Menopause and Skin

The World Health Organisation and the International Menopause Society have designated October as World Menopause month. Raising awareness of health in menopause is extremely important, as this is something that will affect every woman at some point in their lives (and possibly the people around them). I have written this blog to highlight some of the important changes that your skin will experience during menopause and give some advice on what options are available to manage them.

What are the skin symptoms I need to know?

The most common skin problems related to menopause are:

1. Increased dryness
2. Loss of skin laxity
3. Increased wrinkling
4. Hot flushes (sudden reddening of face neck and upper chest)
5. Night sweats
6. Vaginal or vulval dryness, burning and irritation
7. Intimacy issues due to lack of lubrication (can cause discomfort and pain)

Other skin related problems include:

1. Increased risk of genital infections (e.g. candidiasis, bacterial vaginosis) due to changes in the natural balance of the genital skin
2. Lichen sclerosus – this anogenital condition can affect women before puberty and post-menopause. Often women present very late on in the disease process after suffering symptoms for years. Symptoms are itching, irritation, thinned white skin, tears, painful intercourse, structural changes (the vulval area looks different to how it may have). Potent/super potent topical steroids are required to treat this condition
3. Increased hair growth in ‘unwanted’ areas (e.g. face)
4. Hair loss at the front and top of scalp
5. Cracking/splitting of skin on palms and soles

Why is this happening?

These skin related changes are thought to be due to a combination of factors:

1. Decline in oestrogen levels around menopause. Oestrogen receptors are located in the skin and concentrated around the genital area, face and lower limbs, therefore these areas seem disproportionately affected
2. Accelerated skin thinning after menopause (skin thickness reduced by 1.13% every year). Thinned skin, coupled with reduced collagen and elastin levels leads to dryness, itching, wrinkles and fragility. Skin thinning in the genital area (the vulva and vagina) can lead to intimacy issues and pain, similar changes affecting the urinary system predispose to prolapse and increase the chances of infection
3. Decreased levels of soluble collagen, slow turnover and synthesis results in reduced skin suppleness and increased sensitivity (e.g. tingling or crawling sensations). Collagen content decreases by 2.1% every year after menopause.
4. Reduced levels of structural skin proteins lead to lack of moisture and hydration of the skin
5. Cell turnover in the skin slows down, as well as a loss of natural moisturizing factors and fats from the skin
6. Oil and sweat secreting glands become smaller, leading to dryness
7. Androgen (male hormone that we all have) levels tend to decline gradually in post-menopausal women, this may contribute to unwanted facial hair or even acne

I have heard hormone replacement therapy can help, is that true for skin?

Hormone replacement therapy (HRT) is one of the treatment options offered to women troubled by signs and symptoms of menopause. The use of HRT has shown to increase collagen levels, maintain skin thickness and boost hydration, as well as possibly reducing skin wrinkles. The exact mechanisms of how oestrogen affects skin function and delays aging are not fully understood. As with all medications there is need to weigh up the pros and cons of HRT before prescribing it to patients, some of the risks include cardiovascular events and breast/ovarian/endometrial cancer in susceptible people. Your doctor is best placed to discuss this with you.

What can I do that does not involve hormone replacement therapy?

Some females would like to avoid the use of hormone replacement therapy due to potential undesirable side effects. The following are suggestions for skin care in menopause:

1. Use a soap substitute when washing genital skin to keep it hydrated
2. Gently pat dry your skin after washing and avoid aggressive rubbing of fragile skin
3. Liberal use of bland emollients (i.e. unfragranced) and lubricants to keep vulval skin moist
4. Topical or oral pain management may be required for persistent symptoms of burning in the skin
5. Don’t forget to moisturise your face and body as needed! Look for ingredients like glycerin, ceramides, and hyaluronic acid. Non-comedogenic formulations are best for the face
6. For acne-related issues consider evaluating your skin care to include salicylic acid as a cleanser or emergency spot treatment, also consider topical treatments including retinoids, benzoyl peroxide and azelaic acid
7. Retinoids stimulate collagen production and improve skin cell-turnover. Consider adding a retinoid containing product to your night-time facial skincare regime.
8. Peptides stimulate collagen production and improve elasticity. Consider adding this ingredient to your skin care regime
9. Consider a hydroxy acid chemical peel to improve cell turnover, collagen, and elastin production. These procedures are best performed by an experienced practitioner that can evaluate your skin type and match it to the right type of peel. Do your research!
10. Gentle facial massage can improve blood and lymph circulation, this is also a nice way to work products into the skin and promote relaxation
11. Slow down scalp hair loss with topical treatments like Minoxidil, or consider hair thickening fibres, extensions, or hair pieces as camouflage if acceptable.
12. Oral anti-androgen medications may help menopausal acne or hair loss
13. Consider dealing with ‘unwanted’ hair with topical anti-androgens or physical hair reducing procedures (e.g. electrolysis).

What about the psychological impact of menopause?

The changes in hormone levels associated with menopause can lead to physical, psychological, and sexual changes, the experience of which can have a negative impact on the quality of life of females and those around them. Psychological symptoms associated with menopause include depression, memory loss, irritability, poor concentration, tiredness, depressed mood, mood swings, loss of libido, anxiety, and loss of confidence. It is therefore important to consider whether psychological interventions can help people manage their symptoms (e.g. talking therapies). Occasionally mood or anxiety managing medication may be necessary in addition to treating other physical symptoms of menopause. Incorporating phytoestrogens (found in legumes and flaxseed) into diet may help symptoms of hot flushes, low mood and improve quality of life in postmenopausal women.  

Finally

Aging is a natural process and loss of some of the supporting hormones (i.e. oestrogen) is something that affects all women. It is important to be able to make reasonable judgements about how skin related symptoms are affecting a person’s quality of life and seeking the right level of support to deal with this. As discussed, there are several options available, that may or may not include hormone replacement. If you are struggling with any symptoms related to menopause, please see your doctor.

Helpful links

International Menopause Society https://www.imsociety.org/index.php

References

1. Ngan V. Menopause and the skin. 2002. https://dermnetnz.org/topics/menopause-and-the-skin/ Accessed 25/10/2020.
2. Calleja-Agius J, Brincat M, Borg M. Skin connective tissue and ageing. Best Pract Res Clin Obstet Gynaecol. 2013; 27:727–40
3. Bruce D, Rymer J. Symptoms of the menopause. Best Pract Res Clin Obstet Gynaecol. 2009;23:25–32.
4. Nair PA. Dermatosis associated with menopause. J Midlife Health. 2014;5(4):168–175
5. Brincat MP, Baron YM, Galea R. Estrogens and the skin. Climacteric. 2005;8:110–23.
6. Archer DF. Postmenopausal skin and oestrogen. Gynecol Endocrinol 2012; 28(Suppl 2): 2- 6
7. Callens A, Vaillant L, Lecomte P, et al. Does hormonal skin aging exist? A study of the influence of different hormone therapy regimens on the skin of postmenopausal women using non-invasive measurement techniques. Dermatology. 1996;193:289–94. 
8. Schmidt JB, Binder M, Demschik G, et al. Treatment of skin aging with topical estrogens. Int J Dermatol. 1996;35:669–74
9. Shah MG, Maibach HI. Estrogen and skin: an overview. Am J Clin Dermatol. 2001;2:143–50.
10. Phillips TJ, Demircay Z, Sahu M. Hormonal effects on skin aging. Clin. Geriatr Med. 2001;17:661–72.