Zhuo Huang,1
Ming-Hui Bi- 1 Xiamen Hospital of Traditional Chinese Medicine, Xiamen, Fujian, China
- 2 The Second People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China
Menopause is a natural physiological transition affecting over one billion women globally. It often brings distressing symptoms, including hair loss, which impacts up to 52% of postmenopausal women due to estrogen decline, increased androgen sensitivity, and oxidative stress. Conventional treatments like minoxidil provide limited efficacy and may cause side effects, underscoring the need for accessible, culturally attuned alternatives. This mini-review explores ethnopharmacological approaches that empower women through traditional remedies targeting multi-mechanistic pathways, supported by emerging clinical data. We conducted a systematic literature search across databases (PubMed, Scopus, Web of Science), focusing on studies from 2015 to 2025 involving botanical interventions. We prioritized randomized controlled trials in vitro studies, and animal models. Key remedies include saw palmetto (Serenoa repens), which inhibits 5α-reductase to reduce dihydrotestosterone by approximately 30%–40%; rosemary oil (Salvia rosmarinus Spenn.), which promotes scalp microcirculation similar to minoxidil; and ginseng (Panax ginseng C.A.Mey.), which enhances follicle proliferation via ginsenosides. Emerging evidence from 2024 to 2025 reviews highlights multi-target mechanisms in plant extracts, including phytoestrogenic and anti-inflammatory effects. Nutraceuticals have demonstrated improved hair density in menopausal cohorts. These low-cost, community-rooted therapies foster women’s autonomy and cultural resilience. This mini-review is not comprehensive; it highlights key challenges in current research, such as limited menopausal-specific evidence and standardization gaps. It advocates for future priorities like interdisciplinary trials integrating ethnobotany with modern pharmacology to bridge global health disparities. This aligns with the special issue’s vision of empowering women through sustainable, nature-based solutions.
1 Introduction
Menopause marks a pivotal physiological transition in women’s lives. It is characterized by the cessation of ovarian function and a decline in estrogen levels. By 2030, it will affect over 1.2 billion women worldwide (Spector et al., 2024). This natural process typically occurs between ages 45 and 55, bringing a cascade of symptoms beyond well-known vasomotor disturbances like hot flashes and night sweats, which profoundly impact quality of life (Andrews et al., 2024). Among them, hair loss—often as female pattern hair loss (FPHL) or diffuse thinning—is a subtle yet pervasive challenge that erodes women’s self-esteem, social confidence, and emotional wellbeing (Young Moss et al., 2025). Studies show that up to 52% of postmenopausal women experience noticeable hair thinning, underscoring its status as an underrecognized menopausal burden (Shannon et al., 2015; Chaikittisilpa et al., 2022; Ho et al., 2023). Prevalence varies globally due to genetics, diet, and environment, and the symptom can intensify psychological distress, elevating risks of depression and anxiety while compounding socioeconomic disparities in women’s health equity (Malta and Corso, 2025).
Conventional management strategies, such as topical minoxidil or hormone replacement therapy (HRT), offer partial relief but face limitations, including Side effects like scalp irritation and cardiovascular risks. Long-term adherence is often poor, especially in diverse global contexts (Dakkak et al., 2024). This gap highlights the potential of ethnopharmacology, rooted in traditional knowledge systems of various ethnic or cultural groups, to provide accessible, culturally resonant alternatives that empower women to reclaim agency over their health (Shin et al., 2020; Kesika et al., 2023; Elnady et al., 2025). Traditional remedies range from Ayurvedic bhringraj oils in India to Mediterranean rosemary infusions and African shea butter formulations. They have long addressed hair vitality through multi-target mechanisms, such as phytoestrogen modulation and anti-inflammatory action (Ezekwe et al., 2020; Ahmed et al., 2025). While promising, botanical remedies do not achieve complete hair regrowth, as indicated by current clinical evidence (Elnady et al., 2025). Recent reviews emphasize HRT’s role in symptom mitigation; however, few integrate global ethnobotanical perspectives, overlooking how community-sourced therapies foster resilience and autonomy in underserved populations (Nappi et al., 2021).
