Forum Dermatologicum · Jan 20, 2026
Hair follicle niche in menopause: a systematic review
By Sędziak O, Majchrzak I
Background. Menopause is characterized by systemic estrogen and progesterone deficiencies, often manifesting as a “menopausal hair crisis” or female pattern hair loss (FPHL). This systematic review evaluates the molecular mechanisms of hormonal depletion on hair follicle stem cell (HFSC) niches and the regulatory role of the scalp microbiome. Methods. A systematic search of PubMed, Embase, and Web of Science databases (January 1998–June 2025) was conducted using keywords related to menopause, hair follicle, alopecia, and stem cells. Out of 747 identified records, 50 peer-reviewed studies met the inclusion criteria and were analyzed using a narrative synthesis. Results. Postmenopausal alopecia represents a multifactorial pathology driven by four interconnected pathogenetic axes: a hormonal axis governed by local steroid conversion via 5α-reductase and tissue sensitivity rather than absolute serum androgen concentrations; a cellular axis involving the premature senescence of hair follicle stem cells (HFSCs) and dermal papilla cells; a signaling axis marked by a profound homeostatic imbalance between the downregulated Wnt/β-catenin and overactivated transforming growth factor beta (TGF-β) cascades; and an inflammatory–microbiome axis, wherein menopause-induced biophysical alterations of the skin promote microbial dysbiosis and chronic perifollicular microinflammation. Conclusions. The pathogenesis of postmenopausal hair loss extends far beyond the classical androgen-dependent model. Effective clinical management requires comprehensive, multi-level diagnostic and therapeutic strategies targeting signaling restoration, stem cell niche protection, and the mitigation of localized dysbiosis and microinflammation.