Menopause is a significant phase in a woman’s life, marked by a decline in oestrogen levels that leads to various changes in the skin. These hormonal shifts can cause several skin concerns, ranging from dryness and thinning to increased sensitivity and a heightened risk of developing both medical and cosmetic skin issues. Understanding these changes and learning how to manage them effectively is crucial for maintaining healthy, youthful skin during this transitional period.

How Menopause Affects Your Skin

During menopause, the body undergoes several hormonal changes, particularly a reduction in oestrogen and progesterone levels, which have profound effects on the skin:

• Loss of collagen and elasticity: Oestrogen is vital for maintaining collagen, the protein that provides structural support and elasticity to the skin. With menopause, collagen production decreases significantly—by up to 30% within the first five years—and continues to decline at a rate of about 2.1% per year thereafter. This reduction leads to thinner skin, loss of firmness, and decreased elasticity, resulting in sagging, fine lines, and deeper wrinkles. 
• Increased dryness and skin thinning: Oestrogen plays a key role in regulating the skin’s moisture levels by promoting sebum production. As oestrogen levels decline, the skin becomes drier and the moisture barrier weakens, leading to increased transepidermal water loss (TEWL) and a rough texture. Thinning skin is more fragile and prone to bruising and injury, and reduced thickness also makes blood vessels more visible, contributing to increased redness.
• Pigmentation changes: Hormonal fluctuations during menopause can lead to pigmentation issues such as age spots, melasma, and uneven skin tone. Prolonged exposure to UV radiation further exacerbates these changes, as the skin’s ability to repair sun damage diminishes with age. This results in more pronounced pigmentation and sunspots, especially on areas frequently exposed to the sun, like the face, hands, and chest.
• Altered skin texture: The reduction in collagen and elastin also affects the skin’s texture, leading to enlarged pores and a rougher surface. Decreased skin cell turnover can contribute to a dull complexion, making regular exfoliation and rejuvenation practices essential to maintain a smooth, glowing appearance.
• Increased sensitivity and pruritus (itchiness): Menopausal skin is often more sensitive due to a compromised barrier and decreased hydration. This increased sensitivity can lead to greater reactivity to skincare products and environmental factors. Pruritus, or itching, is also a common complaint among postmenopausal women, often associated with dry skin conditions like xerosis.
• Higher risk of medical and cosmetic skin issues: As skin ages and hormone levels change, there is an increased risk of developing both medical and cosmetic skin concerns. Women with outdoor hobbies, frequent sun exposure, or a history of sun damage are particularly vulnerable to skin cancers, including melanoma. Regular mole checks and skin screenings are crucial for early detection. Some laser treatments, such as Halo, not only improve the skin’s aesthetic appearance by reducing pigmentation and fine lines but can also help reduce the risk of skin cancer by targeting and treating precancerous lesions.

The Role of Hormone Replacement Therapy (HRT)

Hormone Replacement Therapy (HRT) can be effective in alleviating some of the skin changes associated with menopause by replenishing oestrogen levels. HRT has been shown to increase collagen production, enhance skin thickness, and improve elasticity, potentially restoring some of the skin’s youthful qualities. However, it is not without risks. While oestrogen in HRT can improve skin hydration and reduce signs of ageing, some women may experience side effects like acne, especially if their HRT regimen includes progesterone. Progesterone can increase sebum production, leading to clogged pores and breakouts.

For women experiencing acne due to HRT, laser treatment designed to target sebaceous glands, may offer a solution. It works by reducing oil production, thereby minimising acne flare-ups without the need for long-term medications, providing a non-invasive option for managing hormone-induced acne.

Effective Strategies for Managing Menopausal Skin

To manage these changes effectively, a comprehensive approach involving skincare, medical treatments, and lifestyle adjustments is essential:

• Topical retinoids: Retinoids are highly effective in promoting collagen production and enhancing skin cell turnover. They help reduce the appearance of fine lines, improve skin texture, and increase elasticity. However, due to their potential to cause irritation, especially on thinning menopausal skin, retinoids should be used cautiously and under the supervision of a dermatologist.
• Hydrating moisturisers: Moisturisers that contain hyaluronic acid and ceramides are crucial for maintaining hydration and supporting the skin’s moisture barrier. Hyaluronic acid acts as a powerful humectant, attracting moisture to the skin, while ceramides help strengthen the barrier and prevent further dryness and irritation.
• Antioxidant serums: Antioxidants like vitamins C and E play a crucial role in protecting the skin from environmental damage and reducing pigmentation. These serums neutralise free radicals, molecules that accelerate skin ageing, and help improve overall skin tone and texture.
• Energy-Based Treatments: Lasers and ultrasound technologies are highly effective for stimulating collagen and elastin production, tightening, and lifting sagging skin. Treatments such as BroadBand Light (BBL) therapy, fractional laser resurfacing, and Sofwave can rejuvenate the skin and provide a firmer, more youthful appearance. Additionally, lasers like Halo can aesthetically enhance the skin while targeting and treating precancerous lesions, potentially reducing the risk of developing skin cancer.
• Injectable treatments – Polynucleotides and Profhilo: Polynucleotides and Profhilo are innovative injectables that promote skin regeneration and hydration. These treatments help improve skin elasticity and overall quality by providing deep hydration and stimulating collagen production, making them particularly effective for addressing thinning skin and volume loss.
• Microneedling with radiofrequency: This advanced treatment combines microneedling with radiofrequency energy to enhance collagen production and improve skin texture and firmness. It is particularly beneficial for menopausal skin, helping to reduce fine lines, improve skin tone, and provide a smoother appearance.
• Sun protection and lifestyle modifications: Protecting the skin from UV damage is critical during menopause. Using a broad-spectrum sunscreen with SPF 30 or higher, wearing protective clothing, and avoiding sun exposure during peak hours can help prevent further pigmentation and damage. Additionally, maintaining a healthy diet rich in antioxidants, staying hydrated, and managing stress can significantly impact overall skin health and resilience.
• Intimate wellness treatments – Emfemme and Emsella: Beyond the skin, menopause can also affect intimate health, leading to pelvic floor weakness, urinary incontinence, and sexual dysfunction. There are lasers which can be used as non-invasive treatments that use electromagnetic energy to strengthen the pelvic floor muscles, improving urinary control and enhancing sexual function. These treatments offer a holistic approach to managing menopause-related changes, supporting both skin and overall wellness.

The Importance of Expert Care in a Multidisciplinary Team (MDT)

As menopause becomes a more widely discussed topic, many clinics and providers are offering treatments without a deep understanding of the complexities involved. Seeking care from a multidisciplinary team (MDT) that integrates both dermatology and gynaecology expertise ensures a high standard of care. At a specialised clinic like Self, where dermatologists and gynaecologists work closely together, patients receive a comprehensive approach that considers all aspects of health during menopause. This collaboration ensures that any treatment plan is tailored to the individual’s unique needs, combining expertise in both skin health and hormonal management.

An MDT approach provides a holistic view of a woman’s health, ensuring that all aspects of menopausal care are covered, from managing skin changes to addressing other symptoms like pelvic floor dysfunction. This high standard of medicine is crucial as menopause becomes a popular topic, and it is essential to seek care from providers with specialised knowledge and experience.

Final Thoughts

Menopause brings about various skin changes, but these changes can be managed effectively with the right approach and expert guidance. By understanding the specific needs of menopausal skin and choosing evidence-based treatments, women can maintain a healthy, vibrant appearance throughout this transition. Consulting with experts in both dermatology and gynaecology ensures comprehensive care, providing the best possible outcomes for skin health and overall well-being.

Inspiring skin confidence with Hertility and Self London