Ask An Expert: Dr Sharon Wong, Tricho-Derm

Dr Sharon Wong is one of only a handful of people combining medical trichology with dermatology. She explains the changes your hair goes through during the menopause and gives her recommendations

Alongside her day-to-day work with patients, Dr Wong is committed to creating a more educated and empowered stance around the psychological impact of hair loss, which can often be underestimated. In 2018, she founded ‘Get Ahead of Hair Loss’, a charitable foundation which aims to change the narrative around hair loss, fighting stigma and providing education.  

Over the last few years, the foundation has held public educational events, bringing together leading UK experts in hair science, dermatology, trichology, hairdressing, cosmetic camouflage and psychology to raise awareness and create conversation.

Here, Dr Wong explains the changes your hair goes through during the menopause, recommends products and shares her suggestions on ways to keep your hair healthy and strong.

What are the hormonal changes affecting hair in the perimenopause and menopause years?

Approximately 40% of women experience hair loss during the menopause. Although this is likely an underestimation and in many cases the hair changes are noted progressively for some years in the lead up to menopause. 

Before menopause, the ratio between female sex hormones (oestrogen and progesterone) and male hormones (androgens) is high. Oestrogen and progesterones are hair ‘protective’ and maintain hairs in the growth phase of the hair cycle. Androgens are the hormones involved in kick-starting the balding process in genetic hair loss.

Approximately 40% of women experience hair loss during the menopause.

In perimenopausal and menopausal women, the ratio between female and male hormones is gradually reversed. The decline in oestrogens/progesterones means you lose the protective effect on your hair, whilst the effect of androgens on the follicle is amplified.


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What are the most common symptoms?

A number of changes are commonly reported including loss of volume and generalised thinning all over. Hairs become finer and have poor or slow growth, as well as a change in texture with increased dryness and brittleness of hair.

READ MORE: A hairdresser shares his dry hair repair kit.

Menopause is also a time which coincides with the onset of female pattern hair loss (FPHL). This is the female equivalent of male pattern balding, with loss of density and thinning specifically over the crown. The parting progressively becomes wider and the scalp starts to show through the hair more. 

Do symptoms improve as women move from perimenopause into menopause, or are the hormonal changes permanent?

These changes in the peri- and menopausal period are progressive over years. However there are many licensed and off licensed treatments to potentially improve hair growth or at least slow down the progression.

What are the key product ingredients to help with symptoms, and how does each ingredient work?

The only licensed medical treatment for female hair loss is topical Minoxidil (available over the counter). This is believed to work partly by improving the microcirculation around the follicles and prolonging the active growth phase, resulting in longer and thicker hairs with long term use. Dermatologists are also able to prescribe off license medications to reduce the effects of androgens on the hair.

READ MORE: Rosie Green’s favourite products for thinning hair.

There are also many useful ingredients in cosmetic products (shampoos and conditioners) which will help with the aesthetic properties of the hair e.g. its shine, softness and volume. Examples include hydrolysed proteins which can strengthen and bulk up strands and temporarily patch up damaged cuticles. Hyaluronic acid can improve the hydration of the scalp and coconut oil not only imparts a shine to the hair but also penetrates the hair shaft and improves the moisture within. 

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How should you change your hair care routine in the perimenopausal years?

As the hair is more delicate in perimenopausal years, minimise heat and chemicals/dyes onto the hair. This means, for example, leaving longer gaps between getting your hair dyed, turning down the heat on styling tools and using a heat protectant.

Once or twice weekly, use a scalp exfoliant like the Inkey List Salicylic Acid Exfoliating Scalp Treatment to keep a healthy cell turnover on the scalp, just as you would with your facial skin. Also, a hair mask for deep conditioning like the Philip Kingsley Elasticizer.

Invest in a good quality sunscreen for the hair and scalp. For the hair this is to minimise heat and UV damage to the structural proteins of the hair. For the scalp, it’s to reduce the risk of pre- and cancerous changes on the skin, especially as the hair thins and provides less coverage for the scalp. I like Brush On Block and Supergoop Poof Mineral Part Powder​​.

