Whether you are currently on your menopause journey, or someone you love is going through it, it’s something that should be talked about. It’s a huge part of my wife’s life, and every woman’s life as she enters mid life. There are major factor in hair (and life) changes as we age. I don’t want to just throw products at you, but give you takeaway advice for your journey from one of the experts in the field.

My wife Dionna has recently been seeing changes in her hair as she goes through perimenopause, and during her research, she discovered Dr. Mary Claire Haver, a board-certified OB/GYN and expert in menopause and nutrition. Dr. Haver runs The Menopause Clinic - a practice that specializes in women going through their menopause journey. She is also the author of The New Menopause, where she dives into a self-advocacy approach during the menopause journey. We wanted to bring Dr. Haver to the table to answer some questions the community might have about menopause.

I’m hoping this discussion with her will provide some useful tips and help you feel less alone in your menopause or perimenopause journey.

Q: Why does your hair texture change and how do you help it?

Dr. Mary Claire Haver: So what’s happening hormonally, through perimenopause, is a transition from normal reproductive cycles to full menopause. The estrogen and progesterone levels in perimenopause begin to fluctuate wildly and then in menopause, they both plummet to almost undetectable levels. Both of these hormones can affect not only our hair growth cycles, but the amount of natural oils that are produced that give us our hair’s lustrousness and healthy appearance.

The hormonal changes can also cause the hair shaft to become thinner and more brittle. Our estrogen levels decline and half of our testosterone that is made in our adrenal glands is also affected. So, at the level of the hair follicle, this basically leads to a functional excess of testosterone, and then we can see something like male/female pattern baldness. So during the transition, we see testosterone dominance where testosterone is higher because there's no estrogen to oppose it.

Q: How do you manage the change in hormones?

Dr. Mary Claire Haver: You need a physician's help to do this - but going in knowing what you want to ask for is key. There's some emerging science coming out on women who are treated with hormone therapy in the form of estrogen plus or minus progesterone, and it looks at their patterns of hair health throughout the menopause transition if they're treated. Theoretically, women who are on hormone therapy during perimenopause and into menopause will have less hair loss and hair degradation. Perimenopause is a wonderful time to begin talking to your doctor about hormone therapy.

A second option is pharmacologics that are DHT blockers. Testosterone has to be converted with an enzyme to the actual testosterone derivative that binds to the hair follicle, and we can either block that enzymatic change, or block it at the hair receptor. Something like spironolactone is used for that, and women can recover some of the hair loss from that. But that requires a prescription, so you need to see the doctor so you know if it’s safe for you.

Q: What are your thoughts on Rogaine-type products?

Dr. Mary Claire Haver: The gold standard of therapy - at least in a physician's office - seems to be Minoxidil. It works at the level of the androgen receptor and hair follicle, effectively blocking it. I use Minoxidil myself. I didn't have female pattern baldness, but I did have significant hair loss through my menopause journey.

It is important to note that there are other medical and nutritional conditions that can lead to hair loss, and sometimes it's difficult as a provider to see what exactly is causing hair loss. For example, in patients with hyperthyroidism, we will see changes in the hair follicle, and sometimes hair loss treatment with thyroid hormone to control an overactive thyroid will often resolve that for the patient.

There are also nutritional deficiencies, such as an iron, certain B or D vitamin deficiencies, that can lead to hair loss. There are treatments that try to increase blood flow to the hair follicle and make the scalp a healthier environment to promote hair growth. Treatment for this could also be LED light therapy, or PRP scalp injections.

Q: How do you manage hot flashes?

Dr. Mary Claire Haver: Hot flashes, which 85% of us will have during the menopause transition, can last up to 14 years. Hot flashes can be severely disruptive, especially if you're a super flasher.

The gold standard of treatment is always going to be hormone therapy in the form of estrogen plus or minus progesterone. Again, you need to see your doctor, and hopefully one that is menopause-friendly and knows how to prescribe hormone therapy.

Many studies have been published that look at dietary patterns. From a nutrition standpoint, an anti-inflammatory diet can be really effective at decreasing the amount of hot flashes and menopausal symptoms. The Mediterranean Diet and The Galveston Diet are other healthy patterns of eating

There’s also a couple of supplements that might be helpful for hot flashes. Ashwagandha is one that women have done well on. There are some things you can try, but nothing is going to work better than giving your body back the hormones it needs.

Q: What is your opinion on using pharmacology vs. natural remedies?

Dr. Mary Claire Haver: I think you should use both! Not every woman is going to be a candidate, or choose pharmacology, but she at least deserves an educated conversation on the latest data and research. Then it's her choice. We are bio-diverse individuals and there's no magic bullet that is going to work for everyone. But I think every person needs to understand what their risks are, and then make an informed choice.

When looking for a menopause physician, you need to search for a doctor who is willing to say: there's eastern and western medicine and we need to meet in the middle and recognize that both are beneficial in certain cases.

I have a medical doctorate. But there were significant gaps in my education. One of those gaps was the nuances of menopausal treatment. In my OBGYN residency, it wasn't prioritized. We also learned very little about nutrition, which is why I went back to school to get certified. I felt like I could not serve my patients as well without that background.

Q: Do you have tips for men to help support the women in their lives during this transition?

Dr. Mary Claire Haver: Her body is going through more changes than it did with a potential pregnancy and through puberty. It is something that is not discussed in our society. The first thing you can do is to just talk to her and ask her how she's doing. Ask her what has changed and what she is feeling. So much of our culture is ingrained with the concept that it's all in her head, and that these changes and the way she expresses things is more emotional than physical. Of course there's an emotional component to how our body expresses itself, but remember she's going through some massive physical changes.

They just need your support and understanding, because it's hard enough when she gets dismissed at the doctor's office, and she’s told it's just part of aging and there’s nothing that can be done. There is actually lots of things that we can do. My patients just want their life back. They want to feel like they used to feel. You being supportive of this, and helping her find her way through this journey is going to go so well for your relationship.

A big thanks to Dr. Mary Claire Haver for answering our questions. She’s made a huge impact in our life, and we hope that these answers can help you or someone you love through the menopause journey. Her new book The New Menopause hits shelves on April 30th.