Eyelash Thinning in Perimenopause: Causes and Treatments

Why Your Eyelashes Might Look Thinner in Perimenopause

Estrogen and progesterone influence many tissues throughout the body, including hair follicles. As these hormones fluctuate during the transition to menopause, changes in the appearance of eyelash hair are common.

These changes can look like:

• Mascara not creating the same fullness or length.

• Lashes appearing less dense.

• Lost lashes seeming slower to grow back.

When these changes are a part of perimenopause, they will usually develop gradually along with other skin and hair changes associated with the transition.

When these changes are a part of perimenopause, they will usually develop gradually along with other skin and hair changes associated with the transition.

As a menopausal woman myself, this was yet another thing that surprised me about the changes brought on by menopause even though I knew a lot about menopause and the effects of hormones on almost every system in our bodies.

The Eyelash Growth Cycle

Eyelashes are like any other hair on the body and go through growth, transition, and resting phases. The eyelash growth phase, known as anagen, is relatively short and typically lasts only one to two months. In comparison, scalp hair can remain in its growth phase for several years. Because eyelashes already have a limited window to grow, even small changes in the growth cycle may affect their length and density.

Eyelashes naturally shed and regrow throughout a person’s life, but if the rate of regrowth becomes slower, lashes can look thinner as time goes on.

Estrogen Decline and Hair Follicles

Research suggests that estrogen is involved in normal hair follicle functioning. As estrogen levels decline, follicles may spend less time in their active growth phase and more time in resting phases. Changes in the balance between estrogen and androgens after menopause may also affect hair growth patterns. However, although eyelashes are similar biologically, most of this research comes from studies of scalp hair, and more specific research is needed.

How Lash Thinning Differs from Scalp Hair Loss

During menopause, scalp hair loss often appears as widening of the part line or thinning over the crown of the head. Eyelashes usually do not disappear entirely, but instead they will start to appear finer, shorter, or less dense. Other medical conditions can also cause thinning and loss of eyelashes and some conditions affect eyebrows and eyelashes more prominently than scalp hair. One example is frontal fibrosing alopecia which is seen primarily in postmenopausal women.

Other Reasons Eyelashes May Thin in Midlife

Although hormonal changes do influence the appearance of eyelashes during menopause, they are not the only possible explanation.

Other reasons for eyelash changes are:

• Thyroid disorders

• Medications

• Certain autoimmune conditions and inflammatory skin diseases

• Mechanical damage from repeated rubbing, lash extensions, or aggressive makeup removal

• Nutritional deficiencies that can occur with rapid or significant weight loss or after a significant illness

In many cases, more than one factor may be contributing at the same time. If you notice other new symptoms, it is important to have these conditions evaluated, ruled out or reviewed - more about this below.

Treatments That May Support Lash Growth

A variety of products are marketed for thinning eyelashes, but they are not supported by the same level of evidence.

Prescription bimatoprost (Latisse) is the most extensively studied treatment for eyelash growth and is FDA approved for eyelash hypotrichosis (sparse, thin, or insufficient eyelashes ). It works by extending the active growth phase of the eyelash follicle.

Some over-the-counter products contain prostaglandin analogues such as isopropyl cloprostenate. These ingredients may be helpful for some minor eyelash growth, but they have not undergone the same FDA review process as prescription bimatoprost. Other products focus on conditioning lashes with moisturizing ingredients. These formulations may reduce breakage and improve lash appearance but have not been shown to help with any new growth.

Supporting the Skin Around the Eyes During Menopause

Declining estrogen is associated with collagen loss and thinner, less elastic skin. The skin around the eyes is delicate and changes in this area can sometimes make eyelashes appear less prominent. Moisturizing the skin around the eyes can help improve the appearance of this area.

Generic Latisse (Bimatoprost 0.03%)

Among prescription options, bimatoprost has been studied more extensively than any other treatment for eyelash growth. Bimatoprost is the only FDA-approved treatment for eyelash hypotrichosis. It works by increasing the number of follicles in the active growth phase and extending how long that phase lasts. The medication is applied nightly to the upper lash line. Improvement may begin after about two months, with maximal results typically seen around four months and continued use is required to maintain results.

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Important Safety Information for Bimatoprost

Common side effects include eye redness, irritation, itching, and dry eyes. Skin darkening around the eyes may occur and is generally reversible. Changes in eye pigmentation may occur, especially for those with lighter colored eyes, and can be permanent. Application must be even to ensure even growth. Soft contact lenses should be removed before application and can be reinserted 15 minutes later.

