Q: How does perimenopause affect your hair, and how does menopause cause hair loss? Please explain the relationship between perimenopause, menopause, and thinning.

A: Hair loss does not just affect men. Hormonal changes or imbalances that cause excessive hair shedding due to pregnancy and childbirth rear their ugly head in women with perimenopause and menopause. Over half of women aged 50+ begin to experience hair thinning, fallout, and loss as estrogens are depleted when they go through “the change.” During perimenopause or pre-menopause, hormonal fluctuations occur, which are significant factors in hair loss. At this time, the amount of estrogen and progesterone in the blood diminishes while the male hormones (androgens) rise, affecting hair texture and growth. Hair loss that results from these hormonal changes is called androgenic alopecia. Here’s how menopause affects hair loss and why hair thinning happens:

I am often asked, “Does menopause affect hair texture?” Yes, hair becomes coarse, dry, and brittle when estrogen levels decline - usually the first symptom women notice. The next question is, “Can menopause affect hair loss?” Yes! Androgenic alopecia in women occurs as the hormonal imbalance continues; more hair follicles enter the “resting” phase” and shrink while the diameter of the hair strands follows suit. Some women have a sensitivity to testosterone and DHT, which triggers hair thinning and loss. Hair tends to fall out more easily and grow more slowly, reducing hair volume. Female pattern hair loss typically appears as temple hair loss, hair thinning on top of the head, receding hairline, and crown hair loss manifesting as widening of the part and scalp showing through the hair. Menopausal hair loss in women often occurs in those with these key factors of hair loss:

• Stress related hair loss: Stress over the other unsavory symptoms of menopause (hot flashes, moodiness, brain fog, dryness, etc.) exacerbates this hormonal upheaval. Worry over hair growing in places it did not previously, along with seeing your brush and shower fill up with hair, can raise the male hormone levels in your body, creating a vicious cycle.
• Genetic hair loss: Genes strongly indicate how much hair you have and will keep, so if your parents lost their hair, you'll want to start a hair loss prevention routine now to preserve your existing thickness. High testosterone levels due to PCOS or therapeutic medications can also be a cause of androgenic hair loss.

Hair Loss Solutions:
Ask your doctor to run labs for your estrogen, testosterone, and FSH to determine if your levels are low. Hormone Replacement Therapy (HRT) for hot flashes, night sweats, bone loss, and vaginal dryness can benefit hair regrowth but may take up to 12 months to see results. See last month’s newsletter, where we reviewed the pros and cons of other oral medications for hair loss, and the What’s Trending section this month, featuring invasive hair thinning and hair loss solutions. Before starting a new regimen or medication, consult your dermatologist or physician, share all your conditions first, and then weigh and balance what is right for you. If you prefer a more natural approach, the ideal hair loss shampoo for women, hair loss conditioner, and growth serum will help address the root causes of hair loss.

While Ketoconazole shampoo helps reduce DHT levels, it can have side effects, such as dryness, irritation, itching, and more. A better choice is a non-drying Sulfate free shampoo and conditioner for hair loss with Saw Palmetto to help counteract DHT and Pumpkin to support a healthy scalp - vital for new hair growth and thickness. A serum with encapsulated Caffeine and Pea Extract stimulates hair growth, completing your natural remedy for thinning hair. Remember to skip hair ties, headbands, excessive brushing, and pulling, as these cause tension, contributing to hair thinning. (Perhaps years of manipulating strands catch up with women about the same time menopause kicks in, a perfect hair loss storm!) For more holistic solutions, check out my article on avoiding hair loss here.


Q: Why was Accutane® taken off the market? I took it years ago. Am I ok?

A: The question, “Why was Accutane® pulled from market?” is excellent. Accutane® seemed like the holy grail treatment for eradicating severe acne vulgaris, effectively targeting the oil production, bacteria, clogged pores, and inflammation involved with acne cysts and nodules. Lesser Accutane® side effects like temporary sun sensitivity, worsening of acne, dryness, irritation, itching, cracked lips, nosebleeds, dry mouth, and irritated, dry eyes seemed a small price to pay in light of its skin-clearing results. However, the avalanche of lawsuits in the 1980s alleging that its packaging did not adequately warn patients about the possibly dangerous side effects of Accutane® led Roche Pharmaceuticals to halt its production in 2009. While the brand name Accutane® was discontinued, it was not officially recalled, and generic isotretinoin medications, such as Amneseteem, Clarais, and Sotret, are still available. Critics cite scientific studies that link oral Isotretinoin treatment with the development of the following severe side effects:

• Inflammatory Bowel Disease (IBD), Crohn’s disease & Ulcerative Colitis
• Bone degradation
• Heart attacks
• Seizures
• Strokes
• High suicide risk

However, the FDA has not recalled isotretinoin. They did add a black-box warning in 1984, warning of the high risk for congenital disabilities. Pregnancy risk is another well-known side effect that led to the mandate that patients taking this drug get two pregnancy tests before treatment to ensure they were not pregnant, use two forms of birth control, and receive monthly pregnancy tests. This was to prevent complications, including miscarriage, birth defects, and stillbirth. In 2005, the iPledge program was created to educate medical personnel and patients about the risks, with users having to register for this centralized system to ensure patient safety. The AAD (American Academy of Dermatology) indicates that there is not adequate evidence to link Accutane® with patient reports of IBD, depression, suicidal ideation, psychosis, and aggression. They add that having severe acne increases the chances of developing depression and thoughts of suicide, which tend to abate once the acne clears. However, there is a science backed reason why Accutane® causes depression and other abnormal behaviors: The Journal of Experimental Biology and Medicine cited a study that showed that Accutane® increases the action of reuptake transporters which decreases the happiness neurotransmitter (serotonin) levels, leading to symptoms like depression.

Still more concerning is a study reported by the American Journal of Psychiatry that found 21% decreased orbitofrontal cortex activity on average (which governs cognitive processing, decision-making, and personality) in Accutane® patients. The NIH reports that it can affect adrenal hormone levels as well as cause menstrual irregularity in teens. Despite warnings, the other potential adverse effects of allergic reactions, conjunctivitis, dizziness, elevated blood sugar, and cholesterol levels, decreased red and white blood cells, fragile skin with increased scarring risk, hearing problems, joint and muscle pain, liver and other organ damage, poor night vision, rash, skin infections, stomach issues, thinning hair, pressure on the brain leading to headaches and potential blindness, were also hazarded for the sake of clearer skin. Because of the seriousness of these possibilities, close monitoring via regular blood tests is required.

Note: Lower doses may not induce the commonly recognized side effects.

What are the long term effects of Accutane®? While some side effects were deemed bearable to users, people did not gamble on self-reported long-term side effects like persistently dry skin and hair, mental health problems (anxiety and depression), constipation, IBS, dry eyes, visual disturbances, brain fog, fatigue, joint and muscle pain, and sexual dysfunction, which are undoubtedly troubling. However, to date, there does not seem to be enough information to tie the two together. Considering the mental anguish and embarrassment that accompanies acne and the dramatic Accutane® before and after photos, it is understandable why some decide to ignore Accutane® side effects and give it a go. But patients must seriously ask themselves if the side effects outweigh its benefits.