Menopause may contribute to several distinct forms of hair loss.
Dr. Paradi Mirmirani is the regional director of hair disorders at Kaiser Permanente. She presented 'Midlife hair loss: What every menopause clinician needs to know' at The Menopause Society 2026 Annual Meeting, held October 20 to 24, 2026, in San Diego, California. Her talk was part of the plenary symposium, ‘Midlife dermatology: evidence-based care for skin and hair changes in menopause.' She described how menopause may affect hair and outlined her treatment approach.
She opened with three patients: a 48-year-old woman with female pattern hair loss, a 39-year-old woman with telogen effluvium, and a 52-year-old woman with scarring alopecia. She asked whether menopause could be exacerbating, perpetuating, or triggering these conditions. 'My answer is yes,' she said.
She linked each case to a form of follicular dysfunction: miniaturization in pattern hair loss, hair cycle disruption in telogen effluvium, and loss of immune privilege in scarring alopecia. She stressed looking at the hair shaft as well as the follicle. Hair fibers vary widely in color, curl, texture, shine, and strength, which shapes how hair loss is perceived. In data she presented, hair diameter and density declined with menopause.
Androgen excess is one influence. 'But I think we've neglected for far too long the potential effects of that loss of estrogen,' she said. She compared optimal follicular function to an orchestra playing a symphony. 'When menopause happens, it's like the first violinist just got up and left. You're still making music, but it's not the same.'
What a holistic, three-pillar approach to menopausal hair loss includes
'There's no good evidence supporting the use of estrogen or menopausal hormone therapy for treatment of hair loss,' Dr. Mirmirani said, suggesting, however, that the right estrogen regimen may not yet have been found.
Her holistic approach rests on three pillars: supporting hair growth, reducing inflammation, and a healthy lifestyle. Minoxidil and antiandrogens are her 'workhorses.' She often uses off-label low-dose oral minoxidil, which may improve adherence, and counsels about leg swelling, palpitations, and lightheadedness. Adding an antiandrogen can offset facial hair growth from minoxidil.
Among the patients Dr. Mirmirani introduced at the beginning of the talk, the first patient pattern hair loss received minoxidil and finasteride, with platelet-rich plasma and lifestyle changes added later. Her photos at 6 and 12 months showed visible improvement. For telogen effluvium, she looked for recent triggers and hormonal fluctuations. In scarring alopecia, she suggested sudden or patchy hair loss, eyebrow loss, and scalp inflammation were red flags for dermatology referral, since early treatment may prevent permanent hair loss.
'Menopause is a particularly vulnerable time for the hair follicle because of that androgen excess and because of the loss of the estrogen protective effect,' Dr. Mirmirani concluded. 'No matter how it manifests, if you take a holistic approach to that patient, if you look at the three pillars of treatment, you can help that patient.'