When to Talk with a Clinician About Lash Loss

Gradual thinning, reduced density, and slower regrowth are often less concerning and may occur as part of normal aging or menopause-related changes. Sudden lash loss, patchy areas of loss, concurrent eyebrow thinning, significant scalp hair loss, or eyelid inflammation should be evaluated by a clinician. A clinician may review medications, health history, hormone changes, and other possible causes. Thinning of the eyelashes can occur along with other menopause-related changes in the skin and hair, which can make it difficult to determine whether hormones, aging, an underlying condition, or several factors together are contributing to the change.

During menopause, concerns about hair, skin, and aging are often interconnected and finding the right treatment means finding someone who understands the full picture. Women in midlife have different clinical needs than earlier in life and should be treated on an individual basis by an expert in midlife care. Access to care is easier than ever at Alloy with menopause-informed physicians who understand that eyelash thinning during midlife may be occurring along with other changes and should be addressed by looking at your overall health and wellbeing. For women interested in treatment, Alloy offers bimatoprost, the only FDA-approved treatment proven to regrow eyelashes.

Frequently Asked Questions

How does estrogen decline cause eyelash thinning during perimenopause?

Estrogen and progesterone play an important role in the normal functioning of hair follicles throughout the body. As estrogen levels drop during the transition to menopause, hair follicles can shift their behavior, spending less time in the active growth phase—known as the anagen phase—and more time in the resting phases. Because eyelashes already have a naturally limited growth window of just one to two months, this hormonal shift slows down the rate of regrowth. Over time, this causes the lashes to gradually appear finer, shorter, and less dense than they did earlier in life.

What factors other than hormonal changes can cause eyelashes to thin out during midlife?

While fluctuating hormones are a primary culprit, eyelash changes during midlife are often interconnected with other factors. Underlying medical issues such as thyroid disorders, inflammatory skin diseases, and certain autoimmune conditions can cause thinning. Mechanical damage from repeated eye rubbing, lash extensions, or aggressive makeup removal can also break or pull out fragile hairs. Additionally, specific medications and nutritional deficiencies brought on by a significant illness or rapid weight loss can further contribute to a less dense lash line.

How does prescription bimatoprost treat thinning lashes, and what are its side effects?

Prescription bimatoprost is the only FDA-approved treatment for sparse or insufficient eyelashes. It addresses thinning by increasing the total number of eyelash follicles in the active growth phase and extending the duration of that phase. When applied nightly to the upper lash line, users generally begin to see changes after two months, with full results appearing around four months. Potential side effects include eye redness, irritation, itching, dry eyes, and a generally reversible darkening of the skin around the eyes. It can also cause changes in eye pigmentation, which may be permanent, especially for individuals with lighter-colored eyes.

References

Zouboulis CC, Blume-Peytavi U, Kosmadaki M, et al. Skin, hair and beyond: the impact of menopause. Climacteric. 2022;25(5):434-442. doi:10.1080/13697137.2022.2050206

Kamp E, Ashraf M, Musbahi E, DeGiovanni C. Menopause, skin and common dermatoses. Part 1: hair disorders. Clin Exp Dermatol. 2022;47(12):2110-2116. doi:10.1111/ced.15357

Yoldemir T. Postmenopausal hyperandrogenism. Climacteric. 2022;25(2):109-117. doi:10.1080/13697137.2021.1915273

Vañó-Galván S, Molina-Ruiz AM, Serrano-Falcón C, et al. Frontal fibrosing alopecia: a multicenter review of 355 patients. J Am Acad Dermatol. 2014;70(4):670-678. doi:10.1016/j.jaad.2013.12.003

del Ghianda S, Tonacchera M, Vitti P. Thyroid and menopause. Climacteric. 2014;17(3):225-234. doi:10.3109/13697137.2013.838554

Alonso MR, Pérez Damonte S, Anesini C. Jarilla-Coffea extract: a natural cosmetic product that improves eyelash and eyebrow growth in women. Clin Cosmet Investig Dermatol. 2019;12:47-55. doi:10.2147/CCID.S189742

Bimatoprost Prescribing Information. Current FDA-approved prescribing information for bimatoprost ophthalmic solution 0.03%.