Hello and Welcome to ‘Ask A Doctor’ service. I have reviewed your query and here is my advice. Hormonal imbalance is considered to be the primary cause of hair loss during perimenopause. DHT—a form of testosterone—is generally to blame for hair loss when its levels are out of balance. The end result is the excessive hair loss and hair thinning that women experience during perimenopause. Also anxiety and stress can also be contributing factors. Diabetes has been linked to a condition called Alopecia Areata where the immune system attacking causes hair loss. Metformin also interferes with our ability to use two other vital nutrients, Vitamin B9 and Coenzyme Q10 in the human body. This can cause a range of side effects – from hair loss and insomnia and heart palpitations to unexplained muscle pains. So primarily what I think you should start with is start with a healthy diet for hair growth as well as any supplements available (contact a nutritionist for advise on this matter) as well as a dermatologist if the condition is getting more severe. Hair loss is also a natural part of ageing and shouldn t be a worry, cosmetic alternatives like wigs or hair plugs can be considered if we are unable to find a solution. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Ankit Gopinath