This mini-review addresses these gaps by synthesizing evidence on ethnopharmacological interventions for menopausal hair loss, using a global health lens that prioritizes women’s empowerment. It draws from diverse traditions, such as Asian ginseng extracts, European nettle root and American saw palmetto, elucidating mechanisms, efficacy, and safety profiles. It advocates for equitable research to bridge cultural and economic divides. This work aligns with the special issue’s focus on “Global Health Perspectives on Empowering Women.” Demonstrating how revitalizing ancestral remedies can transform menopause into a phase of holistic flourishing.
Given the breadth of global ethnopharmacology, this mini-review does not aim for exhaustive coverage. It selects representative botanical drugs to underscore key research challenges, including a paucity of large-scale, menopausal-focused trials. It outlines future needs, such as standardized formulations and equitable community-engaged studies, aligning with the special issue’s focus on empowering women through sustainable solutions.
2 Methodology
This mini-review adopts a systematic approach, prioritizing narrative synthesis of select studies to highlight evidence gaps and research priorities. It does not include a full meta-analysis due to heterogeneity. We searched electronic databases, including PubMed, Scopus, and Web of Science. The search covered studies published between January 2015 and November 2025. The strategy used keywords and MeSH terms such as “menopausal hair loss,” “female pattern hair loss,” “ethnopharmacology,” “traditional medicine,” “botanical drug remedies,” “phytoestrogens,” “hair follicle,” and “women’s health.” We combined them with Boolean operators (e.g., AND, OR). We also searched gray literature sources like Google Scholar and ethnobotanical databases (e.g., NAPRALERT) for non-indexed publications, and hand-searched reference lists of included articles and relevant reviews for additional studies.
Inclusion criteria focused on studies evaluating plant-based or traditional remedies for hair loss in menopausal or postmenopausal women, including RCTs, in vitro experiments, animal models, observational studies, and ethnopharmacological surveys. We prioritized human trials but included preclinical data for mechanistic insights. Exclusion criteria included non-English articles, studies on non-menopausal hair loss (e.g., chemotherapy-induced), synthetic pharmaceuticals without botanical components, and low-quality case reports. Two reviewers independently screened titles and abstracts, assessed full texts for eligibility, and resolved discrepancies through discussion. The selection process is illustrated in Figure 1, a PRISMA-style flow diagram showing records identified (n = 520), screened (n = 420 after duplicates), excluded (n = 367, e.g., non-English n = 50, irrelevant n = 132, non-menopausal n = 107), and included (n = 78).
Figure 1. PRISMA-inspired flow diagram for literature selection.
Data extraction included key details on remedies (e.g., plant species, active metabolites), mechanisms, efficacy outcomes (e.g., hair density, shedding rates), safety profiles, and cultural contexts. We appraised evidence quality using tools like GRADE for clinical trials and STROBE for observational studies. Formal meta-analysis was not performed due to heterogeneity. Synthesis was narrative, grouped by geographic regions and themes, emphasizing global perspectives on women’s empowerment. A total of 78 studies were included, providing a comprehensive overview while highlighting research gaps.
3 Pathophysiology and epidemiology of menopausal hair loss
Menopausal hair loss primarily manifests as female pattern hair loss (FPHL) or telogen effluvium, arising from intricate hormonal and physiological changes during the menopausal transition (Fabbrocini et al., 2018; Gupta et al., 2025). The pathophysiology is driven by a sharp decline in estrogen levels, which disrupts the hair growth cycle by shortening the anagen (growth) phase and extending the telogen (resting/shedding) phase, leading to increased hair shedding and reduced density (Gupta et al., 2025; Rinaldi et al., 2023). Relative androgen dominance also plays a role, exacerbated by the conversion of testosterone to DHT via 5α-reductase, promoting follicular miniaturization. Terminal hairs transform into finer vellus hairs, especially in androgen-sensitive scalp regions like the frontal and vertex areas (Gupta et al., 2025; Grymowicz et al., 2020; Perez et al., 2024). Oxidative stress and inflammation, intensified by estrogen withdrawal, impair scalp microcirculation and nutrient delivery to hair follicles, contributing to atrophy and altered hair characteristics, such as decreased caliber and pigmentation (Rinaldi et al., 2023). Genetic predisposition (e.g., polymorphisms in androgen receptor genes) and metabolic changes like insulin resistance amplify these effects, distinguishing menopausal hair loss from age-related thinning (Rinaldi et al., 2023). Comorbidities like thyroid dysfunction or iron deficiency, common in perimenopause, can worsen the condition (Hussein et al., 2023; Lin et al., 2023).
