Multiple factors can cause female hair thinning

Q: I need advice for thinning hair. I am perimenopausal, but I don't want to accept losing my hair. What can I do?

A: Perimenopause refers to the transitional period when a woman stops having periods and is no longer able to get pregnant.

Women in menopause produce less estrogen and progesterone, and as a result some experience weight gain, hot flashes, hair growth on the face, hair loss on the head, irritability and changes in libido.

Hair loss in women can stem from aging. But it can also be hereditary. It can be related to diet, stress, styling methods, hormones, vitamin deficiencies, thyroid problems, systemic diseases such as lupus and diabetes and certain medications, among other things.

Dr. Meredith M. Berger, an endocrinologist with Virginia Diabetes & Endocrinology, which has offices in Midlothian and Henrico County, explained how she sometimes approaches female patients who complain of thinning hair.

"Sometimes you can't fix the hair loss of menopause, but you can look at other factors that also cause hair loss," Berger said.

"It depends on where the woman is in menopause," Berger said. For instance, some perimenopausal women may have very heavy periods just before periods stop altogether. That heavy bleeding can lead to iron deficiency, which is linked to hair loss.

"I check other hormones, like testosterone, that can be high," Berger said. In those cases, the medication spironaloctone, which helps block testosterone at the hair follicle site, sometimes helps, Berger said.

"I look to see if somebody is pre-diabetic. That can also cause them to have male-pattern balding," Berger said. "So we … deal with diet, exercise and medications that affect and prevent diabetes."

Basic lab work, including a complete blood count and liver test, are usually part of the medical evaluation.

"Those are the main issues," Berger said. "Where they are in their menopause, what other medications they are taking, and if there are other things that we can also fix or improve on to help reduce hair loss."

Women's Rogaine, which contains minoxidil, is the only drug approved by the U.S. Food and Drug Administration to treat hereditary female baldness. It is applied to the scalp and has to be used daily to obtain and maintain results.

Other drugs are used off label to treat female hair loss.

Endocrinologists, such as Berger, and dermatologists are among the doctors with expertise in treating female hair loss.