A Trichologist's Guide to Perimenopause & Hair Loss
Perimenopause can begin in your late 30s, and for many women, hair changes are among the first visible signs. In a recent conversation with celebrity stylist, and international colour educator Monique McMahon (@moniquemcmahoncolour), Apotecari founder, trichologist, naturopath and nutritionist, Simone Abaron explores the internal biology and external reality of perimenopausal hair loss. What genuinely helps, and why blood tests and reviewing those results with your GP can be a good place to start.
What you may be noticing
More hair collecting in the drain. More hair on your brush or the bathroom floor. Hair that feels finer, weaker, or less full. A part line that looks wider than it did a couple of years ago. You may have mentioned these signs to a GP, your hairdresser or a close friend. Perhaps they gently suggested stress, or low iron, or something that simply happens with age as the cause. While those answers may be on the right track, they offer an incomplete picture.
For many women, these subtle hair and scalp changes begin well before menopause is on their radar, sometimes in your late 30s or early 40s. The cause is often not incidental, but hormonal, structural, and worth exploring further.
The ‘Peri’ conversation opens up
The conversation around hair loss in women is not new, but the openness around it is. More women are recognising what is happening to them, and the wider cultural conversation around perimenopause is finally starting to catch up. For a long time, both have been treated as things to be quietly managed rather than openly discussed.
As Simone says, “I also love that we’re having so many more conversations about perimenopause and menopause than we ever did before. For such a long time, it’s been so taboo.”
But the cultural shift is still running ahead of the research. Perimenopause is a transitional stage: variable in duration, difficult to define with a single clinical marker, and different for every woman who moves through it. That variability has made it harder to study with the same precision as postmenopause, where the hormonal picture is more settled. As a result, most of the clinical data on female pattern hair loss has come from a postmenopausal population, while the perimenopause-specific evidence base is still developing.
This is not a reason to wait, it just highlights a need to understand the biology as clearly as current research allows, and to build a response before the transition is complete. The medical and research communities are catching up, but in the meantime, the conversation being open at all is meaningful progress.
What is perimenopause (and when it starts)
Perimenopause is the hormonal transition leading to menopause. It is not a singular event, it is a phase that can span anywhere from two to ten years1. During this time oestrogen and progesterone levels tend to fluctuate and gradually decline. Menopause itself is defined as the point twelve months after the final menstrual period. This distinction is important because most women associate menopause with their late 40s or early 50s. The perimenopause transition can begin considerably earlier, with some women noticing symptoms in their mid-to-late 30s.
Hair is one of the most sensitive and visible indicators of that hormonal shift. Research estimates that up to 80% of women experience hair loss by age 602. In fact, the majority of consultations for hair loss in women occurred between the ages of 30 and 593.
The key hormones in play are oestrogen, progesterone, and androgens (commonly referred to as "male hormones"). As oestrogen and progesterone decline, the relative influence of androgens, including dihydrotestosterone (DHT), increases. It is these hormonal shifts that have direct consequences for the hair follicle1.
What is happening at the follicle level?
Understanding the mechanisms involved, including hormonal and structural shifts, changes how you approach the problem.
The hair growth cycle
Hair grows in cycles. The anagen phase is the active growth phase, during which the follicle produces a strand. This phase lasts anywhere from two to seven years, depending on genetics. It is followed by the catagen phase (a brief transition) and then the telogen phase, when the hair rests before shedding (exogen phase).
Female hormones, oestrogens, “have long been known to have a significant impact on hair follicle changes affecting the growth of hair follicles through binding to high-affinity, locally produced oestrogen receptors”4. The observance of higher frequencies of female pattern hair loss in women who are postmenopausal “indicates that oestrogens play a role in the stimulation of hair growth”4.
Androgenic sensitivity
As oestrogen falls, androgens become proportionally more influential. In women with a genetic predisposition to androgenic alopecia, DHT binds to receptors in the follicle and triggers a process called miniaturisation1. Over successive growth cycles, the follicle produces progressively finer, shorter strands. The follicle remains, but it has shrunk. This is why perimenopausal hair loss tends to present as diffuse thinning across the crown and part line rather than patchy loss.