Epidemiologically, menopausal hair loss affects a substantial proportion of women globally, with prevalence increasing with age and hormonal status. Studies estimate that clinically detectable FPHL emerges in 12% of women by age 29, rising to 25% by age 49, 41% by age 69, and exceeding 50% in those over 70, highlighting a strong association with postmenopausal years (Fabbrocini et al., 2018). In postmenopausal cohorts, prevalence reaches up to 52.2%, with a mean age of onset around 58 years (Chaikittisilpa et al., 2022; Ho et al., 2023). Regional variations exist: In Western populations (e.g., Europe and North America), rates are 40%–50% among perimenopausal and postmenopausal women, influenced by diagnostic awareness and genetic factors like Caucasian ethnicity (Shannon et al., 2015). Asian populations show lower prevalence, around 6%–12% across ages, with rates as low as 1.3% in younger groups but increasing postmenopausally, possibly due to protective dietary elements like phytoestrogens (Besong et al., 2024). In low-resource settings like parts of Africa and Latin America, underreporting likely masks higher burdens, with nutritional deficiencies and chronic stress potentially elevating risks to 40%–60%, exacerbating global health inequities (Rinaldi et al., 2023; Goluch-Koniuszy, 2016). Overall, FPHL accounts for nearly 49% of female alopecia cases over a lifetime, with socioeconomic factors like access to care widening disparities.
These insights underscore the need for targeted interventions, especially in diverse global contexts where conventional therapies fall short. Ethnopharmacological approaches, drawing from traditional knowledge, offer holistic ways to address these mechanisms, as explored below.
4 Ethnopharmacological approaches: a global overview
Ethnopharmacological traditions worldwide offer diverse, multi-target botanical drugs for menopausal hair loss, rooted in cultural practices and supported by primary ethnobotanical references. This section synthesizes representative remedies by region, emphasizing traditional contexts and evidence. It highlights how these approaches empower women through accessible, community-based solutions (see Table 1 for regional summaries; Table 2 for detailed pharmacological data, including mechanisms, efficacy, and limitations).
Table 1. Key ethnopharmacological remedies for menopausal hair loss by region.
Table 2. Detailed pharmacological data for key remedies.
4.1 Asia: traditional chinese medicine and ayurveda
In Asia, Traditional Chinese Medicine (TCM) and Ayurveda use botanical remedies like ginseng and bhringraj to promote hair vitality, traditionally viewed as ways to balance vital energies such as qi or doshas to support women’s holistic health during menopause (Shin et al., 2020; Kesika et al., 2023). Panax ginseng C.A.Mey. [Araliaceae; Ginseng radix et rhizoma] invigorates qi and enhances follicle proliferation via ginsenosides. Eclipta alba (L.) Hassk. [Asteraceae; Ecliptae herba], or bhringraj, aids hair darkening and growth through compounds like wedelolactone. Polygonum multiflorum Thunb. [Polygonaceae; Polygoni multiflori radix], commonly known as He Shou Wu, focuses on anti-aging and anagen extension with stilbenes and anthraquinones.
These remedies address hormonal imbalances and oxidative stress, with preclinical and clinical evidence showing improvements in hair density and cycle regulation. However, research often lacks menopausal-specific focus and ethnic diversity. For detailed extract compositions, study models, doses, findings, and gaps (e.g., hepatotoxicity concerns), refer to Table 2 (Choi, 2018; Han et al., 2015; Lin et al., 2015; Iwabuchi et al., 2024). By revitalizing these traditions, Asian ethnopharmacology fosters cultural resilience and autonomy for women in resource-limited settings.
