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Menopause Skin Care

Written by: Dr. Leslie Baumann

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Time to read 11 min

Menopause heralds a new stage in a woman’s life, accompanied by many changes throughout the body, including the skin. My patients often complain of hair loss, acne, sun spots, dry skin and itching in the premenopausal, menopausal and postmenopausal years.  As ovarian function wanes, declining hormonal levels significantly impact skin health and appearance. Understanding the science behind these cutaneous changes can help design the perfect skin care routine for maturing skin during the menopausal transition. The key is to protect the skin from aging with the best menopause skin care.


I like to match my patient's menopausal skin care routine to their Baumann Skin Type.  I can d the same for you if you take the skin care routine quiz to find the best skin care products to treat your menopausal skin.


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Effects of menopause on the skin

Menopause Skin Aging

Menopause is defined as the permanent cessation of menstrual cycles, marking the end of fertility, and occurs naturally between ages 45-55 years as the ovaries stop producing eggs and estrogen/progesterone levels decline (2). Many skin changes occur during this time such as wrinkles, skin thinning, and loose, sagging skin. Skin aging increases during menopause. 

Update your routine with menopause skin care by taking the quiz as soon as you start having insomnia, hot flashes and forgetfulness which are signs of menopause.


The skin type quiz will help you find build a menopause skin care routine.


Skin Signs of Menopause

Thin, Fragile Skin

Estrogen promotes types I and III collagen production in fibroblasts. During menopause, estrogen levels drop dramatically, slowing collagen synthesis. Studies demonstrate postmenopausal women lose 30% of skin collagen, mostly type I and III, within 5 years of beginning menopause (4,5). This thinning of the dermis leads to thin, fragile, wrinkled skin.

elastin decreases during menopause

Decreased Elasticity

Menopause is the time when skin begins to sag and lose firmness. Estrogen helps maintain elastin fibers that keep skin supple. With less estrogen, elastin breakdown occurs leading to sagging skin and jowls (6).

Dry Skin

Estrogen helps retain moisture in the epidermis. Declining estrogen causes increased transepidermal water loss, resulting in skin dryness and itching (5.7).

Pigmentation changes during menopause

Skin Pigmentation

Fluctuating melanocyte-stimulating hormones during menopause stimulate melanocytes to make melanin and can cause hyperpigmentation, and uneven skin tone. (6) This is why you may develop dark spots or sun spots on the skin during menopause.  

The good news is that unless you take estrogen replacement medication, melasma tends to get better during menopause because it can be caused or worsened by estrogen.

Acne

Acne breakouts are common as shifting hormones and an increase of androgens trigger acne. Menopausal acne often manifests as pimples and cysts along the chin and jawline.

The best treatment for hormonal acne in menopause is the prescription anti-androgen medication called Winlevi (Clascoterone). Using this hormone blocking cream along your jawline and chin in combination with a retinoid can help prevent menopausal acne cysts.

Hormonal changes that affect skin

Hormonal Changes that Affect Skin

Estrogen

Declining estrogen during menopause correlates with reduced collagen types I and IV in the dermis and basement membrane.  This leads to thinning of the skin, wrinkles, and reduced structural integrity. 

Estradiol therapy can increase transforming growth factor-beta (TGF-β), which upregulates collagen production. Estrogen also increases tissue inhibitor of metalloproteinases (TIMPs), reducing deleterious matrix metalloproteinases (MMPs). Overall, estrogen replacement increases collagen types I and III content, skin thickness, elasticity and moisture content (1,5,7).

Progesterone

Decreased progesterone during menopause is associated with reduced production of skin surface lipids such as ceramides, cholesterol, and fatty acids. This leads to a compromised lipid barrier and leads to dry skin on the face.

When combined with estrogen therapy, progesterone increases skin surface lipids such as ceramides, cholesterol, and free fatty acids. This is thought to occur through stimulation of sebaceous gland activity and increased sebum production. One study found a 48% increase in skin surface lipids with replacement of progesterone plus estrogen versus estrogen alone (20,21).

