Female Hair Loss in Perimenopause: Comprehensive Evaluation and Treatment in Katy and Houston, Texas
Hair thinning in women approaching menopause is common but often misunderstood. Hormonal shifts, nutritional deficiencies, postpartum changes, and genetic predisposition can all contribute to progressive hair loss. At Reena Jogi, MD, we provide thorough evaluation and personalized treatment plans for women experiencing scalp hair thinning in Katy and Houston, Texas.
This case highlights a 48-year-old female presenting with chronic hair loss and scalp flaking.
Patient Presentation
A 48-year-old female, new patient, presented with:
Moderate severity
Gradual onset over several years
No associated itching, burning, or pain
No prior treatment
She reported that hair thinning began after childbirth 8 years ago and had gradually worsened. She also noted absence of menstrual cycles for over one year, suggesting possible perimenopause or menopause, though she had not yet been formally evaluated.
Physical Examination
Scalp examination revealed:
Widened midline part
Preservation of the frontal hairline
No signs of scarring alopecia
Findings were most consistent with androgenetic alopecia (female pattern hair loss).
She was otherwise well-appearing, alert, oriented, and in no acute distress.
Diagnosis
Androgenetic Alopecia
Diffuse non-scarring female pattern hair loss.
Seborrheic Dermatitis
Chronic inflammatory scalp condition contributing to flaking and scalp irritation.
Comprehensive Laboratory Evaluation
Given the patient’s age, menopausal symptoms, and chronic hair thinning, a broad laboratory workup was ordered to evaluate:
Iron studies (Iron, TIBC, Ferritin)
Thyroid function (TSH + Free T4)
Vitamin D
Vitamin B12 and Folate
Zinc
CBC and metabolic panel
DHEA-S
Testosterone (Free and Total)
FSH, LH, Estradiol
Progesterone
Prolactin
Morning cortisol
This allows evaluation of hormonal shifts, thyroid dysfunction, iron deficiency, nutritional deficiencies, and metabolic contributors to hair loss.
Treatment Plan for Female Pattern Hair Loss
After extensive counseling, the patient elected to begin:
Spironolactone 50 mg twice daily
Spironolactone works by blocking androgen receptors and reducing the hormonal impact on hair follicles.
Counseling Provided
We reviewed:
Potential side effects including breast tenderness, fatigue, menstrual irregularities
Risk of hyperkalemia
Need for potassium monitoring in select patients
Pregnancy prevention in women of childbearing potential
Timeline for improvement (typically 3–6 months minimum)
Baseline photographs were obtained for comparison.
The patient expressed hesitation about oral minoxidil due to concerns about initial shedding (“dread shed”), so this was deferred for now.
Additional Hair Loss Options Reviewed
We discussed:
Topical Rogaine® 5% solution twice daily
Nutraceuticals including Nutrafol® and Votesse®
Low-level laser therapy caps (such as Revian)
PRP pricing and maintenance expectations were reviewed in detail.
Seborrheic Dermatitis Treatment
The patient also had seborrheic dermatitis of the scalp, which can worsen perceived hair shedding.
Prescribed:
Ketoconazole 2% shampoo (1–3 times weekly; leave on 5–10 minutes before rinsing)
Fluocinonide 0.05% solution for severe flares only
Counseling included:
Chronic, relapsing nature of seborrheic dermatitis
Use of medicated shampoos for maintenance
Avoiding prolonged high-potency steroid use
Follow-Up Plan
Complete lab testing 2 weeks after spironolactone initiation
Follow-up in 3 months for hair evaluation
Follow-up in 4 weeks for seborrheic dermatitis
Expert Hair Loss Treatment in Katy and Houston, Texas
Hair loss during perimenopause and menopause requires a thoughtful and comprehensive approach. At Reena Jogi, MD, we evaluate hormonal, nutritional, and inflammatory contributors to hair thinning and create individualized treatment plans for women in Katy and Houston, Texas.
If you are experiencing diffuse hair thinning, scalp flaking, or menopausal hair changes, schedule a consultation for expert evaluation.
