The Menopause Exchange Blog

SKIN CHANGES AT THE MENOPAUSE

Around the time of the menopause, you may notice changes to your skin. These are often overlooked in comparison to the more commonly known menopausal symptoms. The relationship between your oestrogen levels, collagen production and skin thickness is key in understanding how your skin changes at this time of life.

This article was included in issue 84 (spring 2020) of The Menopause Exchange newsletter.

Skin changes
Your skin consists of two main layers: the epidermis at the top and the dermis below. Oestrogen is important for the creation of collagen, which is a protein found in your dermis layer that provides most of your skin’s tensile strength.

You lose a significant amount of collagen from your dermis in the first five years of the menopause, with a loss after this of around 2% each year. As your oestrogen levels drop during the menopause, your skin begins to lose its strength, becoming thin and more fragile.

Skin dryness
Skin dryness is caused by many different factors. The blood supply to your epidermis reduces as your oestrogen levels fall, resulting in more water loss across the epidermis, leaving your skin less hydrated. Oestrogen is also partially responsible for your skin’s oil production, and lower oil levels can make dry skin worse.

Dry skin can make you more likely to feel itchy (called pruritus). Some menopausal women find that they also experience sensations of skin numbness, tingling, prickling or crawling (which is called formication). Using fragrance-free moisturisers will help to reduce your risk of skin irritation, and low-pH moisturisers can help to reduce any itching.

Wrinkles
Deeper lines and wrinkles become more prominent as the collagen and elastin levels in your dermis begin to fall. Natural humectants (substances that attract water and help to keep your skin hydrated) start to decrease, leaving your skin looking tired and any fine lines seeming more noticeable. Skin care products containing hyaluronic acid, retinol and vitamin C may help to reduce these effects. You could also try microdermabrasion and laser treatments to stimulate your collagen and elastin production, improving the appearance of any wrinkles.

Age spots and pigmentation
Menopausal skin is more prone to sun damage, wrinkles and age spots. The maintenance of melanocyte cells, which make melanin (the pigment in your skin), is controlled by oestrogen. As your oestrogen levels start to fall, your skin may become lighter. This means there’s less protective melanin in your skin, increasing your risk of sun damage.

Your skin may make more melanin in areas that have been overexposed to the sun’s ultraviolet rays. This can lead to brown age spots, which are typically seen on your face, chest and hands. Skin cancers are also more common at this time of life, so speak to a GP or dermatologist if you’re worried.

Using a sunscreen with a minimum of SPF30 and UVA protection every day is an essential yet simple way to limit further sun damage. This may also help to fade age spots, prevent new areas of pigmentation occurring and reduce your risk of skin cancer. You may be able to use pigment-reducing creams and lasers to lighten persistent pigmentation, but speak to a dermatologist first.

Acne at the menopause
Acne breakouts can occur at the menopause due to reduced oestrogen and increased testosterone levels. Salicyclic acid cleansers may help to reduce breakouts by unblocking pores. In some cases, anti-androgenic hormone therapy may be necessary to control the acne.

If skin redness affects your nose and cheeks, flaring up after alcohol, spicy foods or sunlight, you may have rosacea. This can resemble acne with skin sensitivity, and you should use gentle cleansing milks and sunscreen. Some women may need to take courses of oral antibiotics.

Skin changes in your vulva
There are lots of oestrogen receptors in your genital skin. As your oestrogen levels fall, this area becomes especially vulnerable to dryness and irritation. Your vaginal skin may become thinner, leading to symptoms of itching, burning and painful sex. You can use vaginal lubricants and moisturisers, but it’s important to see your GP or a dermatologist if you’re experiencing problems.

Effects of HRT on your skin
Research studies show that HRT may help your skin in various ways, as well as easing certain menopausal symptoms. These benefits include boosting the levels of collagen in your dermis to improve your skin laxity (looseness) and to increase your skin’s ability to retain water to reduce dryness. A number of women on HRT notice that their skin becomes brighter, with an improvement in its texture and tone as the oestrogen works to strengthen the collagen and elastic fibres.

While HRT can also reduce skin ageing, its role in the improvement of wrinkles in sun-damaged skin is debatable. In addition to this, using HRT isn’t free of side effects, and the increased risks of blood clots and breast cancer limit its use.

Complementary and alternative therapies
A balanced diet and adequate fluid intake are essential for healthy skin. Some supplements, such as vitamin C, evening primrose oil, collagen peptides and omega-3 fatty acids, may benefit your skin. Isoflavones, plant-based substances that are believed to act as phytoestrogens in your body, are of increasing interest as well. Herbal products including sage, red clover, milk thistle and St John’s Wort may provide some relief from general menopausal symptoms. However, it’s important to note that the effectiveness, safety, quality and purity of unregulated bio-identical hormones and herbal supplements have yet to be determined.

References

Hall G et al. Estrogen and skin: The effects of estrogen, menopause, and hormone replacement therapy on the skin. J Am Acad Dermatol 2005;53:555-68

Wines N et al. Menopause and the skin. Australas J Dermatol 2001;42:149-160

Raine-Fenning NJ et al. Skin ageing and menopause: implications for treatment. Am J Clin Dermatol 2003;4:371-8

Nair PA. Dermatosis associated with menopause. J Midlife health 2014;5:168-175

Marjoribanks J et al. Long-term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database Syst Rev 2017;1:CD004143

Rossouw JE et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. JAMA 2002;288:321-33

About the author
Dr Zainab Laftah is a consultant dermatologist at St John’s Institute of Dermatology, and skin cancer clinic lead at University Lewisham Hospital. She has a particular interest in general dermatology, skin cancer and surgery.

Created Spring 2020 

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