Study shows strong correlation between female pattern hair loss and BMI in postmenopausal women

Contemporary OB/GYN JournalVol 67 No 4
Volume 67
Issue 4

More than half of postmenopausal women experience female pattern hair loss, according to a cross-sectional study in the journal Menopause.

The study was conducted at the Menopause Clinic of King Chulalongkorn Memorial Hospital in Bangkok, Thailand, between November 2018 and May 2019.1

Recruitment included a total of 200 postmenopausal women—aged 50 to 65—all with a 12-month history of amenorrhea or oophorectomy. Researchers excluded women who underwent recent hair loss treatments.

Each participant was evaluated for female pattern hair loss (FPHL), based on Ludwig's classification, using standardized global photography in all 6 views and trichoscopy for hair density and diameter.

A team of 3 dermatologists reevaluated all pictures to confirm FPHL, assessing 178 postmenopausal women for hair-loss patterns. The average age was 58.8 years and the time since menopause was 9.2 years.

A total of 82% of these participants had never used menopausal hormone therapy (MHT), while 5% were current MHT users. In addition, 4% of women had diabetes mellitus, 2% had a history of polycystic ovary syndrome (PCOS), and 8% had thyroid diseases.

The prevalence of FPHL was 52.2%, whereas the severity of FPHL by Ludwig grades 1, 2, and 3 were 73.2%, 22.6% and 4.3%, respectively.

Low self-esteem was a common factor that increased with FHPL severity, detected in 60% of the women. All women with Ludwig 3, in fact, indicated low self-esteem.

The median of total and terminal hair density in the FPHL group was significantly lower than in the normal hair group. The median of vellus hair density in the FPHL group, however, was significantly higher than in the normal hair group at the mid-scalp area.

After stratifying based on age and time since menopause, the study showed that frequency of FPHL increased with age in postmenopausal women. At first, significant factors for FPHL included age, time since menopause, and body mass index (BMI).

After adjusting for age and family history of FPHL, only BMI (≥25 kg/m2) was significantly connected to FPHL—adjusted odds ratio (aOR) = 2.65; 95% confidence interval (CI): 1.23 to 5.70.

The authors attribute their findings to the pathophysiological changes in FPHL involving progressive miniaturization of hair follicles and subsequent conversion of terminal follicles into vellus-like follicles.

“These vellus-like follicles have a shortened hair cycle and undergo a reduction in the anagen phase, which leads to short and fine hair shaft production,” they wrote, noting that by age 50, gradual diffuse thinning of scalp hair is already occurring.

The study showed alterations in hair growth and a progressive increase in hair-loss diameter, pigmentation, and scalp hair thinning, thus indicating a strong correlation between FPHL and menopause.

Hair loss in women is polygenic and multifactorial and can be influenced by environmental factors, according to the authors. They noted that the pathophysiology of FPHL has yet to be fully elucidated.

Because of the high prevalence of FPHL among postmenopausal women, the authors advocate hair loss awareness in menopause clinics. “Early detection and proper treatment of FPHL may increase the quality of life in postmenopausal women,” they wrote.

Additional studies are needed to determine whether sex steroid hormones and a history of PCOS are related to hair loss in postmenopausal women. Results could help gynecologists select appropriate MHT regimens for these women.


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