How Does the Menopause Affect Skin?

The menopause can be a challenging subject to talk about, as it is a potentially tricky and emotive time in a woman’s life.

The effects can be felt by many women physically, mentally and emotionally, and it can also impact those around them. If you have ever seen the Sex and the City episode where Samantha has a meltdown as she thought she was going through the menopause, you can see how much of an issue it can be. (As usual, Samantha does have a happy ending in that episode!!)

What is the Menopause?

The menopause is, however, a normal process and part of natural aging. It heralds the end of a woman’s ability to get pregnant naturally. This doesn’t necessarily mean the end of having a baby, though. Post menopause, a woman can still give birth after IVF.

Menopause is defined as the point 12 months after a woman’s last period. The time leading up to this is known as the perimenopause. This transition from your normal reproductive capability usually starts in the mid-forties to mid-fifties, but it can sometimes start a little bit earlier or a little bit later, and can last for quite a few years! The hormones oestrogen and progesterone that are produced by the ovaries will be in a variable state of flux. A woman can still conceive naturally during this transition period; while ovulation and periods may be irregular they do still happen. So if you don’t want a little surprise, contraception is still important during this time!

Menopause can be initiated immediately if a woman has had a hysterectomy (womb removal) or oophorectomy (when one or both of the ovaries are surgically removed). A bilateral salpingo-oophorectomy is when both fallopian tubes and ovaries are removed.

What are the Symptoms of the Menopause?

There is a long list of symptoms associated with menopause. Typical symptoms include:

• Hot flushes. These are sudden surges of heat in areas such as the face, neck and chest. The skin can become red and sweaty, and apart from the undesirable appearances it can feel very uncomfortable.
• Insomnia.
• Headaches.
• Mood changes (anxiety, low mood and short temper).
• Night sweats. These are hot flushes at night, and can be a real detriment to getting a good night’s sleep. Do keep in mind that drenching night sweats, fever and weight loss are known as the B symptoms of Lymphoma. If you have any concerns, see your doctor.
• Cardiac palpitations.
• Cognitive issues.
• Lack of libido.
• Vaginal dryness. This can cause intimacy issues including pain with sexual intercourse (dyspareunia).
• Joint aches, pains and stiffness. Make sure you are not developing an inflammatory arthropathy such as Rheumatoid Arthritis. Check with your doctor if you’re not sure.
• Recurrent urinary tract infections (UTI). Women have a shorter urethra so are more prone to UTIs, and the menopause can exacerbate it due to dryness and impaired skin barrier function.
• Loss of oestrogen causes a decrease in bone density. This leads to osteoporosis and increased vulnerability to fracturing bones.
• Weight gain. This can be caused by alterations in metabolism, especially fatty acid utilisation.
• Last but not least, the menopause can have a real impact on the skin, hair and nails.

If you start getting symptoms such as those mentioned above and you’re not sure whether you are perimenopausal, or you fall outside of the usual age range, see your doctor. There are other conditions such as Carcinoid syndrome and endocrine tumours that can cause some of the symptoms.

There are some possible options to treat symptoms. This includes HRT (hormone replacement therapy). Unfortunately, possible side effects can include an increased risk of blood clots or breast cancer in some women. Other measures include complementary therapies including the use of phyto-oestrogens.

Collagen and the Menopause

For me, the key unifying factor is that the loss of oestrogen during menopause causes a rapid loss of collagen within the skin. Studies have shown that up to 30% of collagen is lost from the skin within the first five years of the menopause. As I have discussed before, collagen is the vital support structure of your skin that literally holds everything together. Loss of collagen within your skin is going to have a highly detrimental effect on your skin’s elasticity, thickness, and o?verall levels of hydration.

This can lead to the typical signs of aging such fine lines and wrinkles. Sagging jowls can appear, as well as a droop in the tip of your nose. Areas like the face, neck and decolletage can be particularly affected. The loss of oestrogen will also cause a reduction in the levels of elastin in your skin. Elastin is responsible for the plump “bouncy” nature of youthful skin.

After the dramatic drop in collagen during the first five years of the menopause, the decline becomes more gradual, with a drop of about 2% in levels every year. The initial large decline in collagen levels explains why women who had fantastic skin before the menopause suddenly notice a deterioration in their skin after menopause.

So let’s look at some of the symptoms in detail.

Dry Skin and the Menopause

Loss of collagen means that the skin has a compromised ability to hold on to moisture, and subsequently becomes dry. It may crack and fissure, becoming flaky. It might also start to become itchy, and you may get strange crawling sensations on the skin. The skin barrier function can become impaired. As I described in my winter skincare blog, dry skin can be exacerbated by cold, dry winter air, so be sure to take extra care of your skin at these times.

There is also a reduction in oil production from sebaceous glands which contributes to this dryness.

You can combat this by sticking to a good skincare routine. Some tips include:

• Use a mild gentle cleanser rather than soaps.
• Moisturise after cleaning and anywhen your skin feels dry. Try using Cerave products which contain ceramides (fatty acids that are an integral part of your skin barrier) and have a patented slow-release formulation.
• Be careful with skin peels and skin scrubs especially deep rough scrubs as menopausal skin can be thinner and more sensitive.
• Use non-comedogenic products if you can, as menopausal skin can be prone to blackheads and acne.
• Use a high quality serum like the Maxerum collagen-boosting serum.
• Skin peptides are another useful ingredient to have in your skincare products.

Thin Skin and the Menopause

Thinner skin is a side effect of collagen loss; it has an impaired skin barrier function and is more prone to tearing and bruising. It is also much more susceptible to sun damage and subsequent photo damage related aging. You should wear a good sunscreen, SPF 30 or higher, every day.