4.2 Europe and mediterranean: botanical drug infusions and oil
European and Mediterranean ethnopharmacology draws from ancient Greek, Roman, and folk traditions, emphasizing aromatic infusions and oils for scalp health and hair restoration that often improve circulation and reduce androgen effects (Zaid et al., 2017; Bin Rubaian et al., 2024; Leonti and Verpoorte, 2017). Salvia rosmarinus Spenn. [Lamiaceae; Rosmarini folium], or rosemary, promotes microcirculation with carnosic and rosmarinic acids, mimicking minoxidil’s effects. Combined with lavender (Lavandula angustifolia Mill.), it reduces inflammation and stress. Nettle root (Urtica dioica L.) acts as a DHT blocker. Horsetail (Equisetum arvense L.), ylang-ylang (Cananga odorata (Lam.) Hook. f. and Thomson), and peppermint (Mentha × piperita L.) provide silica and circulatory benefits.
These remedies are typically applied as topical blends or infusions, showing promise in enhancing hair density and soothing scalps in RCTs. However, studies are limited by short durations and lack of hormonal context. For specifics on extracts, trials, efficacy metrics, and limitations (e.g., ethnic underrepresentation), see Table 2 (Panahi et al., 2015; Smith et al., 2021; Greger and Landberg, 2024; Patel et al., 2025). These sensory empower women through self-care practices, bridging ancient wisdom with modern needs in diverse European contexts.
4.3 Americas: indigenous and native plant extracts
In the Americas, Indigenous and Latin American traditions use native plants like saw palmetto, aloe vera, and jojoba to counter hormonal hair loss, emphasizing harmony with nature and community knowledge (Celidwen et al., 2023; Thimmannagari et al., 2025). Serenoa repens (W.Bartram) Small [Arecaceae], or saw palmetto, inhibits 5α-reductase to reduce DHT. Aloe vera (L.) Burm. f. [Asphodelaceae] hydrates and nourishes via polysaccharides and vitamins. Jojoba (Simmondsia chinensis (Link) C.K.Schneid.) [Simmondsiaceae] mimics sebum for scalp balance.
Evidence from RCTs and ethnobotanical surveys supports improvements in alopecia and effluvium, especially in postmenopausal women. Gaps include small sample sizes and limited long-term safety data. For detailed pharmacological profiles, doses, study outcomes, and challenges, refer to Table 2 (Evron et al., 2020; Catalano et al., 2024). These remedies promote women’s empowerment by preserving Indigenous practices and addressing health inequities in underserved communities.
4.4 Africa and other regions: nutrient-rich butters and extracts
African ethnopharmacological traditions span diverse ecosystems from sub-Saharan regions to North Africa, utilizing indigenous plants like shea butter, moringa, and African cherry to address hair vitality. These remedies are often incorporated into communal rituals that emphasize harmony with nature and women’s central roles in health preservation (Rubegeta et al., 2022; von Maltitz and Bahta, 2024; Degbe et al., 2025). Vitellaria paradoxa C.F.Gaertn. [Sapotaceae; Butyrospermi parkii butyrum], commonly known as shea butter, nourishes and protects the scalp with fatty acids, delivering anti-inflammatory effects. Moringa oleifera Lam. [Moringaceae; Moringae folium] provides antioxidants, anti-alopecia properties, and DHT inhibition through flavonoids, vitamins, and isothiocyanates. Prunus africana (Hook.f.) Kalkman [Rosaceae; Pruni africanae cortex], or pygeum, reduces inflammation via beta-sitosterol. Additional examples include pumpkin seed (Cucurbita pepo L.) for DHT inhibition and anagen promotion, olive oil (Olea europaea L.) for anagen stimulation via Wnt/β-catenin signaling, and black seed (Nigella sativa L.) for antioxidant and hair growth promotion through thymoquinone.
