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Date of release: 23 May, 2011

Physiological changes in scalp, facial and body hair after the menopause


In a new and quite unique study, Ali and Wojnarowska [1] aim to assess the subjective experience of changes in scalp, facial and body hair in a large cohort of healthy postmenopausal females of northern European ethnicity. It is the first epidemiological study of its kind in more than 20 years. The previous three largest studies of normal hair distribution in northern European females were conducted by Beek in 1950 [2], Ferriman and Gallwey in 1961 [3] and Lunde and Grottum in 1984 [4], but only one of these combined assessment of scalp and body hair. However, none of the three studies divided subjects by menopausal status. 


 


The current study included 758 women (median age 59 years, range 45–94 years; mean time since onset of menopause 13 ± 10 years, range 1–45 years), who filled a detailed questionnaire on scalp, facial and body hair changes following the menopause. Their median body mass index was 25 kg/m2 (range 14–85 kg/m2). Twenty percent of women were current hormone users and 22% of the remaining women were past users. 


 


The overall results showed that 41% of the women experienced some hair loss. Diffuse and generalized ‘all over’ hair loss was the most common form of scalp hair loss (26%). The next most frequent type was at the ‘front/top’ of the scalp (9%). Increased dryness of hair was reported by 35% and greasiness by only 3%. There was no significant difference in scalp hair change between women taking hormones at the time of survey and those who were not. The sixth decade was the most frequent period for the onset of hair loss, although the range was wide.


 


Facial hair gain was noted by almost half (49%) the subjects. Of this group, 39% described increased hair on the chin only, 22% on the upper lip alone and 39% on both these areas. Although subjects with facial hair gain were older than those without (p < 0.05), the frequency of facial hair gain in this group did not increase incrementally with age. There was no significant difference in facial hair scores between users and non-users of hormones at the time of the survey. 


 


Axillary, pubic and lower leg hair loss was commonly reported as well. Body hair loss significantly correlated with older age (p < 0•001) and was noted most frequently at androgen-sensitive sites. Hair loss on the areola, abdomen and thigh was less prominent and only a small proportion of women reported increased hair at these sites. There was no significant difference in total body hair score between women taking postmenopausal hormones at the time of the survey and those who were not. In conclusion, two distinct patterns of hair loss were observed: (1) diffuse generalized scalp hair loss significantly correlating with body hair loss and increasing age; (2) frontal hair loss which was associated with higher facial hair scores and relatively younger age than in women with diffuse hair loss. Postmenopausal hormones had no significant impact in this respect.

Comment

Facial hirsutism and female-pattern hair loss are associated with hyperandrogenism. Androgens stimulate body hair at specific sites such as the axilla, chest and pubic area. In some cases, facial hirsutism and female-pattern hair loss are clinical signs of serious endocrine disease or malignancy. Without an accurate knowledge of the normal range of hair changes associated with the menopause, it is difficult to identify which changes may require further medical investigation. In addition to this, both scalp alopecia and facial hirsutism have a negative impact on self-esteem. To my knowledge, this is the first comprehensive study based on subjective evaluation of hair changes in the menopause. It demonstrates two distinct patterns of hair change relating to age; these may reflect different underlying pathophysiological mechanisms and are of relevance to the medical management of these women as well as being possible predictors of health outcomes. The changes may reflect normal physiological and endocrine processes, but could represent a pathological process with potential implications on general health. The incremental decrease in body hair score decades beyond the average age of menopause suggests that aging influences hair density independently of the endocrine changes related to the menopause. Also, the age-related decline in androgen levels may have a lasting effect over several decades and could explain the gradual age-related loss of body hair observed in this study.
 
Only 9% of women described frontal hair thinning, which significantly correlated with temporal hair loss and increased facial hair, suggesting an androgen-associated pathology similar to baldness in men. These women had relatively higher body hair scores and were younger than women with diffuse hair loss. In men, dihydrotestosterone is a key factor in the stimulation of beard growth and the development of male-pattern balding. A similar process may occur in females, which may have an important implication for potential therapeutic options in the form of 5α-reductase inhibitors. Nevertheless, the most common pattern of postmenopausal hair change was generalized loss of scalp and body hair, whereas body hair gain was uncommon.

Comentario

Martin Birkhäuser
Basel, Switzerland

    References

  1. Ali I, Wojnorowska F. Physiological changes in scalp, facial and body hair after the menopause: a cross-sectional population-based study of subjective changes. Br J Dermatol 2011;164:508-13.
    http://www.ncbi.nlm.nih.gov/pubmed/21128905

  2. Beek CH. A study on extension and distribution of the human body-hair. Dermatologica 1950;101:31731.
    http://www.ncbi.nlm.nih.gov/pubmed/14802145

  3. Ferriman D, Gallwey JD. Clinical assessment of body hair growth in women. J Clin Endocrinol Metab 1961;21:1440-7.
    http://www.ncbi.nlm.nih.gov/pubmed/13892577

  4. Lunde O, Grottum P. Body hair growth in women: normal or hirsute. Am J Phys Anthropol 1984;64:307-13.
    http://www.ncbi.nlm.nih.gov/pubmed/6540999