Changes to the skin during menopause
The menopause can be a sensitive topic for women, many of whom consider it something they just have to suffer through. The changes usually last for several years however; the skin effects can start before the menopause (perimenopause) and continue after it1. Although the skin is very durable, a loss of both function and structural stability is inevitable as we get older1. Pharmacist Deborah Evans explains how it is important to let women feel they are supported in caring for their skin during this time.
How and why can a woman’s skin be affected during menopause?
Changes to skin can be the result of both intrinsic and extrinsic processes.
Intrinsic aging proceeds at a genetically determined rate, primarily due to the damaging products of cellular metabolism on cell membranes, a reduction in the turnover of cells of the epidermis and increasing biological aging of cells.
Changes to the skin happen due to a range of factors including reduction in our skin’s collagen and fat composition, elastin calcification and alteration in vascular permeability. Collectively these lead to diminished elasticity and skin strength. Furthermore, a decrease in oestrogen levels, as we move into the menopause, strongly influences the aging process in women and can produce premature ageing2 as compared to men of similar age. As the oestrogen hormone decreases, women can experience a range of symptoms:
- Epidermis thins and skin turnover rate slows, leading to a more fragile and transparent skin
- An increase in the number and depth of wrinkles
- Increased dryness, with the skin becoming rougher
- Decreased firmness and elasticity, leading to slackness and sagging skin• Increased susceptibility to sun damage, pimples, rashes and irritation• More easily bruised skin due to thinner blood vessel walls
- Unwanted hair for example, on the chin and along the jawline and lip
- Wounds may heal more slowly.
In addition to a reduction in hormones and other cellular aging processes, extrinsic factors from the environment can add to the dermatological signs of aging. These include:
- Lifestyle (poor diet high in junk food, low physical activity, smoking, alcohol consumption, poor hydration)
- Exposure to sun and pollution
- Sleeping position, face-down into a pillow
- Some medicines and conditions such as diabetes and cardiovascular disease.
Supporting women with their skin around the menopause
Despite a substantial loss of function in aging skin, most skin-aging therapies focus on reversing the unwelcome visible signs of aging. Whilst this is important to many women, prevention is definitely better than cure when it comes to protecting the integrity of the skin. It is important for pharmacy professionals to approach a consultation sensitively, potentially in the privacy of the consultation room, and ask open questions to understand the impact the menopause is having. You could start by asking what symptoms are causing your patient the most concern and enquire into her current skincare routine.It is worth establishing what she already knows about the intrinsic processes that can affect skin, in particular it could be helpful to explain the impact lower levels of oestrogen will have and how she can care for her skin with both skincare and lifestyle changes to minimise these effects of aging.Once you have established what she knows and where to focus the discussion, the following advice can be helpful to slow down the aging process. These recommendations are focussed on those external factors that she has control over:
- Eat a healthy diet high in vegetables and fruit, of many different colours and containing anti-oxidants such as Vitamin C. Aim for at least five portions a day. Seven to eight is a good starting point
- Eat at least two portions of oily fish, such as salmon or mackerel, per week and a daily portion of nuts, seeds and oils high in omega fatty acids
- Choose high fibre carbohydrate options to stimulate digestion and avoid constipation and accumulation of toxins. Eating enough fruit, veg and grains daily should help
- Reduce sugar consumption. This has been shown to have a negative effect on the skin’s collagen 3
- Keep alcohol to below the recommended 14 units per week
- Aim to have seven to eight hours of sleep a night so that your skin has time to regenerate
- Stop smoking
- Use high factor sun protection, even in winter
- Wash skin with a mild cleanser avoiding highly perfumed products and detergents that can compromise the skin’s natural barrier
- Always moisturise after washing and cleansing to protect the integrity of the epidermis
- Use an oil based product to help protect the skin’s natural barrier
- Consider skin care products for the face which contain retinol and/or peptides to support cell renewal
- Look out for changes to the skin such as change in appearance, size or colour of a mole and emergence of a new lesion.
Hormone replacement therapy (HRT) can delay the skin aging process due to its effects on the basic components of the skin as well as the more complex structures residing in the skin. This may be something that you can explore with your patient particularly if they are experiencing a range of symptoms. Make sure you are aware of the evidence currently available on the risks and benefits of HRT4 and sign post the patient to their GP if appropriate.
Understanding that caring for skin is more than how it looks
Changes in skin can be the most visible indication of age and whilst this is important for many women, it is advisable for pharmacists to understand that the care of aging skin should shift focus from aesthetic concerns to how the loss of structure and function affects quality of life. In fact, most people over 65 have at least one skin disorder, and many have two or more.5 Older skin can be prone to a wide range of conditions including eczema, contact and allergic dermatitis, seborrheic dermatitis, autoimmune diseases that have cutaneous manifestations, seborrheic keratoses, and various forms of cancers including basal and squamous cell carcinoma and malignant melanoma. Advise your patient to see a doctor if you think it may be more serious.
Finally, the aging process can have a significant impact on an individual’s mental well-being. Feeling more comfortable in our skin can make a big difference to how we feel.
Resource to support healthcare professionals:
Like any topic, there is always something new to learn and having seen the Bio-Oil professional series, I would recommend the resources as being very relevant for supporting healthcare professionals in their conversations with patients.Resources for healthcare professionals:
Resources for your patients:
Deborah Evans FFRPS FRPharmS FRSPH is Managing Director of Pharmacy Complete and a practising community pharmacist @pharmacycomplet @HLPharmacist. Deborah does not endorse any specific product or brand.
1 Characteristics of the Aging Skin Miranda A Farage, Kenneth W Miller, Peter Elsner, Howard I Maibach. Advances in Wound Care 2013 Feb; 2(1): 5–10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3840548/
2 Farage MA. Miller KW. Berardesca E. Maibach HI. Clinical implications of aging skin: cutaneous disorders in the elderly. Am J Clin Dermatol. 2009;10:73
3 Nutrition and aging skin: sugar and glycation. Clin Dermatol. 2010 Jul-Aug;28(4):409-11. doi: 10.1016/j.clindermatol.2010.03.018.
4 NICE Guidance 23 Menopause Diagnosis and Management https://www.nice.org.uk/guidance/ng23/chapter/Recommendations#managing-short-term-menopausal-symptoms
5 Kligman AM. Koblenzer C. Demographics and psychological implications for the aging population. Dermatol Clin. 1997;15:549