Best Hair Loss Treatments for Women Over 40

For most women over 40, a wider part or thinner hair on top is female pattern hair loss, which often shows up around menopause as estrogen falls. Minoxidil is the treatment to start with. Topical minoxidil is the only FDA-approved drug for this kind of thinning, and in a nine-month trial, low-dose minoxidil pills grew hair in women too. Whether the pill or the foam fits you depends on your scalp, your routine and your heart health. If your results stall, you can add spironolactone or microneedling.

Why is my hair getting thinner after 40?

Menopause usually arrives between 45 and 55 as estrogen falls. Estrogen helps keep hairs in their growing phase, and postmenopausal women have fewer growing hairs, especially toward the front of the scalp.

Female pattern hair loss thins the top of the head and leaves the front hairline in place. It often first shows during menopause, and most women who have it have normal testosterone levels. It is common. Over half of postmenopausal women have some hair loss, so if your ponytail feels thinner, you have a lot of company.

Some hair loss has a different cause from slow thinning on top. This includes hair loss that comes on suddenly, falls out in patches, follows childbirth or has no clear cause. The Women's Rogaine foam label says not to use the foam in those cases, so tell your clinical team how your hair loss started.

Slow thinning usually doesn't call for blood tests. Testosterone and prolactin checks can make sense if you also have irregular periods, bad acne or new facial hair.

Which hair loss treatment works best for women over 40?

Minoxidil is the base treatment. Spironolactone and microneedling are add-ons for when minoxidil alone isn't doing enough. HRT and supplements haven't been shown to treat this kind of thinning.

Should I take minoxidil as a pill or use the foam?

Pick the one you will keep using every day. Both forms grew hair in women, and the trial comparing them didn't show either one coming out ahead.

The foam takes some routine. According to the label:

• It goes on your scalp rather than your hair.
• It stays on for about four hours before you wash.
• It needs two to four hours to dry before bed.
• It is flammable while it's wet.

Topical minoxidil can also feel heavy. One woman wrote that it coats her hair so thickly she ends up "double and sometimes triple shampooing to get that 'squeaky clean' feeling."

The pill can be a better fit if the foam itches or irritates your scalp, or if you know you'll skip a daily scalp step. The trial researchers suggested pills for women who struggle to keep up with topical minoxidil.

Minoxidil pills call for caution if you have a history of heart disease, so tell your clinical team about your heart health and blood pressure. If minoxidil fits your goal, our clinical team can prescribe it as a pill or for your scalp.

What can I add if minoxidil alone isn't enough?

Dermatologists may add spironolactone to low-dose minoxidil pills when results are disappointing. In one clinic review of 21 women, the combination showed a trend toward more hair density. The difference from minoxidil alone was not statistically significant.

Spironolactone has trade-offs. In the 24-week trial, the group taking minoxidil plus spironolactone reported the most side effects, and 15 of 37 women in that group had changes to their periods. If you take spironolactone, your potassium and other blood salts are checked one week after you start or change the dose. After that, they are checked every three months.

Microneedling done along with minoxidil is the add-on with the strongest trial result in women. The women in that trial still had regular periods and normal hormone levels, though. The result may not carry over the same way if you're past menopause.

How long does minoxidil take to work for women, and what side effects should I expect?

• When you'll see it: Results can show up as early as 3 months. For some women it takes at least 6 months. The label says to stop and check in if nothing has changed by then.
• Early shedding: You may shed more for up to two weeks after you start. The label says this is expected and temporary.
• What new hair looks like: New hair can come in soft and fine at first, then match the rest of your hair.
• Keeping the results: You need to keep using minoxidil to keep the new hair. If you stop, you'll probably lose it within three to four months.
• Unwanted hair: Some women grow unwanted facial or body hair. One woman using topical minoxidil said, "I now shave my face monthly." Another woman wrote: "even if I turn into a little monkey as long as I have hair on my head I don't care." The label says unwanted hair caused by the foam should fade after you stop.
• When to stop and call: Stop and contact your clinical team if you get any of these: chest pain, a racing heartbeat, faintness or dizziness, sudden weight gain, or swollen hands or feet.

You want your part to look fuller and your ponytail to feel thicker again. Take the quiz so your clinical team can see whether minoxidil, as a pill or for your scalp, fits your hair, your routine and your health.