The Truth About Hair Loss in Perimenopause: What's Normal, What's Not, and What You Can Do
- Melissa Nichols
- Nov 10, 2025
- 4 min read
You're getting ready for an important meeting when you notice it: more hair than usual circling the shower drain. Again. You run your fingers through your hair, and a few strands come away in your hand. Is this normal? Is this perimenopause? Or is something else going on?
Let's cut through the confusion and get you some answers.
What "Normal" Hair Loss Actually Looks Like
Here's something that might surprise you: you're supposed to lose hair every single day.
The average person sheds between 50 to 100 hairs daily. Yes, really. Your hair grows in cycles, and at any given moment, about 85-90% of your hair is actively growing while 10-15% is resting before it falls out to make room for new growth. Since the average scalp has 100,000 to 120,000 hair follicles, losing this amount daily is typically not noticeable or concerning.
You may lose approximately 10-20 hairs while brushing, 50-80 during washing, and around 20-30 hairs naturally throughout the day. Those with longer or thicker hair may notice more visible strands, but that doesn't necessarily mean excessive loss.
Too much hair loss is usually indicated by:
• Shedding significantly more than 100 hairs per day consistently
• Noticeable thinning, bald spots, or widening of the hair part
• Hair not regrowing after shedding episodes
• Sudden or patchy hair loss
This excessive shedding is often referred to as "telogen effluvium" when it is temporary or "alopecia" when it is associated with permanent hair loss. Factors like stress, illness, hormonal changes, and nutritional deficiencies can trigger abnormal hair shedding. If these signs appear, consulting your healthcare provider is recommended to determine the cause and appropriate treatment.
Hair loss in women can be multifactorial, involving hormonal, nutritional, inflammatory, autoimmune, genetic, and environmental causes. Lab testing can determine the root causes. Below we will explore the potential reasons, suggested testing, and treatments appropriate across age groups.
Potential Reasons for Hair Loss in Women
Hormonal Imbalances:
o Androgen excess (e.g., polycystic ovary syndrome (PCOS), adrenal
hyperplasia)
o Thyroid dysfunction (hypothyroidism or hyperthyroidism)
o Menopause-related estrogen decline
o Elevated cortisol (stress-related)
o Insulin resistance
Nutritional Deficiencies:
o Iron deficiency or anemia (including ferritin levels)
o Vitamin D deficiency
o Zinc deficiency
o Biotin insufficiency
o Protein malnutrition
o Essential fatty acid deficiency
Autoimmune and Inflammatory Conditions:
o Alopecia areata (autoimmune attack on hair follicles)
o Lupus erythematosus
o Chronic scalp inflammation or dermatitis (seborrheic dermatitis, psoriasis)
Genetic Predisposition:
o Female pattern hair loss (androgenetic alopecia)
Medication and Toxic Exposure:
o Chemotherapy, hormonal contraceptives, anticoagulants
o Heavy metals or toxin exposure
Stress and Lifestyle Factors:
o Hair loss triggered by acute/chronic stress, illness, surgery
o Physical or emotional trauma
o Excessive hair styling or harsh treatments
Other Causes:
o Chronic illness, infections, autoimmune polyendocrine syndromes
o Rapid weight loss or eating disorders
o Scalp infections (fungal, bacterial)
Recommended Tests for Evaluation
Blood Tests:
o Complete blood count (CBC) with differential (to assess anemia,
inflammation)
o Serum ferritin, iron, total iron binding capacity (TIBC), transferrin saturation
o Thyroid panel: TSH, free T3, free T4, thyroid antibodies (TPO, TgAb)
o Hormone panel: total and free testosterone, DHEA-S, SHBG, estradiol,
progesterone, LH, FSH
o Vitamin D 25(OH)
o Zinc, copper, and biotin levels
o Fasting glucose, insulin, HbA1c (for insulin resistance)
o Inflammatory markers: ESR, CRP
o ANA (antinuclear antibody) and other autoimmune screening if indicated
o Heavy metal testing if suspected exposure
Specialized Testing:
o Scalp biopsy (for unclear diagnosis)
o Hair pull test: Gently grasp about 60 hairs between your fingers and pull
slowly. If more than 6-8 hairs come out, you may have excessive shedding.
o Microscopic examination
o Trichoscopy (dermatoscopic evaluation)
Potential Treatments to Improve Hair Loss
The results of the lab tests can determine the root cause of the hair loss. The first course of action should be to improve your diet, or add supplements if deficiencies are a factor. Try additional changes after that as needed. Here are some options:
Nutrition and supplement Support:
Iron for deficiency (meat, lentils, soy, fish)
Vitamin D repletion if needed (exposure to sunlight)
Zinc and biotin supplementation as needed (oysters, beef, pork, pumpkin
seeds, eggs)
Protein-rich diet with balanced omega-3 fatty acids (meat, tofu, walnuts,
salmon)
Autoimmune and Anti-Inflammatory Approaches:
Topical or systemic corticosteroids for alopecia areata
Scalp care with anti-inflammatory shampoos and treatments
Anti-inflammatory diet
Lifestyle and Supportive Therapies:
Stress management techniques (meditation, deep breathing, yoga)
Acupuncture
Low-level laser therapy (LLLT)
Platelet-rich plasma (PRP) injections
Avoidance of damaging hair practices
Alternate or loosen tight hairstyles
Limit heat and chemical treatments, use heat protectants, and allow hair to air-dry when possible.
Use gentle, sulfate-free shampoos and avoid harsh ingredients.
Detangle gently, ideally with a wide-tooth comb when hair is damp, not wet.
Give the scalp regular care and avoid buildup from heavy products.
Emerging/Adjunctive Therapies:
o Microneedling for scalp stimulation
o Nutraceuticals and botanical treatments targeted for hair growth
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