Expert: Melanie Vonzabuesnig - 6/24/2009

Question
Can switching HRT treatments cause an increase in hairloss?  It's a long story, but after being postmeno for 6 years, I started having terrible meno symtoms again(worse than before), and I noticed my wonderfully thick, healthy hair begin to shed.  At first I wasn't concerned, but it got worse and worse.  I saw every type of doctor imaginable.  I begged my gyn for HRT to see if it would help.  He put me on 1 mg estradiol and 100 mg prometrium.  Shedding improved, but I didn't see much regrowth.  I saw a hairloss specialist(endo) who switched my estrogen to the vivelle dot.  It seems the hairloss has gotten worse.  I did have my estradiol checked since going on the patch and it has increased.  Obviously, the estrogen is being absorbed, but would that make my hair begin shedding more?  I am very concerned.  The "new" doctor says I must give it time???  My testosterone is zilch, so I don't think it's androgens, although he suggested I might start a low dose of spironolactone.  So, does switching forms of HRT cause increased shedding even if your estrogen is improved(still not up to what he wants it to be)? I started the oral HRT in Feb(2009) and switched to the transdermal estrogen in May(2009).

Answer
Hello Wendy: Starting, stopping, switching or changing dosages of any medications can cause hair loss. This is especially true of medications that influence hormones, as hormonal balance is intricately connected to healthy hair growth. In many cases, as the body adjusts to the change, the hair loss tapers off and normal growth resumes. Some women do better with oral HRT and others do better with transdermal. Have your other symptoms improved with either method? If all your symptoms were better with oral HRT, it may be a better choice for you. With medication induced hair loss, shedding often begins 1-4 months after medication is started. Because the oral HRT and the transdermal were both started within the past 4 months, it would be difficult to say which (if either) increased the shedding.
Thinning of hair is common with menopause and with aging. The most common type of hair loss related to menopause is miniaturization rather than excessive shedding. With miniaturization the individual hairs become thinner and weaker, providing less scalp coverage.
The excessive shedding you are experiencing may or may not be related to menopause as there are many possible causes for this type of hair loss. Any change, disturbance or imbalance experienced by the body can disrupt the hair growth cycle, sending more hairs than usual to the telogen (resting) phase where they will be shed 1-3 months later. Other common causes include low ferritin levels, change in diet, recent surgery or trauma, stress, medical procedure, flu shot, medication, exposure to toxins, infection, systemic inflammation, etc. Thinking back to the months prior to the shedding may provide clues.
Sincerely, Melanie Vonzabuesnig
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