Do you have any other favourite products that you recommend to perimenopausal women?

As the hair is generally drier, more fragile and brittle, I like to recommend TLC treatments such as hair masks for a deep condition, to improve texture and dryness. Philip Kingsley Elasticiser, which I’ve already mentioned, is a firm favourite. 

If you cannot face reducing the use of a hairdryer I would definitely recommend investing in the Dyson supersonic hair dryer – quicker dry time and reduced surface heat will all help to minimise thermal injury to the hair fibre.

What is your own hair care routine and the products you use?

I generally keep things very simple. I wash my hair alternate days (unless I’ve done a work out that day) and tend to be a wash-and-go type of person. I will let my hair air dry as much as possible and then use a hairdryer right at the end to finish off.

I am currently using The Inkey List Salicylic Acid Exfoliating Scalp Treatment once to twice weekly, and Kerastase Resistance Bain Volumifique shampoo and conditioner. Once weekly I would use the Philip Kingsley elasticizer.

Are there any supplements that can help with the symptoms?

Certain vitamins such as iron and vitamin D can impact hair growth and should be supplemented if blood tests reveal there is a deficiency. However, there is little evidence to support blanket supplementation to support hair growth where there is no specific deficiency in the first place. It is important to realise that over supplementation in some cases can have adverse effects.

READ MORE: 10 of the best menopause supplements. 

There has been increasing popularity in the use of hair mesotherapy. Mesotherapy involves multiple tiny injections of combinations of peptides/amino acids, vitamins, hyaluronic acid and growth factors directly into the scalp. Mesotherapy has not been sufficiently researched to be able to provide more robust data on its effectiveness in actual hair growth but many people report beneficial effects in improving the general condition of their hair. 

Any lifestyle/diet changes that can help with perimenopausal hair changes?

Lifestyle and diet changes are relevant regardless of your stage in life. When it comes to diet, hair follicles are sensitive barometers of our nutritional status and nutritional deficiencies often show in your hair. Crash dieting, dramatic weight loss, protein and iron deficiencies can all cause dramatic hair shedding, a condition known as telogen effluvium

There is no quick fix, and no super food for your hair. Your hair follicle cells are some of the most rapidly dividing in the body and require a lot of energy and nutrients to keep up with this. A healthy, well balanced diet which covers all the macronutrients (proteins, carbs and fats) and micronutrients (vitamins and minerals) is what your hair needs to thrive. For example your hair is over 90% made of protein – ensuring your diet has all the essential amino acids your body can’t make is essential.

READ MORE: The best nutrition for your age and stage.

Carbs have always had a bad rep but they are a vital source of energy. The key is to choose carbs wisely. Avoid heavily processed carbs like white breads and white pasta. Instead, opt for slow release carbs which don’t give you rapid sugar spikes, such as pulses, vegetables, brown rice etc.

Iron deficiency from inadequate dietary intake and cumulative menstrual losses is common amongst women. Ensure you have enough Vitamin C in your diet to help iron absorption especially if you are on a plant-based diet. 

When it comes to lifestyles, it is well known that smoking accelerates skin ageing (and the scalp is no different!) but it has also been associated with accelerated hair thinning in some clinical studies. 

Also, the stress-hair connection is real! Studies have shown that stress results in neurochemical substances released from the brain that can hinder the growth of hair follicles. Stress/psychological trauma can result in a number of hair conditions including shedding (telogen effluvium) and in some people it may trigger alopecia areata – an autoimmune condition where your own immune system attacks the hair follicle resulting in circular patches of hair loss most commonly on the scalp.

Stress management can really make a difference in reducing the risk of stress-related hair loss. This may be as simple as using relaxation techniques at home to divert stress (eg practising meditation or mindfulness) or doing a work out several times a week.

Are the perimenopause and menopause years a time when women need to review their existing hair care routines?

Yes. Most women will notice a gradual change in their hair and scalp from their 40s and will come to realise that what was working for them in their 20s and 30s is no longer the case. This may be earlier in women who experience premature menopause. As our bodies change our habits and routines will also need to adapt in response to these changes accordingly.

As told to Alex Peters.

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