Menopause hair · Evidence led

Menopause hair loss treatments: an evidence guide

What exists, what the research shows and the questions to ask. Information to help you talk to your pharmacist, GP or specialist, not a recommendation.

In seven years beside a specialist, I saw women who had spent a small fortune on serums, supplements and gadgets before anyone had looked at their scalp. I also saw women who were frightened to try anything at all. Both deserved better information.

This page is an overview of the treatments that exist for menopausal hair thinning and what the research shows about each one. It is information, not a recommendation. Prescription decisions belong with a qualified prescriber who knows your history. For the bigger picture, start with our menopause hair loss guide.

Start with the cause

Shedding after illness or stress often settles once the trigger passes.^[6] Breakage often improves with gentler care. Female pattern hair loss tends to be long term. Scarring conditions need urgent specialist care.^[7][8] These are very different problems, which is why the first step is a proper look at your scalp from a qualified hair expert or your GP. Read shedding, thinning or breakage to understand the patterns.

At a glance

Topical minoxidil

What it is: a lotion or foam applied to the scalp in 2% or 5% strengths. In the UK, licensing is product specific. A women's once daily 5% foam is licensed for female pattern hair loss in women aged 18 to 65.^[1][9]

What the research shows: a Cochrane review of 47 trials found minoxidil more effective than placebo. About twice as many women reported at least moderate regrowth. Evidence quality was mostly moderate to low and there was no clear pooled difference between 2% and 5%.^[3] A 48 week trial in 381 women found both strengths helped, with 5% causing more itch and facial hair.^[4]

Good to know: it takes months, does not work for everyone and any benefit lasts only while you keep using it.^[1] A temporary shed in the first weeks can happen. For the UK women's 5% foam, the product information advises stopping if there is no improvement after 24 weeks.^[9] It is not suitable in pregnancy or breastfeeding, on a sore scalp or for unexplained, sudden or patchy loss. The UK women's foam is not for people with high blood pressure.^[9] Minoxidil can poison cats and dogs, so keep pets away from treated skin, pillows and spills.^[10]

Ask your pharmacist: is this the right product for my pattern, age and health? What should I expect in the first months? When should we review it?

Low dose oral minoxidil

What it is: the tablet form of the same medicine at much lower doses than those used for blood pressure. Use for hair loss is off label in the UK.^[1][11]

What the research shows: a review of 17 studies including 634 patients reported that low doses appeared effective and generally well tolerated, while calling for larger randomised trials.^[11] A small trial in 52 women found no statistically significant difference in hair density between oral and topical treatment after 24 weeks.^[12] The British Association of Dermatologists notes it may be at least as effective as topical treatment in certain scenarios.^[1]

Good to know: possible effects include extra facial or body hair, fluid retention and a faster heartbeat.^[12] It is a decision for a prescriber, never something to buy online or adjust yourself.

Hormone replacement therapy (HRT)

What it is: oestrogen, with progestogen if you have a womb, used for menopause symptoms such as hot flushes after a discussion of benefits and risks.^[5]

What the research shows: HRT is not licensed or recommended as a standalone treatment for hair loss.^[5] Oestrogen does influence how follicles grow, but that does not make HRT a proven hair treatment.^[13][14] Some women notice their hair feels different after starting or changing HRT, in either direction.

Ask your GP: could HRT help my other symptoms? Could the type we choose affect my hair? What are the benefits and risks for me?

Anti-androgen medicines

What they are: medicines such as spironolactone that reduce the effect of androgen hormones. They are not licensed for female pattern hair loss in the UK.^[1]

What the research shows: the evidence is limited, though they may help some women.^[1] They can affect a male fetus, so they are not for anyone who is or could become pregnant.^[1] This is specialist territory.

Finasteride

A year long randomised trial in 137 postmenopausal women found no increase in hair growth compared with placebo.^[15] The Cochrane review also found it no more effective than placebo.^[3] The NHS states that women should not use finasteride.^[2] Never take tablets prescribed for someone else.

Low level laser devices

Combs and helmets that emit low level light. A multicentre sham controlled trial reported higher hair density after 26 weeks and no serious side effects.^[16] Across studies, results were inconsistent.^[3] Long term effect is uncertain and any benefit needs continued use.^[13][17] Ask the seller what trial evidence exists for that exact device and what the returns policy is.

Platelet rich plasma (PRP)

A sample of your blood is spun to concentrate platelets, which are then injected into the scalp. It is not offered on the NHS. The British Association of Dermatologists says research is too limited to know when and how it might work.^[1] The American Academy of Dermatology describes early findings as promising and says more studies are needed.^[17]

Hair transplant surgery

Follicles are moved from the back and sides of the scalp to thinning areas. It is not offered on the NHS for this. It does not suit hair that is thin all over, because there must be enough donor hair.^[1][17]

Supplements and rosemary oil

Findings for hair supplements, including biotin, are mixed, with no effect on growth or thickness in most studies.^[17] Treating a proven deficiency is sensible for general health, but it is not a guarantee of thicker hair.^[18][19] High dose biotin can distort some blood tests, including some heart tests.^[20][21]

Rosemary oil has one small comparative trial against 2% minoxidil in people with androgenetic alopecia.^[22] It is not established as a treatment for menopausal hair loss. Avoid essential oils on broken or irritated skin. More on food and supplements in nutrition for menopausal hair.

Cosmetic options while you wait

Thickening shampoos may help hair look fuller or reduce breakage, but they cannot regrow hair.^[13][17] A good cut, colour, fibres or a topper can make a real difference to how you feel day to day. These are confidence tools, not treatments. There is no shame in using them.

Questions for any appointment

The full picture, in one guide

The Menopause Hair Guide profiles nine treatment options in detail, each with what it is, what the research says, who it may suit, side effects and questions to ask. It also includes a GP script and a minoxidil safety page. It is information to help you make decisions with a professional, not a prescription.

Keep reading

• Menopause hair loss: a clear starting point
• Hair thinning after 50: causes worth checking
• A gentle haircare routine for midlife

This article is general education, not medical advice. It cannot diagnose or treat any condition. Speak to a qualified hair expert or your GP about hair changes and seek medical help promptly for the warning signs above.