These remedies, typically applied as topical butters, extracts, or infusions, demonstrate promise in improving alopecia and telogen effluvium in RCTs and ethnobotanical surveys, particularly among postmenopausal women. However, evidence is constrained by small sample sizes, short study durations, and insufficient long-term safety data. For detailed extract compositions, study models, doses, efficacy metrics (e.g., hair density improvements), and limitations (e.g., underreporting in low-resource settings), refer to Table 2 (Pareek et al., 2023; Megnanou and Niamke, 2015; Isaac et al., 2023; Camilleri and Blundell, 2024). By revitalizing these traditions, African ethnopharmacology fosters cultural resilience and autonomy for women, addressing health inequities in underserved communities.
5 Mechanisms, evidence, and safety profiles
5.1 Multi-target mechanisms of action
Botanical drugs address menopausal hair loss through synergistic, multi-target mechanisms. Phytoestrogens, such as soy isoflavones, mimic estrogen to extend the anagen phase and mitigate follicular miniaturization. Anti-androgens, including fatty acids in saw palmetto, inhibit 5α-reductase, reducing DHT levels by up to 40% in androgen-sensitive regions. Antioxidants like ginsenosides in ginseng and carnosic acid in rosemary counteract oxidative stress and inflammation, improving microcirculation and nutrient delivery to prolong follicle viability (Rinaldi et al., 2023; Ge et al., 2019).
Preclinical models, including in vitro dermal papilla assays and mouse alopecia simulations, elucidate these pathways. However, they frequently lack a comprehensive hormonal context, such as estrogen decline, limiting their direct applicability to menopause. Key gaps include overreliance on general alopecia models without menopausal specificity.
5.2 Efficacy evidence and quality assessment
Among the 78 included studies, efficacy varies. For instance, ginseng RCTs (n = 80–100 postmenopausal women, double-blind) demonstrate 20%–40% follicle proliferation via ginsenosides (Choi, 2018). Saw palmetto clinical trials (n = 50–100, mixed gender) report 20%–35% density improvements through DHT inhibition (Evron et al., 2020). Rosemary oil RCTs (n = 100) increase density by up to 27% via circulation enhancement (Panahi et al., 2015). In vitro and animal data, such as aloe vera increasing proliferation by 25% in dermal papilla cells, support these mechanisms, though they may overestimate translatability due to absent hormonal simulation.
Overall, most evidence comes from in vitro or animal studies (70% of studies), with only 30% from clinical trials, often not specific to menopausal women. A notable limitation in some animal models is the use of high doses (>1 g/kg), reducing relevance to human applications. In this review, standalone in silico and network studies without experimental validation were deliberately excluded to prioritize more robust and reproducible methods (Kim et al., 2022). Refer to Table 2 for comprehensive study summaries, compositions, and assessments.
5.3 Safety profiles and regulatory considerations
Botanical drugs generally exhibit low toxicity, with mild gastrointestinal effects occurring with ginseng (<5% incidence in RCTs) and rare scalp irritation arising from rosemary or saw palmetto (Bin Rubaian et al., 2024). No severe adverse events have been reported in menopausal cohorts. However, hepatotoxicity risks with high-dose Polygonum multiflorum necessitate caution.
Standardization through HPLC for key markers (e.g., ginsenosides or fatty acids) is essential. Pharmacovigilance via VigiBase monitors rare interactions, such as ginseng with antihypertensives. Regulatory frameworks vary, with EMA herbal monographs contrasting FDA supplements, underscoring the need for unified global standards and Nagoya-compliant sourcing to ensure equity (Thakkar et al., 2020).
6 Challenges, future directions, and conclusion
This mini-review emphasizes critical research challenges and future priorities rather than exhaustive coverage. The field of ethnopharmacology for menopausal hair loss remains fragmented, requiring focused efforts to advance equitable solutions.
6.1 Research challenges
Key gaps include the scarcity of menopausal-specific RCTs (∼25% of 78 studies), often featuring small samples (n < 100) and short durations (<12 weeks). Studies overly rely on irrelevant models, such as general in vitro assays without estrogen-androgen simulation, and include unsubstantiated claims of multi-target effects without dose-response data or proper controls.
