Women have had an intimate relationship with their hair, from attracting a partner to making a statement, throughout their lives. It's no wonder panic sets in the minute it begins to feel thinner!

When that same hair to which we've devoted so much time, attention, and money starts to lose its thickness and luster, or when places that never before saw a hair begin sprouting like a cornfield in May, it can be, to say the least, quite disconcerting and a knock to self-confidence.

"Hair problems-shedding of head hair, reduction of body hair, and an increase in unwanted hair such as facial hair-are all common in the years surrounding menopause," says Wilma Bergfeld, M.D., who directs clinical research in the department of dermatology at the Cleveland Clinic in Ohio. She typically sees about 20 perimenopausal and postmenopausal women a day complaining about these issues. One thing they have in common: "It drives women crazy."

Unwanted Hair As women, we're used to plucking, shaving, and waxing, but when you have to start tweezing your chin it's no joke. Hirsutism, the excess growth of hair on the face, or occasionally on other areas, affects between 5 percent and 15 percent of women. While it's less common than thinning hair in postmenopausal women, it's no fun if you're one of the minority who has to endure rogue hairs sprouting from unusual places.

Unlike the fine, downy hairs that cover most of the body, hirsutism tends to produce coarse hairs in areas of the body where the hair follicles are most androgen-sensitive, including the chin, upper lip, and cheeks. Although they're commonly thought of as male hormones, androgens (the most common of which is testosterone) are somewhat to blame. 

Mary Jane Minkin, M.D., clinical professor of obstetrics and gynecology at Yale University School of Medicine in New Haven, Conn., says that as you enter your perimenopausal years, estrogen drops while testosterone remains fairly steady-at first. This shift in the balance of female and male hormones-with the male hormones becoming more dominant-can cause your body to mimic male hair growth patterns (i.e., thinning where it should be growing and growing where it shouldn't be in the first place).

Although you might think testosterone would make your body hairier, like a man, it can do the opposite. "Testosterone does something to certain receptor sites that makes it more difficult for some women to hold onto body hair," says Bergfeld.

Another common hair growth concern is the appearance of "peach fuzz," or fine hairs on the face. These most commonly appear on the upper lip and chin, but sometimes are generalized. 

While the growth of unwanted hair is common in women over 40, it can occasionally occur before perimenopause. Hormones may not always be to blame for excess hair growth on the body. Exactly why you either lose or gain hair during menopausal years remains a mystery. No one knows with certainty whether this is strictly a menopause-related problem or whether it is a natural effect of aging that simply coincides with menopause. We do know, however, that there's a genetic component. You're more likely to pluck if your mother or grandmother did.

Hair Loss While 5 percent to 15 percent of women will experience excess growth of hair, approximately 50 percent of women undergo a thinning of the hair before age 50. Androgenic alopecia, or the loss of hair on the head, is also accompanied by hair loss on the legs, arms, and pubic areas. The severity of hair changes ranges from noticing your hair is slightly thinner to picking clumps out of your brush. Either way, the effects can cause worry or even be devastating.

If you realize your ponytail is thinner than it used to be, your first step should be talking about the problem with your primary care clinician or gynecologist. They may treat you or refer you to a dermatologist. Either way, the diagnosis will most likely start with a medical history because losing your hair can be brought on by a variety of factors, such as:

• Anemia
• Excessive dieting causing a lack of nutrients vital for well-being
• Thyroid problems
• The autoimmune disease lupus
• Vitamin B12 deficiency
• As a side effect of certain medicines, such as blood pressure and cholesterol-lowering drugs
• Certain hair dyes or permanent solutions that do not agree with your body

Once other possible causes are ruled out, hormones may be the culprit. Unfortunately, there is little research about hair and hormone therapy. However, one clinician's approach is to consider estrogen therapy, provided there are no reasons not to.

