Skin Care during Menopause

What Is Menopause and Why You Need Special Skincare?

We can talk of menopause and special skincare for menopause when a woman hasn’t menstruated for 12 consecutive months. The time period before that, when hormonal changes and fluctuations in the menstrual cycle start to occur, is called perimenopause (menopausal transition or climacteric).

Skin changes a lot at this time, but the changes don’t happen all at once and it’s not all about wrinkles and pigment spots. Menopause usually affects women in their mid 50s, the most notable (although not the only one) hormonal change being the drop in oestrogen level.

Oestrogen (estrogen) affects every organ and tissue in the body, including skin, by interacting with oestrogen receptors. These receptors are most abundant around the genital area, legs and face, so these areas would be most vulnerable to the reduced levels of circulating oestrogen and experience some very specific changes. Let's leave all the urinary and vaginal symptoms to the gynaecology and urology doctors and concentrate on what is my area of expertise, skin on the face, hands, neck and décolleté.

The most common perimenopause symptoms here would be:

Hirsutism or excessive hair growth on the face.
Alopecia or hair loss.
Flushes or reddening of the face, neck and décolleté lasting 3–5 minutes and quickly subsiding.
Menopause breakouts due to the change of sebum quality no longer controlled by oestrogens. This condition affects mostly women whose skin tended to be oily at a young age.
Thinning and slower renewal of skin because of the changes in the microcapillary system previously protected by oestrogens.
Reduced barrier function of the epidermis mostly because of lipid and ceramide deficiency which leads to dryness and sensitivity.
Sagging skin due to the loss of supporting fat deposits of the face, neck, hand and arm areas.
Collagen density (and subsequently the skin’s elasticity) doesn’t change very much during perimenopause, but approximately 30% of dermal collagen supposedly disappears in the first 5 postmenopausal years and this loss is followed by a slower decline of an average 2% a year over the following 20 years.
The loss of microbiome diversity, as microbiologists recently discovered. Microbiome change appears to play an important part in the development of skin sensitivity and dryness.
Wrinkles, loss of elasticity and pigment spots are not strictly speaking menopause-specific symptoms as these skin changes ultimately occur to everyone, including men, and not necessarily during menopause. These skin changes are age-related rather than caused by hormonal changes. Menopause does seem to be a factor in the development of wrinkles, but the specific role of oestrogen is yet to be researched.

How to Take Care of Your Skin before and during Menopause

The best way to look after your skin (at any age) is to do it routinely. Unfortunately, many women forget about the importance of daily skin care regime. A gentle cleanser can help maintain the skin’s barrier function and prevent skin dryness and sensitivity. Innovative moisturising and antioxidant solutions enriched with prebiotics can help keep the skin hydrated and protected, at the same time restoring and preserving microbiome. I would also recommend including some facial oils in your daily routine to compensate for lipid deficiency. Weekly exfoliation helps stimulate the skin’s renewal. Finally, pamper yourself with some nice calming, moisturising and anti-ageing masks — some new skincare products can help you feel more comfortable day to day and even reduce flushes.

UV Protection during Menopause

Among other things, oestrogens can make melanocytes (pigment cells) synthesise melanin; this is why pregnancy-related pigmentation occurs for example — increased oestrogen level stimulates melanin production. As perimenopause and menopause progress, melanocytes start to degenerate, and most women lose a significant amount of pigment cells. Their skin actually appears lighter — fewer melanocytes produce less melanin. Other pigment cells, however, grow in size and produce even more melanin than before, making the complexion uneven without proper protection. These changes make menopausal skin susceptible to UV damage, which is why it needs effective and timely protection starting at the earliest stage of hormonal changes. Mind you, skin protection is not limited to the application of sunscreen. Routine skincare is equally important, simply because healthy skin is easier to protect than irritated, dry or inflamed.

Good Cosmetic Ingredients for Menopausal Skin

There are several categories of cosmetic ingredients beneficial for menopausal skin care.

Moisturising water magnets, such as hyaluronic acid, glycerine, carrageenan, Chondrus crispus extract, gluconolactone, etc.

Fatty acids and lipids from organic oils, such as evening primrose, apricot, olive, macadamia, sweet almond, argan, borago, canola, meadowfoam, sunflower and sesame oils. Don’t forget rich substances, such as shea butter, squalane, cocoa and in some cases coconut butter. Ceramides and mineral oil can be beneficial too.

