One of the most visible signs of ageing is the gradual change in hair. While many people associate menopause with hot flushes, mood changes and the end of monthly periods, fewer realise that it also affects hair growth, colour and texture.
For many women, these changes can be surprising and even distressing, but they are a normal part of the menopausal transition.
Dr Maina Muriithi, an obstetrician-gynaecologist at Aga Khan University Hospital, explains that as oestrogen levels decline, several organs, including the skin and hair follicles, begin to respond to these changes.
“Hair naturally grows through a continuous cycle of growth, transition and rest. Melanocytes, cells responsible for the production of hair colour, are prone to ageing, and this is why we see a change in hair colour as we age. These cells are affected by multiple factors, from climatic conditions to hormonal changes in the body, especially those that come with ageing that affect their production,” he says.
“The effects on body hair are not restricted to the hair on the scalp, and so it is not surprising that hair around the armpits, eyebrows and genitals undergoes the same changes.”
“Menopause is like a mirror to the ageing process. Blood flow to hair follicles decreases, the same as does the density of melanin-producing cells in hair follicles. The decrease in blood flow affects delivery of essential nutrients to hair follicles and increases susceptibility to damage by ultraviolet radiation and substances we call free oxygen radicals.”
However, he notes that not all women will experience changes in their hair during menopause in the same way. Some women notice only a few grey strands, while others experience more pronounced thinning over several years.
Besides hormonal influences, other factors such as genetics, stress, diet, and microbiome can affect hair health.
“There is no fixed age when hair begins to change. It happens gradually. What starts as a single grey strand may slowly spread until larger patches become noticeable before the hair eventually turns predominantly grey.”
Dr Maina Muriithi, an obstetrician-gynaecologist at the Aga Khan Hospital.
Photo credit: Pool
However, many of the hormonal changes that influence hair become more pronounced after the age of 40, when oestrogen levels begin to decline more rapidly.
Additionally, many women notice that their once-thick hair becomes finer, more fragile and breaks more easily.
Dr Muriithi explains that this happens because ageing slows the activity of hair follicles. At the same time, lower oestrogen levels make the effects of naturally occurring male hormones, known as androgens, relatively more noticeable.
“This may increase hair shedding, reduce hair density and, in some women, lead to the growth of coarse hairs on the chin or upper lip,” he adds.
"The strands become thinner, and fewer hair follicles continue producing hair," he says. "This leads to the sparseness that many women notice in areas that were previously more densely covered."
Although gradual greying and thinning are expected with age, Dr Muriithi cautions that some hair changes should not be ignored.
Premature greying, severe hair loss, rapid-onset bald patches or excessive facial hair growth may point to nutritional deficiencies like B12, zinc and iron: Also, thyroid disease, autoimmune disorders or hormonal conditions require assessment by a healthcare provider. Some autoimmune diseases, in which the body's immune system attacks its own cells, as well as infections such as ringworm, can also cause patchy hair loss, known as alopecia.
So, does greying or thinning pubic hair have any impact on intimate health? “No. The pubic hair helps protect the sensitive genital skin by trapping dust and other environmental particles, provides cushioning and reduces friction during intimacy and other physical activities," he explains.
While shaving or waxing remains a personal grooming choice influenced by cosmetic or cultural appeal, removing pubic hair also removes some of these natural protective functions.
He encourages women to make informed grooming decisions based on their own comfort, hygiene and personal preference rather than the misconception that pubic hair serves no biological role.
Still, Dr Muriithi reassures women that the once-thick locks may feel thinner; previously manageable hair becomes dry and brittle, and styling routines that worked for decades suddenly seem ineffective as part of the menopausal transition.
“The oestrogen component in HRT is quite essential in the growth of hair follicles and skin changes that support healthy hair. However, HRT is not recommended solely for hair changes but for many other systemic symptoms of menopause and in women who meet the requirements for HRT use and have no contraindication to its use,” he says.