Use retinol, or better yet a natural alternative such as bakuchiol, which is one of the ingredients in Maxerum and provides the benefits of retinoid treatment without the side effects. It can help to make the skin thicker, more radiant, and plumper, by increasing cellular turnover in the skin. It also helps to boost collagen levels in the skin.

Impaired Wound Healing and the Menopause

Hormonal changes and the loss of collagen can mean that skin takes longer to heal. The skin may also be more prone to getting secondarily infected, usually with a skin commensal such as staphylococcus aureus. Make sure to seek medical advice if you think your skin is infected. You may need topical antimicrobial treatment and/or oral antibiotics such as Flucloxacillin.

Sensitive Skin and the Menopause

Menopause can cause your skin PH levels to change, causing dysfunction to the beneficial flora and fauna on your skin as well as various defence cells, and making your skin more prone to rashes, itching and irritation. It can exacerbate pre-existing inflammatory skin conditions such as eczema or rosacea, and can in fact even cause rosacea. You should avoid precipitating factors such as skin irritations like fragranced products, detergents and soaps as well as environmental triggers such as cold, dry air. You should also continue to remain well protected from the sun.

Do also bear in mind that you might not tolerate your usual skincare products anymore, and you might need to look at getting new ones. Remember, when trying new things, always make sure to patch test yourself with all new products.

Menopausal Acne

Hormonal changes cause imbalances, including an increase in the androgen levels. This can result in something very similar to teenage acne with pimples, pustules and inflammatory papules. Topical treatments can contain active ingredients such as salicylic acid, benzoyl peroxide, antibiotics and retinoids. If you feel topical acne products are not working enough for you, do make sure you see a dermatologist who might recommend systemic treatment with an oral retinoid such as isotretinoin or an anti-androgen such as spironolactone.

Age Spots, Sun Spots, Pigmentation and Dark Patches

These are all forms of photo-aging related to accumulated sun damage to the skin. The longer the time you spend on the planet the more UV you have cumulative exposure to, especially UVA. This is exacerbated if you have not been very careful with the sun in the past. Unfortunately, the menopause can be the time when the side effects of excessive sun exposure start to appear or get worse. The usual problem areas are those that were more exposed to the sun such as the face, neck, upper chest and hands.

The most important advice I can give is to keep vigilant for skin cancer and pre-cancerous skin changes, which become more prevalent as you get older. Make sure you see your doctor if you have any concerns. They will have a low threshold to send you to a specialist like myself if they have any concerns. Regular self-examination of your skin with someone like your partner to check on areas like your back is highly recommended. Take baseline photographs as a comparison. They can be useful when I review patients in my clinics.

Use sunscreen every day when you are out and about; apply it to all exposed areas. This can prevent old age spots from getting worse, prevent new spots from appearing, and most importantly reduce your skin cancer risk. So please do educate yourself on sun awareness and skin cancer vigilance.

There are a whole wide range of cosmetic treatments for dark spots and hyperpigmentation. These include AHAs (alpha hydroxy acids), retinoids, bakuchiol, microdermabrasion and microneedling.

Menopause and Facial Hair

Another potential menopause side effect is facial hair, which is due to the hormone imbalance resulting in increased androgens. You may notice hair, usually scraggly and dark, appearing above the lip and on the chin. You can treat this cosmetically with lasers and electrolysis. Your dermatologist might also recommend a treatment such as Vaniqa cream which can reduce the appearance by making the hair lighter in colour and thinner.

Menopause and Thinning Scalp Hair

This can manifest in various ways including as a widening of the central scalp, generalised thinning or as a receding hairline. There are a great many causes of hair loss or hair thinning. This includes conditions such as female pattern hair loss, frontal fibrosing alopecia of Kossard, telogen effluvium and alopecia areata. Make sure to see a dermatologist if you have any concerns.

For me one of the crucial things is to differentiate between a scarring alopecia and a non-scarring alopecia. Scarring alopecia can cause permanent hair loss so will require much more urgent identification and intervention or treatment. Depending on the cause of the hair loss or thinning treatments can include minoxidil, PRP (platelet rich plasma) injections, intralesional steroid injections, microneedling and hydroxychloroquine. Newer emerging therapies include nanoxidil, oral minoxidil, and Jak-inhibitors.

Menopause and Brittle Nails

Loss of oestrogen has a detrimental impact on keratin, which is what your nails are made of. This is why menopause can cause your nails to become brittle. They can be fragile especially distally and they can chip and crack and even break off. Apart from being unsightly this can be painful and cause issues with function.

To help combat this, keep your nails and hands well moisturised. Minimise exposure to detergents and washing by wearing gloves where necessary, such as when washing up. Avoid harsh chemicals such as nail polish removers containing acetone, and keep well hydrated. Supplements such as collagen, Vitamin D, calcium, magnesium, biotin, Vitamin C and selenium will do wonders for your skin, hair and nails.

The menopause can be a tough and challenging time. Remember that things that contribute to a healthy balanced lifestyle such as a healthy diet and exercise will help, as will keeping well hydrated. Remember to look after your mental and emotional health. Talk to friends and family to keep your self-esteem and self-worth levels healthy. 

And a quick note from Maxine: "As someone that has gone through the menopause, I would like to reassure you all that there is life after menopause, and I have never felt so content with my body and who I am. Post menopause life really does feel free!"

Myself and the whole team at Absolute Collagen are always here to help you on your journey. Don’t feel shy if you’d like to get in touch!