Intended for healthcare professionals

Letters Non-hormone treatment of menopause symptoms

Hair loss is an important symptom of the menopause

BMJ 2018; 360 doi: (Published 24 January 2018) Cite this as: BMJ 2018;360:k245
  1. Amr Salam, dermatology registrar,
  2. Christos Tziotzios, dermatology registrar,
  3. David A Fenton, consultant dermatologist
  1. St John’s Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London SE1 9RT, UK
  1. aas596{at}

Hickey and colleagues provide a comprehensive overview of non-hormonal treatments for menopausal symptoms.1 But they do not discuss female pattern hair loss (FPHL), also referred to as androgenetic alopecia, which many women experience around menopause.

FPHL is the most common cause of hair loss in women. It is a non-scarring alopecia that typically presents with progressive hair thinning at the vertex of the scalp, with sparing of the frontal hairline. It can occur at any time after puberty, but most commonly begins at, or soon after, menopause.2 The considerable psychological distress associated with hair loss is well recognised. Symptoms of depression, anxiety, low self-esteem, and obsessional behaviour have been commonly associated with FPHL.3

Although the role of androgens and genetic susceptibility is recognised in male pattern hair loss, it is less well understood in FPHL. The majority of women with FPHL have neither clinical nor biochemical features of hyperandrogenism.4

Clinicians should be aware of non-hormonal treatments for this condition. The strongest body of evidence supports the use of topical minoxidil—a safe, effective, non-hormonal treatment. This is available over the counter in 2% (lotion) and 5% (lotion or foam) preparations and is the only licensed treatment for FPHL.

The exact mechanism of action of topical minoxidil is not known. Its efficacy for producing clinically significant hair regrowth, however, is well documented in a systematic review and meta-analysis of randomised controlled trials.5 Patients may not see an effect in the first four months of treatment, but should use it for at least 12 months before concluding inefficacy.


  • Competing interests: None declared.


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