A white hair brush is shown with brown hair inside it. The brush lies on top of wood.
Hair thinning is an unexpected, yet common, symptom of menopause. (For Spectrum Health Beat)

Hot flashes. Night sweats. Mood swings.

Most middle-aged women are on the lookout for these typical symptoms of menopause.

But hair loss? That one can take some women by surprise—and cause big worries.

“It’s a big deal because our hair affects so much of our self-image and how we think of ourselves,” said Natasha Peoples, NP-C, NCMP, a nurse practitioner specially trained and nationally certified in caring for patients with menopause concerns.

Peoples works with the Spectrum Health Medical Group Midlife, Menopause & Sexual Health practice. She sees women experiencing various menopause symptoms, including hot flashes, night sweats, mood swings, sleeping issues, vaginal dryness, irregular bleeding and more.

“Just like all menopause symptoms, it varies from person to person,” Peoples said. “Women come to us and they’re all going through the same process, but they all experience it completely differently.”

Any degree of hair thinning causes concern among women, but it’s often hard to quantify how much hair you’re losing to know if it’s been a significant change, she said.

Also, unlike with hair loss after pregnancy—a common occurrence—women experiencing it during menopause might wonder if it’s ever going to stop.

“(Post-pregnancy hair loss) always balances out,” Peoples said. “And with women experiencing menopause it’s more concerning because there’s not that expectation that it’s going to reverse.”

While doctors don’t always know why hair loss is happening during menopause, Peoples said that as women experience menopause and normal menstrual cycles stop, they lose the estrogen and progesterone that the body would cycle normally.

With the loss of female hormones, testosterone and male hormones can become more active in the body. And that can affect hair follicles, among other things.

She urges women to talk to their medical providers about all their symptoms of menopause, including hair loss.

The first step would be to rule out other possible causes of the hair loss. Possibilities include thyroid imbalance, anemia, vitamin deficiency, new medication side effects or stressful physical events, such as surgery or illness.

“Whatever they can do to manage stress can be helpful,” Peoples said. “Hair follicles have a four-month life cycle and any change you make to reverse hair loss, you’re not going to see for four to six months down the road. It’s a slow process, which can be frustrating.”

If hormones are to blame, hormone replacement medications or those that block testosterone receptors might be helpful, she said.

Patients also might need to see a dermatologist, she said.

While some menopause symptoms, including hair loss, might be unavoidable for some women, there are things that might help minimize symptoms.

Peoples encourages women to limit caffeine, drink plenty of water, get regular exercise, maintain a healthy weight, keep good sleep habits and quit smoking.

The most important thing: Women need to realize they’re not alone. Help is available.

“It’s nice to be able to help women who start to have these struggles and feel like there’s nowhere to turn,” Peoples said.