How does menopause affect your skin?
From unexpected acne to dry skin and so-called ‘age spots’, the onset of menopause is the time when many of us start to notice our skin changing in often dramatic ways. So what skin issues do women experience around this time, and what do the experts say we should do to treat – and even help prevent them? Leading Dermatologist Dr Sweta Rai reveals all.
Many, but not all, skin issues are down to hormonal fluctuations. Dr Rai explains: “It’s usually due to hormonal influences. What happens around peri-menopause in your mid to late 40s – you start getting lower oestrogen production but your androgens, which are your male hormone levels, remain the same.”
Other skin complaints are simply due to the natural ageing process but can also become apparent around the time of menopause. Here are the most common skin issues women experience.
Dry skin issues are a big one, because, says Dr Rai, “the older you get the less oil the oil-secreting glands, which keep your skin supple and moist, produce so your skin starts getting dryer”. The dryness, she adds, can affect different parts of the body – including the vulval, or genital, area resulting in conditions such as vaginal atrophy. Often patients present with eczema later on in life due to this.
It may be worth seeking an appointment with a Dermatologist, she says, simply to find out which skin products will be best for you – even before you start menopause: “People go through a whole lifetime without knowing what moisturiser is good for your skin… It’s worthwhile investing in seeing somebody to find out what moisturiser you need for your skin type, which sunscreen and so on.”
Added to the mix is “the decline in collagen production termed neocollagenesis”. Collagen is present in the second layer of our skin, called the dermis, and it is the “stuff that makes our skin taut and supple”, explains Dr Rai. As we age, there is less collagen production “so your skin starts becoming saggier because the matrix that holds your skin together and makes it plump and thick starts diminishing”.
A dermatologist can also advise on specific skin conditioning treatments, moisturisers, dietary adjustments, night creams and retinoid creams to benefit dry, menopausal skin.
Says Dr Rai: “Retinoid-based creams, which are topical vitamin A creams, can plump up your skin and have a skin conditioning effect in terms of photo-ageing. Dermal fillers and collagen building fillers are also available to help with this. Sun-induced spots which contribute to photoageing and an uneven skin tone can also be taken away by the retinoids, and they also plump up your skin by promoting collagen production.”
More variable pigmentation of the skin – sometimes dubbed ‘age spots’ – can start to show at this stage in life. More often than not these are actually caused by sun damage so the first lesson is to always use a high factor sunscreen (SPF 30 or above with UVA and UVB coverage and reapply every two hours in the sun), from a young age. Retinoid creams can also help to reduce their appearance, explains Dr Rai.
Hair and nail issues
Other effects include increasing hair and nail problems. “You may start noticing your nails are more brittle and your hair becomes thinner, because of a condition called androgenetic-alopecia.”
This condition most commonly effects women after the menopause, although can be seen in younger women. It results in thinning across the scalp – although it’s important to remember that normal hair loss is 100-125 hairs per day, which are then replaced. If you notice an increased daily loss or the hairs not being replaced, then seek an appointment with a specialist. There are old and new treatments which can be effective for this condition if
Acne in middle age can come as a big surprise to some women, who may never have experienced skin problems or believed they had left teenage skin behind. Says Dr Rai: “Your oestrogen is decreasing but your male hormone (androgens) is remaining the same so you can start getting spots and acne in your 40s and onwards and people think, ‘I’m well past the age of developing it’.
As a hormone-related issue, Dr Rai says anti-androgens rather than antibiotics may be better suited to peri-menopausal breakouts. “If you get acne during the peri-menopause stage or later on in life they will work better for you than antibiotics, which you can give to a younger person with acne.” They are prescribable and come in tablet form, so Dr Rai recommends seeing a dermatologist if you are suddenly noticing spots in your 40s: “You are going to need something to balance the hormone level.”
Retinoids may also help with acne, she adds, and some laser treatments and chemical peels can help to “freshen things up”.
Another type of benign skin spot that shows up from peri-menopause onwards is called sebhorrheic keratosis – otherwise less flatteringly known as the ‘middle-aged wart’. Very common, harmless skin growths, they can be pink to light brown to almost black in colour, thickening over time to take on a wart-like appearance. Most can be safely left alone but they can be removed by a specialist, either through freezing or scraping if they are causing irritation or are of a cosmetic concern.
Skin cancer is unfortunately on the rise, and one in 54 people will be diagnosed with malignant melanoma during their lifetime. Non melanoma skin cancer such as basal cell carcinomas and squamous cell carcinomas are also very common and are as a result of long term sun exposure.
Very often they first diagnosed in one’s mid to late 40s, so Dr Rai advises keeping a close eye on your skin “once a month looking out for any moles that are changing or spots that are appearing and not healing up in three months or more”. Get a family member to check your back or areas you cannot see.
“Often women who are peri-menopausal now, spent their youth in a period where there just wasn’t the awareness of dangers of sun exposure like there is today.”
The key thing is to keep tabs on your skin, and report any changes to your doctor – there are treatments out there, but early diagnosis is vital. And remember to always use a high factor sunscreen from as young an age as possible.
Stay happy! Lifestyle changes always have an impact on your skin – everything from not smoking to eating healthily and using sun protection. But being cheerful is another big boost for the skin, adds Dr Rai: “People who are more positive and upbeat are far less likely to have wrinkles.” So there you have it. Smile!
About the Author
Dr. Sweta Rai, MBBS (Hons); MRCP Dermatology(UK); MRCP Dermatologic Surgery (UK); Procedural Dermatology (USA) is a leading British dermatologist practising in London. Her area of expertise is skin cancer recognition, skin cancer surgery (Mohs micrographic surgery), laser surgery and cosmetic surgery. She trained in top facilities in both the UK and US and can help you get fabulously healthy skin. You can find out more about her work here.