Prebiotics and probiotics, namely alpha-glucan oligosaccharide, inulin, bacterial ferments and lysates (Alteromonas filtrate, lactobacillus lysate, saccharomyces, etc).

Antioxidants, such as resveratrol (especially), its new more effective version, metabiotic resveratrol, green tea, aloe barbadensis, rosemary and wild carrot extracts, vitamins E and C, beta-carotene, etc.

Remodelling ingredients, agents that actively stimulate the syntheses of proteins and hyaluronic acid, such as EGF and other growth factors, plant stem cells, peptides (Matrixyl-3000, Rigin, Syn-TC).

Calming and anti-inflammatory ingredients: centella asiatica, aloe barbadensis, green tea, calendula officinalis, chamomile extracts, panthenol, peptide Skinasensyl, Albatrellus ovinus and some other fungi extracts.

Microcirculation and capillary-strengthening ingredients: niacinamide (vitamin B3), caffeine, horse chestnut extract, escin.

Skincare Ingredients to Avoid during Menopause

Any ingredients potentially increasing skin sensitivity in general and specifically to UV, damaging barrier function and leading to dryness should be avoided. Many of those are actually beneficial in a variety of ways, such as improving renewal process, lightening pigmentation, reducing wrinkles and even restoring skin elasticity to an extent. However, the side effects of regular application of retinol (a classic anti-age ingredient) and alpha-hydroxy acids can outweigh the benefits of skin care through menopause.

Some lucky women blessed with beautifully resistant skin without tendency to dryness and irritation would definitely benefit from intensive treatments. However, most of us will find these too aggressive. Fortunately, today we can find effective substitutes for most harsh ingredients. Retinol and its derivatives can be substituted by Bakuchiol, a natural ingredient with similar benefits and none of the side effects. Stimulating and remodelling effects can be achieved with the application of remodelling peptides, stem cells, remodelling factors, coenzyme Q10 and new epigenetically active ingredients, such as teprenone/geranygeranylacetone and Undaria pinnatifida extract, even niacinamide and metabiotic resveratrol. New acids, namely lactobionic acid or gluconolactone, as well as lactic acid can help restore the skin’s healthy pH without sensitising it.

Hormone Replacement Therapy (HRT) and Its Effect on the Skin

The general positive effect of HRT was recently demonstrated by a large observational cohort study which started about 40 years ago.

However, the effects of HRT on the skin still remain unclear. It appears that the skin’s structure shows no improvement with short-term HRT. The best results are achieved if HRT starts during perimenopause; it is able to prevent skin dryness and sensitivity. Both water retaining and barrier properties of the skin can be restored, at least partially, with long-term HRT. In addition to this, HRT has some effect on dermal thickness and elasticity, collagen content and density and the skin’s mechanical properties and reactions to stress.

There are plenty of studies on this, but they’re controversial; while some researchers report positive effects on skin thickness etc, others deny any significant change. The skin’s varying responses to HRT are also subject of debate. For some unknown reasons, some women respond to HRT very well, while others do not. Weak responses correlate with tobacco smoking and are more common in women who recently entered climacteric period without any significant loss of dermal collagen. In women with low collagen density in the dermis, HRT supposedly increases collagen density and provides prophylactic effect later on, while women with higher levels of collagen only get the prophylactic effect. Simply put, women who experience more skin changes (wrinkles, skin sagging, etc) during menopause benefit from HRT more, than women with less visible symptoms. However, both categories of women can be aided through menopause with hormone replacement therapy to smooth the transition and avoid most unpleasant skin changes and both categories can be aided by daily skin care through menopause.

Curiously, HRT has no effect on the number or depth of wrinkles, but rather increases skin elasticity and helps prevent slacking and sagging. Another thing HRT helps with is of course hot flushes. Summarising all of the above, there is no doubt that HRT has some beneficial effect on the skin. Reduced oestrogen level during menopause is the cause of many skin problems and it can be at least partially corrected by hormone replacement treatments. However, HRT will not get rid of wrinkles, especially not on the areas exposed to the sun, such as face and hands. And as health authorities keep warning, HRT is not licensed for the management of skin symptoms and women should not use it solely for the improvement of their skin problems caused by menopause.