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We hear so much about how the menopause is catastrophic for skin - on a number of levels, but rather than accepting that it’s all doom and gloom, we thought we’d take a bit of a dive into what’s happening on a hormonal level, why it has such an impact on skin, and — crucially — what you can do about it...
THE HORMONE FACTOR
“You have hormonal shifts and fluctuations throughout your life,” explains consultant dermatologist Dr Alexis Granite. “Puberty is one of them; perimenopause is another.”
The hormone that we tend to talk about in relation to the menopause is oestrogen. Known as one of the female sex hormones and produced largely by the ovaries, it’s the one that starts to rise when you hit puberty to give you breasts, mature the internal sexual organs and start menstruation. While it does fluctuate across the course of your cycle, it stays relatively constant until we get to the perimenopause. Exactly when that happens will vary from woman to woman, and there are several factors that can have an effect — some forms of chemotherapy, being a heavy smoker and having surgery on your ovaries can predispose you to an earlier menopause — but the most significant factor seems to be the age your mum was when she experienced the menopause.
Although we talk about “hitting the menopause” or about “hormone levels falling off a cliff”, this isn’t something that happens overnight, as Alice Smellie, co-author of “Cracking the Menopause: While Keeping Yourself Together”, a new book on the subject due to be published this September, explains.
“It’s a really gradual process. The official age of perimenopause is 45, but in fact symptoms may begin in your late 30s or early 40s and last for a few years, as the number of eggs declines, and oestrogen levels start to fluctuate. These can go up as well as down, but the general trend is downwards.” And that, as you’ve probably heard, is not good news for your skin.
“Oestrogen and oestrogen receptors are found in all types of skin cell, so it’s likely that oestrogen influences most structures of the skin,” explains Dr Sajjad Rajpar, a dermatologist with a special interest in perimenopausal and menopausal skin. “And the skin is the body’s biggest organ — the skin of an average woman weighs around 15kg! So that’s a lot of oestrogen that’s required to keep it functioning properly.”
Depressingly, he points out that, from a purely biological perspective, we weren’t meant to live much beyond our child-bearing years and that it’s only as life expectancy has increased that we’ve started to appreciate the importance of oestrogen.
AGE IS MORE THAN JUST A NUMBER
We can argue about whether it’s OK to use the term “anti-ageing” or not, but can we agree that using the term “ageing” when it comes to talking about skin is just a convenient shorthand that covers a lot of the ways in which skin changes with the passage of time? It just means that we don’t have to say “wrinkles, changes in skin colouration, sagging skin, loss of volume etc” every time. So, with that in mind, it’s time to break the bad news that the menopause is really ageing.
“Essentially you have a few things going on when it comes to skin ageing,” says Dr Rajpar. “There’s chronological ageing that happens in men as well as in women. That happens because, as we age, our cells don’t live as long, so there are fewer cells, and they also function less efficiently. When it comes to skin, you can speed up that process with external lifestyle factors, such as the sun, smoking, stress, and bad diet.
But, in addition, there’s the skin ageing that is caused by oestrogen deficiency and, in women, that’s actually more important than the chronological age of the patient.” Research suggests that the number of years women are post-menopause is a better indicator of how aged their skin is likely to appear than their actual chronological age. This doesn’t necessarily apply in women who are taking HRT (see below). But, while the menopause really does stick the boot in on a number of aspects of skin ageing, there are things you can do.
TURNING DOWN THE VOLUME
Collagen is one of the proteins that give skin that firm, bouncy, juicy, plump appearance and, as one of the roles of oestrogen is to stimulate collagen production, a loss of oestrogen means a loss of collagen. There are some studies that suggest that you can lose around 30 per cent of the collagen in your skin in the first five years after the menopause. And the thickness of the skin also reduces by around two per cent each year. Some of that is down to collagen loss, but other skin structures will also diminish with age.
So, not only are you likely to lack volume, but your skin will also be thinner and so may bruise more easily. From a skincare point of view, to tackle issues like this, you want ingredients such as retinoids and peptides, which will stimulate collagen growth. But that’s only part of the issue because, as Dr Rajpar explains, the collagen in your skin seems to be less well organised so the same mass won’t give you the same sort of volume-boosting as it might have done ten years before.
“Topical products can help, but they have their limit,” says Dr Alexis Granite. “That’s when clinic treatments can come in. Fillers can help replace lost volume, while radio frequency treatments, such as the Morpheus 8 and Ultherapy, can help boost sagging skin.”
