More than half of postmenopausal women ages 50 to 65 years have female pattern hair loss (FPHL), and low self-esteem is associated with severe FPHL, according to findings from a study published in Menopause.

Researchers sought to estimate the prevalence of FPHL in healthy postmenopausal women and determine the postmenopausal hair characteristics and factors associated with FPHL.

The cross-sectional study enrolled postmenopausal women aged 50 to 65 years with a 12-month history of amenorrhea or oophorectomy from a Menopause Clinic in Bangkok, Thailand, from November 2018 to May 2019.

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FPHL was analyzed according to the Ludwig classification. Hair density and diameter were measured with trichoscopy, and scalp sebum was measured with sebumetry. Low self-esteem severity was assessed according to responses on a questionnaire. A diagnosis of FPHL was confirmed when 3 dermatologists with special interest in trichology reached an agreement.

A total of 200 postmenopausal women were initially enrolled, of whom 178 were assessed for their characteristic hair patterns. Participants had an average age of 58.8 ± 4.1 years and an average time since menopause of 9.2 ± 5.6 years. A total of 82% of the women had never used menopausal hormone therapy (MHT), and 5% were using MHT.

The cohort had an FPHL prevalence of 52.2% (95% CI, 44.6-59.8). After stratification according to age and time since menopause, the prevalence of FPHL increased as the women’s age progressed. Ludwig grades I, II, and III percentages were 73.2% (95% CI, 62.9-81.8), 22.6% (95% CI, 14.6-32.4), and 4.3% (95% CI, 1.2-10.7), respectively. About 60% of the women were determined to have low self-esteem, which increased with the severity of FPHL. All women with Ludwig grade III hair loss severity had low self-esteem.

Age 56 years or older (OR = 3.41, 95% CI, 1.67-6.97), time since menopause of more than 6 years (OR = 1.98, 95% CI, 1.03-3.83), and body mass index (BMI) of 25 kg/m2 or greater (OR = 2.28, 95% CI, 1.11-4.66) were all significantly associated with FPHL in the women, according to simple logistic regression analysis.

Multivariable logistic regression analysis after adjustment for age and family history of FPHL in 1 model showed that only BMI 25 kg/m2 or greater was significantly associated with FPHL in postmenopausal women (adjusted OR = 2.65; 95% CI, 1.23-5.70). After adjustment for time since menopause and family history of FPHL, a second model also indicated that a BMI of 25 kg/m2 or greater was significantly associated with FPHL in the women (adjusted OR = 2.48; 95% CI, 1.18-5.20).

Study limitations include the cross-sectional design and convenience sampling conducted at a menopause clinic, and women who underwent hair loss treatment were excluded. Most data were collected based on the participants’ memory, and one-third of the women had serum testosterone levels lower than the assay limits.

“High BMI or obesity was associated with a higher prevalence and worsening of FPHL in postmenopausal women,” stated the study authors. “Further studies are necessary to determine whether sex steroid hormones, especially estrogen and testosterone, and history of polycystic ovary syndrome are related to hair loss in postmenopausal women. This may help gynecologists select appropriate menopausal hormone therapy regimens for postmenopausal women with FPHL.”


Chaikittisilpa S, Rattanasirisin N, Panchaprateep R, et al. Prevalence of female pattern hair loss in postmenopausal women: a cross-sectional study. Menopause. Published online February 14, 2022. doi:10.1097/GME.0000000000001927