From the Research
For perimenopausal women with a history of endometriosis experiencing hair loss, hormone replacement therapy (HRT) with estrogen and progesterone is often the first-line treatment, as declining estrogen levels during perimenopause can contribute to hair thinning, as suggested by the most recent study 1.
Treatment Options
- A typical regimen might include transdermal estradiol (0.05 mg/day patch) combined with oral micronized progesterone (100-200 mg daily) to protect the uterine lining.
- Topical minoxidil 5% solution applied twice daily to the scalp is also effective and can be used alongside HRT.
- For women with more severe hair loss, oral minoxidil at low doses (0.25-1 mg daily) may be considered under close medical supervision.
- Spironolactone (50-200 mg daily) can help by blocking androgens that contribute to hair loss, but requires monitoring of potassium levels.
Considerations for Endometriosis
- Given the history of endometriosis, it's crucial to work with both a gynecologist and dermatologist, as endometriosis can be estrogen-dependent, and hormone therapy must be carefully balanced, as noted in 2 and 1.
- The risk of recurrence with hormone therapy is probably increased in women with residual disease after surgery, as mentioned in 3 and 4.
Additional Support
- Nutritional support with iron, vitamin D, zinc, and biotin supplements may help if deficiencies are present.
- Addressing stress through mindfulness practices and ensuring adequate sleep are important complementary approaches, as stress can exacerbate both hair loss and endometriosis symptoms.
Key Recommendations
- Estrogen-only HRT should be avoided, and combined HRT preparations should be recommended, even after a hysterectomy, as advised in 1.
- Women should be advised of the possibility of reactivation of symptoms of endometriosis or its lesions and the theoretical possibility of malignant transformation before starting HRT after the age of natural menopause, as discussed in 3 and 1.