Finding peace with menopause part 3: Hair loss and hair thinning
- Nebulla Stephen
- Sep 4, 2025
- 2 min read
I remember my first year working in breast oncology listening to a patient share very vividly the experience she had of her hair falling out after starting letrozole, a medication for hormone positive breast cancer. She was so distressed, angry, and said how hopeless she felt. I was extremely naive and found myself at a loss for words. Did everyone have hair loss? Will she stop taking her medication because of this? I found in my deep dive that yes medications like letrozole do lead to hair loss because of overall hormone drop in estrogen. Menopause is also a huge factor in loss of estrogen, and a majority of women experience some form of hair loss. I found myself feeling at a loss for this patient, and went to find out what kinds of resources were available. Only thing that was FDA approved was topical minoxidil, better known as Rogaine. So I felt happy that I had some news for her, and called her back the next day with the recommendation to start it. My little heart grew slightly when she said hadn’t heard of it, and would give it a try.
Fast forward to my last year after completing chemotherapy and radiation. Cold capping had prevented loss of all my hair, but it was ravaged. I was still having hair fall out after I started receiving medications to put me into menopause and lower all of the estrogen in my body. This wasn’t an elegant little shed, it was huge nests of hair loss. The worst part was I started to use minoxidil everyday after I completed radiation, knowing that it would take at least 2-3 months before I saw any improvements. But after I was 8 months out after chemo with so much continued hair loss, and tears every-time I washed my hair I reached out to a dermatologist. It took a long time to get an appointment, but when I finally met with her she was very understanding and discussed options that were off label treatment. At this point I felt desperate to start feeling normal again, so I could look at myself in the mirror and not start crying. She ended up prescribing me with low dose oral minoxidil, and reminded me to keep up with good nutrition and water intake. It’s the same topical medication I was using, and was originally meant to be used for blood pressure. The unintended side effect was hair growth. With hair loss being such a high side effect for patients on medications like letrozole I do hope there will be more research and work into mitigating these symptoms.
Now I appreciate the level of distress my patient experienced when she was suffering from rapid hair loss. I also hope that more oncologists can start from a place of anticipating this as a problem for patients, and more of our co-workers in dermatology can do some teaching/training especially around managing hair loss due to breast cancer treatment. My experience has colored my practice, and now I am discussing hair loss openly with some solutions that are available to patients. But I also had to start thinking about how I perceive myself as healthy and beautiful. It’s a process, and something I think most people can relate to.
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