When your brush quickly becomes clogged with hair or you start finding increasing numbers of stray strands on your clothes, it’s enough to make any woman feel uneasy—especially if you’re also getting older. But in most cases, it’s an ordinary part of aging. Research has found that more than 50% of women over age 50 experience female pattern hair loss (on the crown of the head), which is the most common form of hair loss in women.
The simple truth is: Time isn’t on your side when it comes to holding onto the hair on your head. “You probably have the thickest and most luxurious head of hair between the ages of 15 and 30,” says Dr. Mary Lupo, a dermatologist based in New Orleans. “After that, there’s a gradual decline, followed by precipitous changes after menopause. Estrogen is very good for the hair. After menopause, women lose estrogen and hair.”
It’s normal to lose 50 to 150 hairs per day. That may seem like a lot, but most people have about 100,000 hairs on their heads at any given time. A strand of human hair has its own life cycle with four phases: anagen (the growth phase), which lasts several years; the transitional “catagen” period, which lasts a few weeks; telogen (the resting phase), which lasts three to four months; and exogen (shedding). At that point, the follicle from which a hair sprouted begins to grow a new one. Fortunately, different hairs are in different phases of the growth cycle at any given time, which is why you don’t go bald every few years.
The trouble is: “Once you decide you have hair loss, all you see is hair falling out,” says Dr. Doris Day, a clinical associate professor of dermatology at NYU Langone Health and author of Beyond Beautiful: Using the Power of Your Mind and Aesthetic Breakthroughs to Look Naturally Young and Radiant.
But there are objective signs that the loss may be excessive. If you suddenly notice a widening of your part, or you can see your scalp through your hair in the front, these are signs that you may be losing too much. Other women notice their ponytails are thinner than they used to be, or they discover clumps of hair in the shower drain or on their pillows.
The roots of the problem
Genetic factors often contribute to hair loss in women, and they can be passed down from either side of the family. In addition, emotional stress (like the kind caused by the death of a loved one or a challenging relocation) or physiological strain (such as major surgery, rapid weight loss, or a bad case of COVID-19) can lead to significant hair loss. It may not happen right away. “There’s a lag with stress—when stress happens, you don’t see the change in hair loss for three to four months because of the natural hair cycle,” Day says.
What’s more, the presence of certain medical conditions (such as thyroid disorders, anemia, or polycystic ovary syndrome, known as PCOS for short) or the use of some medications (including certain antidepressants and hypertension drugs) can contribute to excessive hair loss in women. And nutrient deficiencies—particularly in vitamin D, iron, and protein—can play a role in hair loss.
Read More: Multivitamins Are Linked to Slower Brain Aging
Sometimes, intense hair-styling practices can cause strands to fall out before they’re ready to be shed naturally. “About 40% of women lose extra hair every day due to the way they style their hair—[with] tight buns, high pulled-back ponytails, and hair extensions,” says Dr. Elizabeth Bahar Houshmand, a dermatologist based in Dallas.
On top of all this are the effects of getting older. As the decades pass, women often lose more strands and hair growth slows down. Plus, the texture and fiber density of hair changes so that “the new strands are thinner than when you were younger,” Day says. Research has found that the hair shaft diameter increases among women until age 45 and decreases after that; this change, combined with a sparser density in hair, can make hair thinning increasingly visible as women get older.
“It’s important to understand that hair loss and shedding can be multifactorial—you can have multiple causes,” Houshmand says.
Hair loss solutions
If noticeable hair loss is upsetting you, schedule a visit to a dermatologist, who can examine your scalp and order blood work to check for possible underlying causes for the hair loss, Houshmand says.
If a medical condition is to blame, addressing it directly, perhaps with medication, may help restore growth. For example, if an excess of male hormones (androgens such as testosterone) is responsible for the hair loss, as it is with PCOS, a diuretic called spironolactone, which has anti-androgen effects, can be used in an off-label capacity to increase hair growth in women, says Dr. Valerie D. Callender, founder and medical director of the Callender Dermatology & Cosmetic Center in Glenn Dale, Maryland, and a professor of dermatology at Howard University.
If a nutrient deficiency—involving iron, vitamin D, or protein—is at the root of hair loss, taking specific supplements may remedy the situation. “If you have low levels and you get them back to normal, you’ll get a greater volume of hair, and you won’t shed as much,” Lupo says.
You’ve probably seen or heard commercials for a hair-growth-promoting nutritional supplement called Nutrafol—a blend of vitamins, minerals, and botanical ingredients—and one study funded by the company found that taking it regularly enhances hair growth and decreases shedding in perimenopausal, menopausal, and postmenopausal women with thinning hair. Research has found similar benefits with regular use of another supplement called Viviscal.
Read More: Is It Really That Bad to Pop a Pimple?
If scalp conditions such as seborrheic dermatitis—which can involve dandruff, scaling, or inflammation of the hair follicles—are the source of the problem, treating them with a shampoo that contains zinc pyrithione (like Head and Shoulders) or ketoconazole (such as Nizoral) may help with hair loss. “Lather the scalp more than the hair, and give yourself a vigorous scalp massage to increase blood circulation to the area,” Lupo advises. “Let the shampoo sit for a couple of minutes before rinsing.”
For female pattern hair loss, minoxidil, a 5% over-the-counter foam preparation that’s applied directly to the scalp once a day, can be helpful with continuous use, says Callender. “If you stop using it, the benefits stop within three months, and you’ll go back to baseline.”
If you’re prone to hair loss, you may need to modify the way you take care of your hair. Avoid pulling on your hair with tight buns or ponytails or over-processing your hair (with coloring, straightening, or other treatments). It also means treating your tresses with TLC, including using a leave-in conditioner to moisturize hair and a satin pillowcase to prevent stress to hair while you sleep, Callender says.
None of these are quick fixes. “With any hair-loss remedy, it will take a minimum of six months before you see a positive effect,” says Lupo. And most women use more than one approach to manage hair loss, experts say.
If these approaches don’t sufficiently address hair loss, dermatologists have stronger weapons in their arsenals. These include laser and light therapy treatments, PRP (platelet-rich plasma) injections to the scalp, and hair transplantation procedures. “There are a lot of treatments,” says Callender, “and more are coming out.”