Testosterone

Testosterone

Menopausal testosterone decline along with estrogen reduction leads to impaired stimulation of collagen production. Testosterone therapy combined with estrogen results in up to 48% higher skin collagen content compared to estrogen therapy alone. Testosterone is converted to estradiol via aromatase to activate estrogen receptors. However, testosterone combined with estrogen particularly increases type II collagen synthesis, which is not seen with estrogen alone (22,23)

Human Growth Hormone

Diminished HGH levels during menopause correlate with thinning of the dermis as cellular proliferation and extracellular matrix components are reduced. Supplementing with growth hormone can help increase skin thickness and collagen. (1)

Thyroid hormone

The active thyroid hormones triiodothyronine (T3) and thyroxine (T4) increase mitochondrial activity, ATP production, and antioxidant enzymes in dermal fibroblasts. At the molecular level, they upregulate collagen types I and III gene transcription, helping to thicken aged skin (1).

Decreased thyroid hormones during menopause reduce mitochondrial activity and collagen production in fibroblasts. This leads to skin thinning and fragility. T3 and T4 supplementation can help stimulate fibroblast activity and collagen synthesis (1,29,30)

Caring for pre and post menopausal skin

Pre and Post Menopausal Skin Care

Whether you are in premenopause, menopause, or post menopause, your skin care routine matters.  Below in the Menopause skin care section I will discuss what I tell my patients about  skin care products to use in pre menopause, menopause and post menopause.  Basically- all 3 stages of menopause need the same skin care routine which should be matched to your Baumann Skin Type.  


Here are tips I give my patients for improving their skin in menopause.  Note that hormone replacement is not for everyone and should be discussed with your doctor, especially if you have a history in your family or self of breast, ovarian or uterine cancer.


Caring for Dry Menopausal Skin:

With this approach, menopausal skin can maintain a healthy, vibrant youthful  glow and texture- but you must use the right products for your Baumann Skin Type.  There is much more to treating menopausal skin than using moisturizers and sunscreen.

 

Best products for menopausal skin

Menopause Skin Care for Face

Not all menopausal skin is dry so make sure you take the quiz to see if you are dry or oily. (Most people guess incorrectly) Once you know if you are considered dry or oily in the Baumann Skin Typing System, you should choose your cleanser by your skin type.  The cleansers below may be good for your skin, but it is better to take the quiz and let us tell you exactly which cleansers to choose.




Cleansers

  Cleansers can make a huge difference in menopausal skin by depositing fatty acids on the skin and exfoliating. But make sure you shop by your Baumann Skin Type.


Eye Creams and Serums

Face Creams

The best face cream to use for menopause should have antiaging ingredients. The right one for you depends upon which Baumann Skin Type you are. I recommend the products below but take the skin type quiz to be certain before you buy.


Serums for menopausal skin

Face Serums

Antioxidant serums such as Vitamin C serums and retinol serums are good for most skin types to help increase skin collagen lost during menopause. These may also help firm skin and prevent sagging.


Masks for Menopause

Wild Yams are a natural source of estrogen.  This vegan mask is a natural way to plump up and hydrate menopausal skin. It also has caffeine which is an antioxidant, anti-inflammatory and helps reduce any facial puffiness.


This antiaging mask also helps stabilize your skin's microbiome.

Sunscreens

Menopause Skin Care For Body

Body Wash

Stay away from soaps, bubble baths, and very foaming body washes that strip lipids from the skin and injure the skin barrier.  These can make menopausal skin even drier.

Instead choose creamy body washes and follow with an oil or body cream.


Body Creams

When estrogen levels drop, you need a barrier repair body cream and a body oil to help replenish skin lipids.


Menopause Supplements and Vitamins

Eating a healthy diet is so important when you are going through menopause. You can also look for antioxidant supplements with ingredients like green tea, polypodium leuctoomas, pomegranate, ascorbic acid, and resveratrol among many others.