HUNG OUT TO DRY
“The number one complaint I get from my menopausal patients is about skin dryness,” says Dr Rajpar. And, he explains, there are several mechanisms at play here. “Oestrogen is required for the quality and quantity of ceramide production — ceramides are your skin’s in-built moisturising system. But they’re not the only ones — there’s also sebum, another form of oil or moisturiser that is also stimulated by oestrogen.”
Add in the fact that hyaluronic acid, an ingredient found naturally in the skin that helps the skin hold onto water, is also stimulated by oestrogen and you can see why, if you diminish the supply of oestrogen, you're choking the pipeline of all these essential skin moisturisers.
The solution? Look for good moisturisers, that might feel slightly heavier than what those you’ve used in the past, to help replenish levels of oils and ceramides, and layer these on top of a good hyaluronic acid serum. In a clinic, skin boosters, such as Profhilo, that inject lots of hyaluronic acid at a superficial level, can help increase moisture levels and give you back your glow.
FEELING IRRITATED?
We’re not just talking about your mood. “In healthy skin, ceramides and other fatty acids, coat the skin cells and help to form the skin barrier, but when skin is lacking in those moisturising factors, the barrier is compromised and you’ll find that skin is more sensitive or reactive as a result,” says Dr Rajpar. “Many women might find that products that they’ve happily used in the past suddenly start irritating the skin as. its threshold for injury is much lower.”
If this is happening to you, he advocates simplifying your routine and avoiding anything that could be an irritant. “Use gentle cleansers, avoid over exfoliating and scale back the number of products you’re using. More products mean more ingredients, which means more potential for problems.”
IT’S IN YOUR BONES
You might think that even if your skin is giving up the ghost, at least your bones are underneath it all as a strong foundation. Sadly, that’s not true. You might have worried about post-menopausal bone density and being more prone to breaking a leg or a hip, but it seems you also need to worry about your jaw. “If we look at men and women, the facial skeleton ages at a similar rate until you hit around 50 when we see an accelerated rate of ageing in women in the lower face due to a loss of bone mass,” says Dr Rajpar. “There is more bone loss with low oestrogen after the menopause and some bones — including those in the lower face — seem more prone than others to density loss.” The result can be jowliness and heaviness in the lower face. Judiciously placed filler can help to counteract this, as can other skin-tightening treatments, or procedures such as thread lifts.
SPOT THE DIFFERENCE
Just as not all teenagers will get acne at puberty, so not all perimenopausal or menopausal women will suffer this condition. But if you do, you’re not alone. The mechanism behind why it happens is not clearly understood, although there is one theory that the drop in oestrogen means that testosterone, one of the hormones associated with acne, is relatively higher.
There are several dedicated ranges on the market designed to treat acne (which is normally associated with oily skin) without drying out already dry menopausal skin. But if you’re really struggling, speak to a dermatologist as acne can be very distressing.
IS HRT THE SOLUTION?
Taking HRT (aka Hormone Replacement Therapy) where, using patches, pills, or gels, to increase your levels of oestrogen to offset the natural drop, could help with pretty much all the above. As yet, there’s not enough research to know, (as I’d like to), whether sticking a 40-year-old woman on HRT and maintaining “youthful” levels of oestrogen for the rest of her life will mean that she will never show any of the symptoms of ageing that are associated with a lack of oestrogen. But, as Dr Rajpar explains, “we know that women who take HRT have better skin than women who aren’t taking it.”
Of course, improving — or preserving — your skin quality isn’t the only benefit you’ll get from HRT. It’s also been associated with a reduced risk of dementia, heart disease and fractures. But a lot of people are worried about it because, says Dr Rajpar, “we’ve been subjected to two decades of misinformation, much of which was based on old studies done on synthetic oral oestrogen.
“But now, the application of HRT is increasingly likely to be topical (delivered through the skin rather than as a pill) and body-identical (meaning it’s in exactly the same form as the hormones women produce naturally in their bodies) so it’s much safer.”
Let’s get things straight, HRT isn’t going to be for everyone. However, according to Dr Rajpar, there are actually very few women who can’t take HRT. “Only one in eight people who are eligible for HRT are on it,” he says. “That’s a lot of women who are missing out.” And, interestingly, he advises it’s never too late to start. “Some women think that if they’re more than ten years post-menopause, there’s no point taking HRT, but actually even at that point, you will get some benefits — for example studies show that you’ll get some bounce back in your levels of collagen.”
Ultimately, only a medical professional can help you decide whether HRT is right for you personally and, if you’re not getting the answers that you need from your GP, ask to be referred to a specialist. It’s not a silver bullet for every woman, but it could make a significant difference to the appearance of your skin.
