Female pattern hair loss common in postmenopausal women
Click Here to Manage Email Alerts
Female pattern hair loss was common in postmenopausal women and was significantly associated with BMI, researchers found.
They emphasized that awareness of the disorder is needed to enable early detection and appropriate treatment, which can improve women’s quality of life.
“Generally, the postmenopausal period lasts for almost one-third of women’s lives and is associated with heightened emotional distress, low self-esteem and low quality of life,” Sukanya Chaikittisilpa, MD, MSc, associate professor and member of the Menopause Research Group at Chulalongkorn University and King Chulalongkorn Memorial Hospital in Bangkok, Thailand, and colleagues wrote in Menopause. “As hair quality and quantity accentuate a woman’s [aesthetic] look and personality, suffering from hair loss, especially [female pattern hair loss (FPHL)], may worsen this experience.”
Defining FPHL and its emotional effects
Chaikittisilpa and colleagues enrolled 200 postmenopausal women in the cross-sectional study, which was conducted at King Chulalongkorn Memorial Hospital’s menopause clinic from November 2018 to May 2019.
The researchers evaluated 178 patients (average age, 58.8 years ± 4.1; average time since menopause, 9.2 years ± 5.6) for hair loss patterns using Ludwig FPHL classification — which increases with the severity of hair loss from grade I to grade III — and measured scalp sebum and hair density and diameter. They also assessed BMI and levels of hemoglobin, thyroid stimulating hormone and sex steroid hormone.
Participants self-reported baseline menopausal characteristics, medical history, family history of hair loss, feeling of hair loss and self-esteem through questionnaires.
Prevalence of FPHL
FPHL occurred in 52.2% (95% CI, 44.6-59.8) of participants, and its prevalence increased with age and years since menopause. Among those with FPHL, 73.2% had Ludwig grade I (95% CI, 62.9-81.8), 22.6% had Ludwig grade II (95% CI, 14.6-32.4) and 4.3% had Ludwig grade III (95% CI, 1.2-10.7).
“The postmenopausal women with FPHL in our cohort had lower total hair density, terminal hair density, hair thickness, hair unit density and average hair per unit than those with normal hair patterns,” Chaikittisilpa and colleagues wrote. “Only vellus hair density was higher in post-menopausal women with FPHL in our cohort. We ascribed our findings to the pathophysiological changes in FPHL that involve progressive miniaturization of hair follicles and subsequent conversion of terminal follicles into vellus-like follicles.”
Age 56 years or older (OR = 3.41; 95% CI, 1.67-6.97), being more than 6 years removed from menopause (OR = 1.98; 95% CI, 1.03-3.83) and having overweight or obesity (OR = 2.28; 95% CI, 1.11-4.66) were significantly associated with FPHL in a simple logistic regression analysis. Adjusting for age and family history of FPHL revealed that only BMI of 25 kg/m2 or greater was significantly associated with FPHL (adjusted OR = 2.65; 95% CI, 1.23-5.7).
Low self-esteem was reported by 60% of participants and increased with FPHL. All women with Ludwig grade III hair loss reported low self-esteem.
To the researchers’ knowledge, this was the first FPHL study focused on healthy postmenopausal women. However, the study was limited by convenience sampling, exclusion of women who underwent hair loss treatment, recall bias, low sensitivity of steroid hormone tests and low testosterone levels in participants.
“Further studies are necessary to determine whether sex steroid hormones, especially estrogen and testosterone, and history of PCOS are related to hair loss in postmenopausal women,” Chaikittisilpa and colleagues wrote. “This may help gynecologists select appropriate menopausal hormone therapy regimens for postmenopausal women with FPHL.”
Perspective
Back to Top
Female pattern hair loss can be incredibly distressing for women and is, unfortunately, quite common. This small cross-sectional study conducted in women seen at a menopause clinic in Thailand found that FPHL was prevalent, occurring in 52% of the women. The etiology of FPHL, also known as androgenetic alopecia, has yet to be fully elucidated, but it may be inherited (involving several different genes) and, as the name suggests, likely relates to the action of androgens. Women may develop this type of hair loss at any time in their reproductive years, but it is much more common around menopause, suggesting that estrogen supports hair growth. However, high-quality data confirming an association between menopause and hair loss are not available. We know that age and a family history of hair loss (on either side) are also risk factors. Unfortunately, research on the role of menopausal hormone therapy and estrogens specifically in mitigating hair loss after menopause is lacking.
In my menopause practice, hair loss is a common complaint and often one of the biggest concerns women have. There are no proven self-care strategies, vitamins, herbs or nutraceuticals for FPHL, despite the plethora of products touting efficacy for the same. Topical minoxidil (Rogaine and generic versions) is available over the counter as a 5% foam applied to the scalp twice daily, and while not a miracle cure or a quick fix, it can stimulate hair growth in some women. Sadly, there is a “pink tax” associated with this product, which is frequently several times more expensive for the “female” than for the “male” versions (note the only difference is the product packaging). Clearly, greater awareness about this issue is needed in addition to more robust clinical data on the association of female pattern hair loss with menopause and the impact of hormonal (and nonhormonal) treatments.
Collapse
Read more about
Click Here to Manage Email Alerts