Every product that you use in your skin care routine is important.  They interact with each other so your skin care routine step order and how you layer the products affects how well they absorb and how effective they are.


Let us help you find the best skin care brands to treat your menopausal skin.  You will be able to combine products from different medical grade brands into the perfect perimenopausal, menopausal or postmenopausal skin care routine.


Level up your skin care knowledge with medical advice from dermatologists

What does estrogen depleted skin look like?

Low estrogen levels cause a decrease in collagen production, and increased dehydration. This gives you skin that looks rough, dry, and has many fine lines. If you have skin of color such as black skin, your skin make look ashy. Sagging, dry, fragile, wrinkled skin is characteristic of low estrogen levels.

Will my skin go back to normal after menopause?

On it's own, skin will not go back to normal. However, if you use estrogen replacement therapy and the right skin care products that will help. You need to start as early as possible because sagging skin will not improve because you cannot increase elastin in skin once it is lost.

What products help with menopause?

Exosomes, growth factors, topical estrogen, heparan sulfate, retinoids and antioxidants can all help menopausal skin. Which is best for you depends upon your Baumann Skin Type.

Best References and Scientific Publications on

  1. Baumann L. Antiaging Ingredients in Ch. 37 of Baumann's Cosmetic Dermatology Ed 3. (McGraw Hill 2022)
  2. Vázquez F, Palacios S, Alemañ N, Guerrero F. Changes of the basement membrane and type IV collagen in human skin during aging. Maturitas. 1996;25(3):209-15.
  3. Baumann, L. (2005). A dermatologist’s opinion on hormone therapy and skin aging. Fertility and Sterility, 84(2), 289-290.
  4.  Affinito P, Palomba S, Sorrentino C, Di Carlo C, Bifulco G, Arienzo MP, et al. Effects of postmenopausal hypoestrogenism on skin collagen. Maturitas. 1999;33(3):239-47.
  5. Brincat M, Versi E, Moniz CF, Magos A, de Trafford J, Studd JW. Skin collagen changes in postmenopausal women receiving different regimens of estrogen therapy. Obstet Gynecol. 1987;70(1):123-7.
  6. Brincat M, Moniz CJ, Studd JW, Darby A, Magos A, Emburey G, et al. Long-term effects of the menopause and sex hormones on skin thickness. Br J Obstet Gynaecol. 1985;92(3):256-9.
  7. Piérard-Franchimont C, Letawe C, Goffin V, Piérard GE. Skin water-holding capacity and transdermal estrogen therapy for menopause: a pilot study. Maturitas. 1995;22(2):151-4.
  8. Harvell J, Hussona-Saeed I, Maibach HI. Changes in transepidermal water loss and cutaneous blood flow during the menstrual cycle. Contact Dermatitis. 1992;27(5): 294-301.
  9. Liu T, Li N, Yan YQ, Liu Y, Xiong K, Liu Y, et al. Recent advances in the anti-aging effects of phytoestrogens on collagen, water content, and oxidative stress. Phytother Res. 2020;34(3):435-447.
  10. Thornton MJ. Estrogens and aging skin. Dermatoendocrinol. 2013;5(2):264-70.
  11. Kassira N, Glassberg MK, Jones C, Pincus DJ, Elliot SJ, Fritz JR, et al. Estrogen deficiency and tobacco smoke exposure promote matrix metalloproteinase-13 activation in skin of aging B6 mice. Ann Plast Surg. 2009;63(3):318-22.
  12. Castelo-Branco C, Duran M, González-Merlo J. Skin collagen changes related to age and hormone replacement therapy. Maturitas. 1992;15(2):113-9.
  13. Brincat M, Versi E, O’Dowd T, Moniz CF, Magos A, Kabalan S, et al. Skin collagen changes in post-menopausal women receiving oestradiol gel. Maturitas. 1987;9(1):1-5