The scalp environment
Oestrogen also influences sebum production and the skin's barrier function. As levels decline, the scalp’s capacity to maintain hydration and barrier integrity reduces1. Some women notice their scalp becoming drier, sensitive or reactive for the first time during perimenopause. An impaired scalp environment directly affects the health of the follicles within it.
From the salon: In conversation with Monique McMahon
In their chat, Simone and Monique unpack what perimenopause does to hair from two different but complementary perspectives.
Monique has worked in the industry for decades. She sees clients in her chair every six to eight weeks, year after year, and often notices changes in their hair before anyone has attributed or named them. "Hair fall and hair loss is really quite a big topic right now" Monique says.
From the salon floor, the picture is rarely straightforward. Clients "bring in" stress, life transitions, hormonal shifts, and nutritional gaps. All of it shows up in the hair. "It’s still a very sensitive topic. Even though I may be doing a client for 20 years….her hair’s starting to thin, her hairline’s receding backwards. These are really emotional moments for a woman to go through."
She is deliberate with how she handles it. "I never like to say straight away, '...are you going through perimenopause?' because that freaks people out. It’s such an unusual topic that no one wants to talk about."
Simone agrees on the sensitivity required, and on why the stylist-client relationship can be so deeply connected. "You probably know more than her closest friend knows about what is happening in her life and how she’s feeling about things… As a hairstylist, you are in a very privileged position to be having those conversations."
The advice Monique reaches for first, even before the conversation turns clinical, is the same starting point Simone recommends professionally. "Have you had your bloods done? Have you checked what is going on inside first?"
Why this often goes unrecognised
Hair changes during perimenopause are routinely attributed to stress, poor nutrition, thyroid dysfunction, or the catch-all of "hormonal changes". These factors may play a role, but they are only a part of a much bigger shift taking place.
The hormonal mechanism at a follicle level is not really discussed in standard medical consultations, and scalp health is rarely addressed at all. Because the symptoms overlap with other causes of hair loss, women frequently spend months ruling out deficiencies and managing stress before the perimenopausal component is considered.
What can help
Both Simone and Monique agree on the approach: Start internally, then address the external signs. As Monique says: "If I am trying to achieve hair growth, I am going to hit that from every angle."
Investigate first
Before adding anything to your routine, understand what is driving the hair loss. Blood tests are the starting point: iron and ferritin levels, thyroid function, vitamin D status, and a hormonal panel where relevant.
Nutrition
Hair is made primarily of keratin, a structural protein, so inadequate protein intake can affect strand strength at the most basic level. Beyond that, iron-rich foods, omega-3 fatty acids, zinc, B vitamins and vitamin D all support follicle function from within. "Protein, iron, omegas," says Simone. Monique adds: "I need so many more omegas because that’s going to give me moisture in my skin, and in my hair."
Medical options
HRT and bioidentical hormones are both valid pathways depending on your approach. "Every treatment type has its pros and cons, and that decision is a very personal one," says Simone. Your GP is the right starting point for this conversation.
Scalp health
The scalp is the environment in which follicles operate. Scalp care should prioritise gentle cleansing, barrier support, and active hydration. Crowning Glory® addresses the dryness and barrier disruption that hormonal changes bring, creating the foundation that follicle activation depends on.
Targeted follicle support
"Amino acids, at their core, they're the building blocks of peptides, they're the building blocks of proteins." Simone explains. "The structure of hair is essentially protein." Mane Event Elixir® uses liposomal delivery to take a bioactive peptide and botanical complex directly to the follicle, reducing shedding within 30 days while extending the active growth phase. For internal support alongside a topical regimen, Mane Event® capsules target growth, thickness, and condition from within, addressing the same follicle-level concerns through a nutritional pathway. Hair Atelier® complements both, providing the collagen support, keratin precursors, and bioactive micronutrients the follicle needs from within.
References
1 Zouboulis CC et al Skin, hair and beyond: the impact of menopause. Climacteric. 2022. 25. 1-9.
2 Rose PT. Combination Approaches for Combatting Hair Loss. Dermatol Clin. 2021 Jul;39(3):479-485.
3 Gupta, AK et al Menopause and hair loss in women: Exploring the hormonal transition, Maturitas, Volume 198, 2025.
4 Hasan R et al Effects of Hormones and Endocrine Disorders on Hair Growth. Cureus. 2022 Dec 20;14(12).