Hair Loss at Midlife: Why It Happens — And What You Can Do About It

Hair loss is one of the most common concerns I hear from women in my menopause clinic. Somewhere around 30% of my patients mention it — often quietly, often frustrated, and often feeling like nothing can help.

Here’s the good news:→ Hair loss at midlife is incredibly common.→ There are things you can do.→ Hope is not lost.

Why Am I Losing Hair?

Hair thinning in midlife can happen for many reasons — often a combination of factors:

Common Causes:

• Genetics (family history of thinning hair)

• Hormone changes (declining estrogen and progesterone)

• Hair care habits (frequent heat styling, tight ponytails, extensions)

• Nutrient deficiencies (low iron, vitamin D, thiamine- as your doctor to check your levels)

• Medications (some blood pressure meds, antidepressants)

• Illness or stress

  
  

Stress-Induced Hair Loss (Telogen Effluvium)

This is a temporary type of hair loss that happens after physical or emotional stress — including illness, surgery, major life changes, or weight loss.

The good news: This type of hair loss usually improves on its own within 3-6 months as hair cycles reset.

What Labs Are Worth Checking?

Healthy hair needs the right building blocks — and two of the most important are iron and vitamin D.

Hair loves iron and vitamin D.If these levels are low, hair growth can slow or shedding can increase.

Labs I may check:

• Vitamin D

• Ferritin (iron stores — I like this above 50-70 for optimal hair support)

• Thiamine (Vitamin B1)

• Sometimes Vitamin B6

Correcting deficiencies won’t fix all types of hair loss — but it creates the best foundation for healthy hair growth.

What Treatments Can Help?

Supplements

Products like Nutrafol, Viviscal, and Wellbell have small studies showing some benefit for certain women — especially for stress-related or hormone-related hair loss.

They often contain:

• Saw Palmetto (may block androgens)

• Ashwagandha (stress support)

• Collagen (benefits skin more than hair)

• Vitamins C, E, Zinc, and other minerals

Reality check: These are not FDA-approved and can be expensive. Always review supplements with your physician to avoid interactions.

Red Light Therapy

This is one of my favorite treatment options because it’s safe and easy to use at home.

Low-level laser therapy (light in the 620-678 nm range) improves blood flow to hair follicles and can improve hair density by 10-25% over time.

Devices include:

• Hairmax

• iRestore

• Omnilux FaceMax

Important: Red light therapy works best when applied directly to the scalp — not at a distance from the head. Use 3-4 times per week for 20-30 minutes.

(If it were me — I’d absolutely use a red light face mask regularly. It helps with skin and hair. Now I just need to get one.)

Topical Minoxidil (Rogaine)

Still the gold standard for hair loss treatment.

• Women should use the 5% strength for best results (not the 2%).

• Foam is gentler on sensitive skin.

• Apply twice daily for at least 6 months before judging results.

• It is fairly cheap from Amazon and Costco.

  
  

My Favorite Topical Treatment for Post-Menopausal Hair Loss

For post-menopausal women dealing with hair thinning, the most effective topical option is a compounded prescription combining:

• Minoxidil 7-10%

• Finasteride (blocks androgens at the scalp level)

• Sometimes other products may be added such as progesterone or tretinoin

This combination seems to work better than minoxidil alone — especially for women with androgen-sensitive hair loss.

What about tretinoin? Some compounded formulas include tretinoin to help with absorption, but I don’t really think it’s necessary — and in fact, it may be drying for some scalps although my favorite compounding pharmacist likes to include it.

Nizoral Shampoo 2% — A Helpful Add-On

If you have an oily scalp or struggle with excess buildup (sometimes called seborrhea), I recommend considering adding Nizoral 2% shampoo once weekly.

• It has anti-androgen effects right at the scalp.

• Helps reduce excess oil, which can allow for a healthier environment for hair growth.

• Available by prescription.

  
  

Oral Minoxidil

This is an emerging favorite among dermatologists for female hair loss — especially when topical products aren’t enough.

It increases blood flow to hair follicles and prolongs the growth phase.

Things to Know:

• Low doses (0.25-2.5mg daily) are used for hair loss.

• The most common side effect is increased fine hair growth ("peach fuzz") on the face, arms, or body.

• Other possible side effects include low blood pressure, leg swelling, faster heart rate, or rare fluid buildup around the heart (black box warning).

Tip: Once you see improvement on oral minoxidil, the dose can often be lowered for long-term maintenance.

What About Hair Volume Shampoos?

Hair-thickening or “volume-boosting” shampoos can temporarily improve the appearance of fuller hair — mostly by adding texture and reducing oil or residue on the scalp.

Some shampoos also include botanical ingredients like ashwagandha, which may help support hair health by reducing stress on the scalp or blocking androgens locally.

Are they a cure? No — but they can absolutely be part of a well-rounded plan for healthier-looking hair.

Tip: Look for shampoos that include ashwagandha or other scalp-supporting ingredients as an added bonus.

What About Rosemary Oil?

Rosemary oil has gained popularity online as a natural hair growth remedy.

The theory is that it may reduce free radicals on the scalp and improve circulation — but there’s no good evidence that it actually promotes hair growth.

That said — it’s generally safe to try as long as you don’t have a skin reaction or sensitivity.

If you like it and want to massage it into your scalp — go for it.

Just know it likely won’t make a dramatic difference on its own, but it isn’t harmful for most people.

Other Options You May Hear About:

Treatment	What to Know
Platelet-Rich Plasma (PRP)	Injections from your own plasma — mixed results but may help in early hair loss.
Spironolactone	Blocks androgens but can lower libido and raise potassium. Not for women who could become pregnant.
Finasteride	Oral androgen blocker — modest benefit for some women but less effective than dutasteride. Not for women who could become pregnant.
Dutasteride	Stronger than finasteride — more likely to improve hair loss, especially in frontal or temporal areas. Can lower libido. Not for women who could become pregnant.
Exosomes	New, experimental option — very limited data so far.

Can Hormone Therapy (HRT) Help With Hair Loss?

Some dermatologists and menopause experts believe estrogen therapy can improve hair growth — similar to how hair often thickens during pregnancy.

There aren’t large studies to prove this — but many women notice their hair improves when supplementing hormones.

A Word About Testosterone

If you're using testosterone therapy, it's important to know that in some women, it may contribute to hair loss — especially if you’re already prone to androgen-sensitive thinning.

If you’re noticing increased shedding after starting testosterone, we may need to reassess your dose or pause treatment to see if it’s contributing.

What Would I Do?

If I were struggling with midlife hair loss, here’s exactly what I would do:

1. Make sure my Vitamin D, ferritin, and thiamine levels were in a healthy range.

2. Use a red light device (like the Omnilux FaceMax) 3-4 times per week, applied right to my scalp.

3. Start a compounded topical minoxidil 7-10% with finasteride.

4. Consider oral minoxidil if needed — with the plan to lower the dose once results happen.

5. Use a hair-thickening shampoo with ashwagandha to support scalp health.

6. Add Nizoral 2% shampoo weekly if scalp is oily.

7. Optimize overall health: hormones, nutrition, stress management.

8. See dermatology for advanced options if needed.

   
   

Final Thoughts

Hair loss at midlife is common — but you have options.

The best results usually come from combining several treatments — and sticking with them consistently for 6 months or more.

If hair changes are bothering you, I’d love to help guide you and create a personalized plan that makes sense for you.