How to manage skin issues at menopause

The skin is the body's largest organ and is comprised primarily of collagen, a protein that maintains the skin’s elasticity and resilience.

"Collagen is the supporting fibre in the skin and also the nails, hair, muscles, bones and blood," says Dr Anne Henderson, consultant gynaecologist, menopause specialist and dermatologist. "As you age and oestrogen levels drop at menopause, it becomes harder for your body to produce collagen and the skin is more susceptible to dryness and fragility."

Collagen reduction in women correlates with the period of oestrogen deficiency rather than chronological age.

Consultant dermatologist, Dr Sajjad Rajpar, adds that alongside collagen loss, oestrogen is also responsible for the natural hydrating mechanisms in the skin.

"When oestrogen is reduced, the skin also produces less sebum, hyaluronic acid and ceramides. These substances improve the skin barrier and help prevent evaporation. The skin can become dry and itchy when this process is compromised."

Skin issues at menopause

The face

Wrinkles, brown spots, jowls, and dry skin may appear more pronounced as your skin ages. Changes in skin pH and sporadic fluctuations in hormones levels in perimenopause can also make existing skin conditions worse, such as acne, rosacea, eczema, and psoriasis.

"Bone density reduces at menopause and there's an osteoporosis risk from not having as much oestrogen," says Rajpar. "Studies using 3D technology have shown that women are more likely to get shrinkage in the jaw and chin bones. These skeletal changes in the face may worsen skin sagging and jowls."

One study suggests that the severity and placement of wrinkles could actually predict women's bone density - not only in the face, but fracture risk in body's skeletal system.

"Fat redistribution is really important in the face as well," adds Rajpar. "Fat is stored in different compartments in the face - some become bigger with age, while others shrink. That's why you can get that sunken look higher up in your face, but a sagging heaviness in the jaw area."

The genitals

With decreased oestrogen at menopause, some women may have vaginal atrophy, dry, thinning skin, and a change in skin pH. This can trigger bouts of thrush, bacterial vaginosis, and urinary tract infections - and also make sex feel uncomfortable. Existing conditions, such as vulvodynia and lichen sclerosis, may also flare up. A reduction in fat deposits in your labia may make the skin feel looser and less elastic.

Andere Teile des Körpers

The hands, scalp, and other parts of your body may also be subject to menopausal skin changes, particularly dryness and irritation.

"It's important that we don't just talk about aesthetic appearance, but also the important function of skin in keeping us healthy," explains Rajpar. "It's not simply how your skin looks, but how it feels, and also how well it heals after injury. It has been shown that women with decreased oestrogen may heal less well after surgery or if they develop leg ulcers later in life, as a result of having obesity or diabetes, for example."

Daily skincare

Surgical and non-surgical facial procedures

While a surgical facelift remains an option as a more drastic measure to combat skin ageing, the growing cosmetic trend is towards non-surgical procedures. Facial fillers, threads, laser resurfacing, and Botox are often viewed as a cheaper, less invasive alternative.

"These procedures can be effective in reducing the appearance of ageing and are lower risk, but they are certainly not zero risk, particularly because skin doesn't heal as well as we age," advises Rajpar.

In the UK, there are few regulations regarding who can give face fillers and several other cosmetic treatments - so untrained non-medical people can perform the procedure.

"Inject a filler into a blood vessel and it can cause necrosis of tissue or blindness as the filler moves into the arterial system," says Rajpar. "Threading is another facial procedure that is growing in popularity, but thankfully that is considered a surgical procedure and is therefore better regulated in the UK."

He adds that it is important to make sure you are targeting the treatment to the origin of the issue, rather than subjecting the face to multiple interventions that may be inappropriate.

"It shouldn't be about trying to change somebody's face to look anatomically different," he continues. "You're trying to just replace what's missing or improve skin quality so it looks natural."

Hormone replacement treatment (HRT)

Hormone replacement treatment (HRT) can help supplement declining oestrogen levels at menopause - supporting overall wellbeing and also giving additional benefits for skin health.

Henderson says that HRT also has protective health benefits which are sometimes overlooked.

"HRT also strengthens your bones against osteoporosis as well as managing hot flushes and improving brain function, energy levels, and sexual functioning. In addition to this, women will also see some collateral benefit to their skin."

Henderson adds that if vulval and vaginal skin issues are the key issue at menopause these may be managed in the first instance by using topical oestrogen cream or pessaries which are put directly on your skin rather than systemic HRT. Washing with a bland emollient ointment and using a pH-balanced vaginal lubricant - free of silicone, perfumes and glycerine - may also support genital skin health.

Änderungen des Lebensstils

"Without a doubt," Rajpar says, "smoking will really mess up your skin and increase wrinkles and other signs of skin ageing. You've heard it all before, but eating a balanced diet, exercising, and looking after your skin from a young age are what will help in the long run."

Henderson agrees, and points out that women at menopause need to embrace health and lifestyle changes rather than viewing HRT as a potential fix for every symptom.

"I think we've got to be careful that HRT is not presented as a cure-all and an answer to everything," she cautions. "Yes it has many benefits but women under my care also get advice about nutritional supplements, probiotics, nutrition, fitness, and particularly strength training. If you look after yourself, of course your skin will look better than if you smoke, drink too much, or are overweight.

"HRT can relieve many menopausal symptoms, but it will never be the answer to everything. You need to look at your lifestyle and that includes taking care of your skin."

If you are concerned about skin issues at menopause, talk with your doctor in the first instance. They may refer you to a dermatologist or menopause clinic for further assessment. The British Association of Dermatologists offers a wealth of skincare information on its website, including how to access dermatology care. Contact the British Menopause Society for information on how to find a menopause specialist doctor.