Hormones play a major role in hair growth, and many women first notice thinning during a hormonal shift or alongside a hormonal condition. Three of the most common are polycystic ovary syndrome (PCOS), thyroid conditions and menopause. Each affects hair differently, which is why identifying the cause comes before choosing a treatment.
PCOS
PCOS often involves higher levels of androgens (hormones such as testosterone). In women whose follicles are sensitive to androgens, this can contribute to thinning over the top of the scalp, a pattern similar to female pattern hair loss. PCOS can also cause other signs, such as irregular periods, acne or increased facial and body hair.
Because PCOS affects the whole body, it is usually managed with a primary care doctor, gynecologist or endocrinologist. Hair loss treatment may be one part of that care. Anti-androgen options such as spironolactone are sometimes considered by providers, with appropriate screening.
Thyroid conditions
Both an underactive thyroid (hypothyroidism) and an overactive thyroid (hyperthyroidism) can cause diffuse thinning across the scalp. Hair loss from a thyroid condition often improves when the thyroid condition itself is treated, which is why a thyroid problem needs to be identified and managed by a physician. See thyroid hair loss.
Menopause
During perimenopause and menopause, estrogen and progesterone decline. That shift can make androgen effects on the follicle more noticeable, and many women notice gradual thinning, especially along the part. Read more in our menopause hair loss guide.
Why the cause matters
These conditions can overlap with each other and with other causes, such as low iron, stress-related shedding (telogen effluvium) or recent illness. Treating the wrong cause wastes time. A provider may ask about your cycle, symptoms, medications and history, and may recommend lab work or in-person care to confirm what is going on.
How a provider approaches treatment
Depending on the cause, options a provider may consider include minoxidil, anti-androgens such as spironolactone, or a personalized compounded topical formula, alongside treatment of any underlying condition by the appropriate physician. Some options, including spironolactone, must not be used during pregnancy and require screening. Compounded medications are prepared by a licensed pharmacy for an individual patient and are not FDA-approved. Hair changes slowly, so providers typically evaluate response over months rather than weeks.
When to seek in-person care
See a physician in person for sudden or patchy hair loss, scalp pain or scarring, or symptoms such as unexplained weight change, fatigue, palpitations or very irregular periods, which may point to a condition that needs its own evaluation.
Next step
If you are in California, Colorado, Florida or New York and want a licensed provider to review your hair loss, start your online consultation.
Prescription required. A licensed provider decides whether treatment is appropriate. Compounded medications are prepared by a licensed pharmacy for an individual patient and are not FDA-approved. Individual results vary. Prescribed Essence currently serves patients in California, Colorado, Florida and New York.
