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The question

I recently entered menopause and have begun losing clumps of hair. Is this normal? Can I stop it? Will I go totally bald?

The answer

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Along with other changes during menopause such as hot flashes, fluctuating moods and changing sleep patterns, hair loss is a very common issue for women and is considered one of the most disturbing. Studies have shown that hair loss can have significant effects on self-esteem and increase anxiety. But don't worry, there are changes you can make to slow hair loss, and it is exceedingly rare to actually go bald.

If your hair loss is sudden and rapid, this is not normal and it may be a clue that your body is responding to a stressful event, illness, hormonal imbalance or medication. But given that you've started menopause, it is likely your hair loss is related to the physical and psychological changes that occur during this stage of life.

When menopause begins, there is a shift in hormones resulting in an increase in male hormones (also known as androgens) and a reduction in female hormones (estrogen and progesterone). Hair follicles narrow and may close in response to this elevation in androgens, which can lead to hair thinning.

In addition to physical changes, menopause can be emotionally tumultuous. Hair grows in cycles and when our bodies are stressed, hair follicles go into a "resting phase," which can result in rapid loss of hair in large volumes. Chronic stress can also lead to an increase in androgens, which also contributes to thinning hair.

So what can you do?

Treatment for hair loss is a combination of lifestyle changes and medications. Let's start with some changes that are within your control.

Stress management is crucial at this time. Manage your stress by eating healthily. You should also focus on getting regular and adequate sleep. Another way to reduce stress is with relaxation techniques such as meditation and regular exercise. As a bonus, these changes will help not only your hair but also help to reduce other irritating menopause symptoms, such as changes in sleep patterns and fluctuations in mood.

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Along with these steps, book an appointment to see your doctor to review what may be contributing to your hair loss. If the hair loss involves only patches of your scalp or itchiness, redness or scaling, the cause may be an underlying irritation or fungal infection that can be reversed with treatment. Your doctor will also rule out potentially reversible causes of hair loss, such as iron deficiency or abnormal thyroid function, with some simple blood tests.

In addition to lifestyle changes, your doctor may suggest medications to help slow hair loss. For some, this can include hormonal therapy, which is especially helpful if you are struggling with other symptoms of menopause, such as hot flashes. The other common medications have been made popular by male pattern baldness, minoxidil or Rogaine. Both of these medications carry their own risks, so weigh those and the benefits with your doctor before starting.

Send family doctor Sheila Wijayasinghe your questions at doctor@globeandmail.com. She will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail web site. Your name will not be published if your question is chosen.

The content provided in The Globe and Mail's Ask a Health Expert centre is for information purposes only and is neither intended to be relied upon nor to be a substitute for professional medical advice, diagnosis or treatment.

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