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By Vanessa Lyn Gonzales | 6 min read
There is a page on the NHS website about hair loss. It covers male pattern baldness, alopecia areata, and a handful of other conditions.
It does not mention the word "menopause." It does not mention oestrogen, hormones, or perimenopause.
Not once.
For a country in which roughly 13 million women are currently going through some stage of the menopausal transition — a significant proportion of whom will experience notable hair changes — this is a fairly extraordinary omission. It means that millions of UK women experiencing one of the most distressing symptoms of hormonal change are searching for answers and finding nothing relevant at the most trusted health source they have.
So they turn to forums. To expensive salon treatments.
To conflicting advice from well-meaning friends. And most of the time, they still do not find the explanation they are actually looking for: what is happening to their hair, why it is happening now, and what — if anything — can be done about it.
I was one of those women. And the answer, when I eventually found it, was not particularly complicated.
It just required someone to explain it properly.
Here is what the research actually shows.
It starts with a hormone you have probably never heard of
The reason so many women's hair changes in their 40s and 50s is not simply that oestrogen falls. It is what happens to the hormonal balance as a result.
As oestrogen declines, the body's ratio of androgens — male hormones that women also produce in smaller amounts — shifts. Specifically, a hormone called dihydrotestosterone, or DHT, becomes more active relative to oestrogen.
DHT is produced when an enzyme called 5-alpha-reductase converts testosterone. It binds to receptors in hair follicles and, over time, causes them to miniaturise.
Each hair growth cycle produces a thinner, shorter strand than the one before. The process is gradual — which is part of why women often don't connect what they're seeing to the menopausal transition until it has been happening for some time.
Oestrogen, when it is present in sufficient levels, suppresses this process. Progesterone, which also declines during perimenopause, acts as a natural inhibitor of the 5-alpha-reductase enzyme.
As both hormones fall, DHT has less resistance. Follicles that were previously thriving begin to miniaturise.
This is not hair loss in the conventional sense — it is follicular change driven by hormonal chemistry. The follicles are not dead.
They are responding to a change in their hormonal environment.
If you recognise what's described above, ThickTails has built a detailed guide to perimenopause and menopause hair changes — covering the hormonal science and how to build a consistent routine around it. Read the full guide here →
Why this matters for how you approach it
Understanding the hormonal mechanism is not just interesting. It has direct practical implications.
If DHT activity is a central part of what is driving your hair change, then the most useful interventions are those that work to support the follicular environment against DHT — not products that simply add volume to existing strands.
Certain botanical ingredients have been studied specifically in this context. Saw palmetto extract, for example, works by inhibiting 5-alpha-reductase — the same enzyme that produces DHT — and has been the subject of multiple clinical studies for hair loss.
A systematic review published in peer-reviewed literature found improvements in hair quality, hair count, and density among participants using saw palmetto, with minimal side effects.
Topical caffeine has been the subject of several clinical trials. Research suggests it may help extend the hair growth phase by counteracting some of DHT's effects at the follicle.
One open-label clinical study found a caffeine-based topical to be non-inferior to 5% minoxidil — the main licensed treatment for hair loss — over a six-month study period.
Red clover extract contains compounds that may similarly help modulate DHT activity, while also offering phytoestrogen properties that may support the oestrogen-depleted environment of the menopausal scalp.
None of these are pharmaceutical treatments, and individual results vary. But they represent a meaningfully different approach to haircare than simply using a volumising shampoo and hoping for the best.
“This is not hair loss in the conventional sense — it is follicular change driven by hormonal chemistry. The follicles remain alive.”
The 90-day reality
The hair growth cycle is slow. Research consistently points to a minimum of three months of consistent use before changes in follicular environment translate into visible changes in the hair.
This is the most important thing I wish I had understood earlier — not because it is discouraging, but because it explains why so many women give up too soon. Six weeks is not long enough to see results from any meaningful intervention.
Three months is the minimum. Six months is where most of the published research sees the most consistent outcomes.
Building a consistent routine, understanding what each element is doing, and continuing it long enough — that is the approach the research supports.
The guide the NHS page doesn't have.
ThickTails has developed a detailed resource on perimenopause and menopause hair changes — covering the hormonal science behind what is happening, what the published research supports, and how to build a consistent routine around your transition. Use code HORMONEAWARE15 for 15% off your first order.
Build Your Hormone-Aware Routine →
Clinical references
1. Dhurat R, et al. "An Open-Label Randomized Multicenter Study Assessing the Noninferiority of a Caffeine-Based Topical Liquid 0.2% versus Minoxidil 5% Solution in Male Androgenetic Alopecia." Skin Pharmacology and Physiology, 2018. View on PubMed →
2. Evron E, et al. "Natural Hair Supplement: Friend or Foe? Saw Palmetto, a Systematic Review in Alopecia." Skin Appendage Disorders, 2020. View on PubMed →
3. Lueangarun S, Panchaprateep R. "An Herbal Extract Combination (Biochanin A, Acetyl Tetrapeptide-3, and Ginseng Extracts) versus 3% Minoxidil Solution for the Treatment of Androgenetic Alopecia." Journal of Clinical and Aesthetic Dermatology, 2020. View on PubMed Central →
Vanessa Lyn Gonzales writes about women's health, hormonal transitions, and midlife wellbeing. This article is for informational purposes and does not constitute medical advice. Please consult your GP or a qualified trichologist regarding any health concerns.