"Luckily, it only takes a little estrogen to start to block testosterone action on the hair follicles and improve hair problems," says Bergfeld. "So the doses prescribed for hair problems can begin very low, increasing them slowly if a greater response is needed." As a bonus, this small boost in estrogen can improve the overall condition of your hair and skin, she says. It's important to note, however, that estrogen is not FDA approved for these uses and has risks and side effects.

Because it is impossible to know whether hair problems are the direct  result of a hormonal imbalance, healthcare professionals who prescribe estrogen for hair loss will generally prescribe its use only for a few months-the length of a hair cycle-to see if hair thickens as desired. If things don't improve, the next phase will be topical or alternative remedies (see below).

Pamper Your Tresses For many women, the condition of their hair is central to their confidence and self-image, so it can be distressing when it is not in top form. It is important to remember that unnecessary worry is not going to help matters. So during this unsettling time, take the opportunity to pamper yourself a little.

A new haircut can boost your self-esteem and even make hair look fuller if soft layers are incorporated into the style. There are also many styling products on the market specifically designed for thinning hair, which can give your locks a new lease on life.

Don't be afraid to experiment and have fun with wigs-hairpieces have come a long way from the stiff, unconvincing styles of the past, and you're likely to find one that suits you. If you've always wanted to be a redhead? Now's the time! Follow these suggestions, to improve the look and condition of your hair:

• For some, it's OK to wash your hair every day. But for those with dry scalps, a cold water rinse to seal cuticles and get rid of dead hairs is best. "You cleanse your face every day, and your scalp is simply an extension of your face," says trichologist Philip Kingsley, who has treated the tresses of Audrey Hepburn, Jerry Hall, and Barbra Streisand.

• Rosemary has been used for centuries to stimulate hair growth. There is no scientific proof to support this, but that's no reason not to indulge by using this wonderfully invigorating herb. Simply add a few drops of rosemary essential oil to a little carrier oil such as sweet almond or vitamin E oil, and massage into your scalp.

• Make sure you get enough protein in your diet with foods such as cottage cheese, low-fat cheese, fish, and lean ham or chicken. Cut back on sugar, fat, and alcohol, and make sure you drink plenty of water throughout the day and snack on fresh fruit.

• No matter how you and your clinician choose to combat any hair problems you experience around menopause, rest assured you're not alone. Millions of other women-probably even those whose perfect locks you tried so hard to emulate way back when-are going through the same thing. 

Treating Hair Problems

You don't need to suffer in silence when it comes to unwanted hair conditions during the transition to menopause. Try these expert recommendations.

For Excess Hair

Vaniqa(r). The topical prescription cream eflornithine hydrochloride (Vaniqa) is FDA approved to slow hair growth, notes Bergfeld, while Aveeno Positively Smooth Facial Moisturizer(r), available over the counter, can also slow hair growth. These products only work as long as you're using them.

Zinc. "Zinc seems to have some anti-androgen activity, meaning it blocks some testosterone," says Bergfeld. She recommends supplementing with a 30 to 100 milligram tablet a day for hair problems.

For Hair Loss

Rogaine(r). Only one drug has been FDA approved to treat hair loss in women: minoxidil (Rogaine(r)). It stimulates and enlarges hair follicles, encouraging hair growth. A prescription-strength version with 5 percent minoxidil is approved for men, but the only approved option for women is a 2 percent strength available over the counter. Because studies find that the 5 percent works best, Bergfeld recommends asking your clinician to prescribe Rogaine for Men "off label." However, women using this strength must recognize that the risks in women are unknown. Side effects of the 2 percent product include scalp itching and infrequent increase in facial hair, which can be treated with topical medications or mechanically removed. Talk to your clinician before using this product if you are pregnant or could become pregnant during treatment.

Saw palmetto. This herbal remedy, derived from the berries of the saw palmetto tree, is used in Europe to treat prostate enlargement because it reduces dihydrotestosterone, the most potent testosterone, according to Bergfeld. It seems to have the same effect in women when it comes to combating hair loss, she adds. Numerous studies attest to its safety. Apply saw palmetto oil extract directly to your scalp, or wash your hair with a saw palmetto shampoo daily.

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