From the Guidelines
The most effective treatment for female androgenetic alopecia in a postmenopausal woman is topical minoxidil 5% solution or foam applied twice daily to the scalp, as it has been shown to prolong the growth phase of hair follicles and increase blood flow to the scalp. When considering treatment options, it's crucial to rule out differential diagnoses such as thyroid gland dysfunction, iron deficiency, and vitamin D or zinc deficiencies through laboratory testing, including thyroid-stimulating hormone (TSH) and free T4, ferritin, vitamin D, and zinc levels 1.
In postmenopausal women, the presentation of female androgenetic alopecia may be similar to endocrine therapy-induced alopecia (EIA), characterized by grade 1 alopecia primarily on the crown of the scalp and recession of the frontal and bitemporal hairline 1. However, the treatment approach remains focused on promoting hair growth and addressing underlying hormonal imbalances.
Key considerations in the treatment of female androgenetic alopecia include:
- Topical minoxidil as first-line therapy
- Potential addition of oral spironolactone if androgen excess is suspected
- Low-level laser therapy devices for additional benefit
- Platelet-rich plasma injections to stimulate hair growth
- Identification and management of underlying causes such as thyroid disorders or iron deficiency through blood tests.
Given the potential for significant psychosocial impact, even mild forms of alopecia should be addressed promptly, and treatment typically requires at least 6-12 months before significant improvement is observed, with continued use necessary to maintain results 1.
From the Research
Treatment Options for Female Androgenetic Alopecia
The appropriate treatment for female androgenetic alopecia (female pattern hair loss) in a postmenopausal woman includes:
- Topical minoxidil, which is the first-line therapy for treating both male and female androgenetic alopecia 2
- The only approved treatment for female pattern hair loss is 2% topical minoxidil, which should be applied at a dosage of 1ml twice a day for a minimum period of 12 months 3
- Low-dose oral minoxidil has also been used as an off-label treatment for non-scarring alopecia, including female pattern hair loss, with successful treatment reported in some cases 4
- Other treatment options include platelet-rich plasma injections, which represent an interesting alternative treatment for androgenetic alopecia, as monotherapy or as an adjuvant treatment 5
Efficacy of Topical Minoxidil
- Topical minoxidil has been shown to be effective in treating female androgenetic alopecia, with an average increase of 23 nonvellus hairs in a 1-cm2 evaluation site after 32 weeks of treatment 6
- The efficacy of topical minoxidil varies by concentration, with concentrations ranging from 0.01% to 15% resulting in hair growth ranging from 17% to 70% 2
- Combination therapies using minoxidil with systemic, topical, and injectable therapies demonstrate increased effectiveness over monotherapies 2