein rich foods such as meats, poultry, milk, cheese, shellfish (especially oysters) and in legumes, nuts and wholegrain.
3. Healthy Fats
Healthy fats are involved in making hormones from cholesterol and prevent hair fall by producing a protective coat and hydrating the hair. When fat consumption in the diet is decreased, especially that of polyunsaturated fats – omega-3 and omega-6, deficiency can lead to hair loss and dry hair, as well as loss of eyebrows.
Good dietary sources of omega-3 fats include oily fish, flaxseeds, and flaxseed oil, walnuts and wheat sprouts.
Good dietary sources of omega-6 fats included safflower oil, walnut oil and sunflower oil. Although these plant oils are necessary for healthy hair, too much can lead to inflammation and lead to hair loss.
4. Protein and Amino Acids
Protein malnutrition causes fragile hair, brittleness and hair loss. Although protein malnutrition is rare, certain amino acids, which are the building blocks of proteins, are important in maintaining healthy hair and preventing hair loss.
The sulfur containing amino acids – cysteine and methionine are hair building, and cysteine is particularly involved in growth rate and hair thickness. Cysteine is also incorporated in keratin, which is the main component of the hair shaft and gives hair it’s shine and elasticity. Another amino acid, L-Lysine has a significant impact on zinc and iron absorption and dietary deficiency results in brittle, thin and limp hair.
Dietary sources of cysteine and L-lysine include cottage cheese, yoghurt, fish, meat (veal, beef), poultry (chicken, turkey), legumes (soya, lentils, beans, peas), seeds (pumpkin, sunflower, sesame), nuts (pistachio, peanuts), grains (buckwheat, hulled barley, brown rice, rye wholemeal bread) and eggs.
5. Antioxidants
Antioxidants are compounds found in foods that fight free radicals that damage our cells due to oxidation, which is linked to hair loss. There are many substances that can be classified as antioxidants,
including zinc, selenium, vitamins A, C & E, and polyphenols. Polyphenols are compounds found in plant foods such as fruits, vegetables and grains. The most abundant and most studied antioxidants are the flavonoids. They influence the blood vessels and stimulate the skin circulation which in turn nourish the hair.
Flavonoids are found in 70% dark chocolate, onions, tomatoes, broccoli, apples, berries, grapes, citrus fruits, grains, lentils, spices, red wine, green tea and cocoa.
Phytoestrogens such as isoflavones (soy and soy products) and lignans (cereals, flaxseeds and berries) are also flavonoids that will nourish the hair and prevent hair loss, but also act on oestrogen receptors and alleviate menopausal symptoms.
A word about Supplements
When the diet is lacking in certain nutrients, it may be necessary to include supplements in your diet. However, it is always better to first increase dietary nutrition to include the deficient nutrients first, as this also adds all the other great benefits such as fibre and other vitamins and minerals. Supplementation can be expensive and toxicity may occur if they are not really needed. It is always best to check with your doctor first, and have the relevant blood tests to get a baseline on current nutritional status before taking supplements.
If hair loss is a concern for you book a Free 15 minute Discovery Call and we can have a look at your current diet and see if improvements could be made by doing a dietary analysis to improve your condition.
References
1. Australasian Menopause Society, Information sheet, Menopause and Body Changes
http://www.menopause.org.au/images/stories/infosheets/docs/Menopause_and_body_changes.pdf
2. Blume-Peytavi et al. Skin academy: hair, skin, hormones and menopause – current status/knowledge on the management of hair disorders in menopausal women, Eur J Dermotol, May-June 2012;22(3):310-8
https://pubmed.ncbi.nlm.nih.gov/22503791/
3. Chan L, Cook DK, Female Pattern Hair Loss, Aust J of Gen Prac, Volume 47, Issue 7, July 2018.
4. Goluch-Koniuszy ZS, Nutrition of women with hair loss problem during the period of menopause, Menopause Rev, 2016; 15(1): 56-61.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4828511/
5. Guo EL, Katta R, Diet and hair loss: effects of nutrient deficiency and supplement use, Dermatol Pract Concept, 2017, Jan;7(1):1-10
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5315033/
6. Harvard Health Publishing, Harvard Medical School, Treating female pattern hair loss, Published April 2010, Updated August 31 2020.
https://www.health.harvard.edu/staying-healthy/treating-female-pattern-hair-loss
7. Pierard-Franchimont C, Pierard GE, Alterations in Hair Follicle Dynamics in Women, Biomed Res Int, 2013, Article ID-957432.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3884776/pdf/BMRI2013-957432.pdf