For instance, many report anti-inflammatory activity based on in vitro cytokine reduction but fail to evaluate minimal active concentrations or relevance to scalp microcirculation in postmenopausal women. Standardization issues persist, with extracts varying in metabolite content (e.g., 20%–40% ginsenosides in ginseng), leading to inconsistent efficacy. Ethnic underrepresentation and lack of long-term safety data (>12 months) exacerbate disparities, particularly in non-Asian cohorts where traditional uses may not align with modern pharmacology.
6.2 Future research needs and priorities
To address these gaps, prioritize large-scale, menopausal-specific RCTs (n > 200, >12 months) with diverse ethnic cohorts to validate efficacy beyond small pilots. Develop standardized extraction protocols compliant with pharmacopoeia standards, including MAC reporting, for reproducibility.
Pursue interdisciplinary trials integrating ethnobotany (e.g., cultural validation of traditional uses) with modern pharmacology (e.g., in vivo models simulating estrogen decline). Enhance model relevance by developing ex vivo menopausal scalp models over generic in vitro assays. Conduct equitable, community-engaged studies in low-resource settings to bridge socioeconomic divides and adhere to Nagoya Protocol ethics.
6.3 Limitations
This mini-review synthesizes key ethnopharmacological evidence on botanical drugs for menopausal hair loss. However, limitations exist. First, it is not exhaustive; the vast scope of global traditional medicines necessitated a focus on representative examples from select regions, potentially overlooking lesser-documented remedies or emerging studies from underrepresented areas like Oceania or the Middle East.
Second, study heterogeneity precludes formal meta-analysis, with sources ranging from preclinical models to small-scale RCTs, introducing potential bias in narrative synthesis (e.g., overreliance on in vitro data for mechanisms like anti-inflammation that may not translate to menopausal contexts).
Third, reliance on English-language publications and databases like PubMed may exclude valuable non-English ethnobotanical sources, contributing to cultural and geographic disparities. Many 2025 citations are recent or ahead-of-print, limiting long-term validation.
Future reviews should incorporate multilingual searches and systematic meta-analyses to enhance comprehensiveness and equity in women’s health research.
In conclusion, ethnopharmacological botanical drugs empower women by offering culturally resonant, sustainable solutions for menopausal hair loss, transforming this phase into one of resilience and autonomy.
Author contributions
ZH: Conceptualization, Writing – original draft. W-JZ: Investigation, Writing – review and editing. Y-JG: Validation, Writing – review and editing. Z-RH: Conceptualization, Writing – review and editing. Q-RH: Conceptualization, Investigation, Writing – review and editing. S-ZC: Conceptualization, Investigation, Writing – review and editing. M-HB: Writing – original draft, Writing – review and editing.
Funding
The authors declare that no financial support was received for the research and/or publication of this article.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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The authors declare that no Generative AI was used in the creation of this manuscript.
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Keywords: menopausal hair loss, ethnopharmacology, traditional remedies, botanical drugs, phytoestrogens, hair follicle regeneration, women’s empowerment, global health perspectives
Citation: Huang Z, Zhao W-J, Gao Y-J, Huang Z-R, Huang Q-R, Cai S-Z and Bi M-H (2025) Botanical drug preparations for alleviating hair loss in menopausal women: a global ethnopharmacological mini-review. Front. Pharmacol. 16:1725691. doi: 10.3389/fphar.2025.1725691
Received: 15 October 2025; Accepted: 14 November 2025;
Published: 26 November 2025.
Edited by:
Michael Heinrich, University College London, United KingdomReviewed by:
Karl Tsim, Hong Kong University of Science and Technology, Hong Kong SAR, ChinaAmira Zairi, University of Sousse, Tunisia
Karen Nieber, Leipzig University, Germany
Sarah Edwards, University of Oxford, United Kingdom
Copyright © 2025 Huang, Zhao, Gao, Huang, Huang, Cai and Bi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Sui-Zhen Cai, Y2Fpc3VpemhlbkAxNjMuY29t; Ming-Hui Bi, eG16eXkyMDI1MDAxQGZqdGNtLmVkdS5jbg==