  14. Creidi P, Faivre B, Agache P, Richard E, Haudiquet V, Sauvanet JP. Effect of a conjugated oestrogen (Premarin) cream on ageing facial skin. A comparative study with a placebo cream. Maturitas. 1994;19(3):211-23.
  15. Fuchs KO, Solis O, Tapawan R, Paranjpe J. The effects of an estrogen and glycolic acid cream on the facial skin of postmenopausal women: a randomized histologic study. Cutis. 2003;71(6):481-8.
  16. Zouboulis CC, Boschnakow A. Chronological aging and photoaging of the human sebaceous gland. Clin Exp Dermatol. 2001;26(7):600-607.
  17. Dieudonné MN, Leneveu MC, Giudicelli Y, Pecquery R. Evidence for functional estrogen receptors alpha and beta in human adipose cells: regional specificities and regulation by estrogens. Am J Physiol Cell Physiol. 2004;286(3):C655-61.
  18. Rosenthal A, Jacoby T, Israilevich R, Moy R. The role of bioidentical hormone replacement therapy in anti-aging medicine: a review of the literature. Int J Dermatol. 2019 Oct 11.
  19. Sator PG, Schmidt JB, Sator MO, Huber JC, Hönigsmann H. The influence of hormone replacement therapy on skin ageing: a pilot study. Maturitas. 2001;39(1):43-55.
  20. Brincat M, Moniz CF, Studd JW, Darby AJ, Magos A, Cooper D. Sex hormones and skin collagen content in postmenopausal women. Br Med J (Clin Res Ed). 1983;287(6402):1337-8.
  21. Savvas M, Bishop J, Laurent G, Watson N, Studd J. Type III collagen content in the skin of postmenopausal women receiving oestradiol and testosterone implants. Br J Obstet Gynaecol. 1993;100(2):154-6.
  22. Baulieu EE, Thomas G, Legrain S, Lahlou N, Roger M, Debuire B, et al. Dehydroepiandrosterone (DHEA), DHEA sulfate, and aging: contribution of the DHEAge Study to a sociobiomedical issue. Proc Natl Acad Sci U S A. 2000;97(8):4279-84.
  23. Nouveau S, Bastien P, Baldo F, de Lacharriere O. Effects of topical DHEA on aging skin: a pilot study. Maturitas. 2008;59(2):174-81.
  24. Herman, J., Rost-Roszkowska, M., & Skotnicka-Graca, U. (2013). Skin care during the menopause period: noninvasive procedures of beauty studies. Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii, 30(6), 388-395.
  25. Lephart, E. D., & Naftolin, F. (2021). Menopause and the skin: Old favorites and new innovations in cosmeceuticals for estrogen-deficient skin. Dermatology and Therapy, 11, 53-69.
  26. Reus, T. L., Brohem, C. A., Schuck, D. C., & Lorencini, M. (2020). Revisiting the effects of menopause on the skin: functional changes, clinical studies, in vitro models and therapeutic alternatives. Mechanisms of ageing and development, 185, 111193.
  27. Nouveau S, Bastien P, Baldo F, de Lacharriere O. Effects of topical DHEA on aging skin: a pilot study. Maturitas. 2008;59(2):174-81.
  28. Rudman D, Feller AG, Cohn L, Shetty KR, Rudman IW, Draper MW. Effects of human growth hormone on body composition in elderly men. Horm Res. 1991;36 Suppl 1:73-81.
  29. Paus R, Ramot Y, Kirsner RS, Tomic-Canic M. Topical L-thyroxine: The Cinderella among hormones waiting to dance on the floor of dermatological therapy? Exp Dermatol. 2020;29(9):910-923.
  30. Vidali S, Knuever J, Lerchner J, Giesen M, Bíró T, Klinger M, et al. Hypothalamic-pituitary-thyroid axis hormones stimulate mitochondrial function and biogenesis in human hair follicles. J Invest Dermatol. 2014;134(1):33-42.
  31. Baumann, L. (2005). A dermatologist’s opinion on hormone therapy and skin aging. Fertility and Sterility, 84(2), 289-290.

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