Both men and women age, of course it is a natural process, but how does falling oestrogen play a part skin changes in menopause? At Rowena Health Menopause Specialist Clinic we often talk to women about this. Skin changes, hair thins, these symptoms can be distressing.
I am fascinated by the effect of oestrogen everywhere! Skin has an abundance of oestrogen receptors. What happens as oestrogen levels drop? Of course both men and women age, but how does oestrogen play a part for women? Does it affect our epidermis, the top layer of our skin, or our dermis, the layer underneath this, which gives our skin it’s structure? Why does our plump, full, glowing, young skin change?
We can embrace the wisdom of ageing but for some of us the skin changes can result in a visit to the shops to find new creams, scrubs, night creams, eye creams, sun screen, makeup that stays on. We might look at other treatments to help us at this time to help us look brighter, more vibrant and younger.
Ageing is a natural process, nothing can turn back the hands of time. External factors effect skin, the most important one being sunlight, or exposure to UV light, which accounts for 95% of external ageing. Cigarette smoking is another external ageing factor which leads to thickening of the epidermis. Internal factors lead to a decrease in cells of the epidermis and dermis, and a gradual reduction in the amount of collagen and elastin which give the dermis it’s structure and volume.
The skin changes we see in ageing women are dryness, itching, scaliness, acne, rosacea, skin thinning and thickening, pigmentation, thread veins, fine wrinkles, deep wrinkles and sagging.
Often we see those with darker skin presenting with leathery thickened skin, coarse wrinkles and pigmentation, and those with fair skin can develop thread veins, finer lines and enlarged pores. Our skin certainly is affected by the falling oestrogen, oestrogen is required for the skin’s natural hydration but this is not the only factor.
The epidermis
Chronic sun exposure thickens the epidermis, a protective response, the lower surface of the epidermis flattens, there are less new skin cells (keratinocytes) produced, those new cells are randomly shaped, not circular, as young cells are, so that affects their function. An older epidermis takes longer to recover once it has been damaged. Oestrogen stimulates the production of ceramides, a lipid, in the stratum corneum layer of the epidermis, this binds the corneocytes in this layer, forming a strong barrier to toxins and stopping evaporation of water from the skin, so when oestrogen falls this may be affected. There is reduced cholesterol synthesis as we age, and fats are very important in keeping the stratum corneum layer of the epidermis functioning normally. Oestrogen stimulates sebum production from the sebaceous gland, which is fatty rich and protects the skin from dehydration and evaporation. Dry skin can’t desquamate properly (shed the dead skin cells) so becomes scaly. These may explain how falling oestrogen contributes to our changing epidermis.
The dermis
Oestrogen stimulates hyaluronic acid production in abundance in the dermis. This is a glycosaminoglycan. It reduces the visibility of fine lines and wrinkles and is hugely hydrating. Moist skin looks plumper. Low oestrogen leads to thinning of the epidermis and dermis, to a reduction in collagen and elastin amount & integrity, to slack skin, loss of elasticity, hydration and wrinkles. The dermis is mainly composed of two fibrous proteins, collagen and elastin as well as extra cellular components like hyaluronic acid, a humectant, which binds water and helps maintain hydration in the dermis. Structure, flexibility and hydration are important for ‘young skin’. Collagen bundles provide tensile strength to the dermis and account for 80% of the dry weight of skin.
Collagen
There are 14 different types of skin collagen, most commonly type I (80%) and type III (15%). 30% of collagen is lost in the first 5 years after the menopause then the loss rate returns to 1-2% a year. Elastin makes up 2-4% of the dermis, providing resilience and stretchy, bounce back, suppleness. During the 1990’s the discovery of oestrogen receptors on dermal fibroblasts and epidermal keratinocytes provided a possible mechanism through which oestrogen could affect the skin. Fibroblasts, the key cell type in the dermis, respond to oestrogen and they stimulate collagen and elastin production. Keratinocytes make the protein keratin which thickens the epidermis and therefore reduces water loss.
Men have a thicker dermis than women which may explain why women tend to look older more quickly than men.
Sagging and jowls
Many women worry about jowls and sagging skin. These are lack of a defined jawline and deepened nasolabial fold, which is the line between your cheek and your upper lip. Is gravity to blame? Is loss of volume to blame? A decrease in the amount of facial fat occurs as we age, the skin looses elasticity, our facial ligaments weaken, all of these contribute to that sagging.
Age gracefully and accept, or age gracefully and take action?
Healthy skin ages, but there are so many products now marketed to women for menopause or anti-ageing. Different brands and different products but which one? My goodness that is a million dollar question. I have been told that ingredients are the key.
Cleansing
Certainly if we should cleanse with a soap free product, as our skin is happy with a pH of 4.7. It has happy cellular function, happy enzymatic function and happy desquamation at this acidity. If you wash with a soap which is alkaline you will wash off the sebum from the epidermis which is so important to keep our safe skin barrier moist. Johnson’s baby soap has a pH of 11.9 and Imperial leather soap pH 9.4, it’s easy to see how these can upset our skin! They are too alkaline, and will directly denature skin proteins and affect skin function. You can use a soap substitute like dermol or an alternative (it will not lather or bubble but will definitely clean your skin) or you could use a low pH cleanser.
Moisturising
Do we need a moisturise? A moisturiser is an occlusive (stops evaporation) and a humectant (holds water in the skin and attracts water to itself). They purely work in the epidermis. There are no anti-aging benefits of moisturisers, they plump the skin during the time that they work. We all have a favourite moisturiser but maybe we need a better one when our skin dries, longer lasting? Choosing one we love is important (bearing in mind that they aren’t anti-aging and just keep the skin moist) this will help keep our skin healthy, clean and deal with and dryness. Hyaluronic acid in a moisturiser does not penetrate to the dermis, it is too big, but it can stay in the epidermis and works well as a humectant there.
Sunscreen
We should use a daily sunscreen every single day, if we want to protect our skin. A hat is also an excellent idea. We know UV light is a big external ageing factor.
Anti-ageing, is this possible?
Do we use active treatments on our skin?
We could use a topical retinoid like Tretinoin to thicken the epidermis and stimulate the fibroblasts to produce more collagen. What is the difference between retinol and retinoid? Do we buy one over the counter or do we approach a skin care company for a product tailored to our skin? We could spend money on collagen supplements or we could eat a healthy balanced diet rich in protein which is broken down to amino acids. Do we use active treatment to reduce pigmentation like Hydroquinone? Is Vitamin C necessary? Is Niacinamide necessary? Do we exfoliate or rely on our skin naturally doing this, as it does? What is important to us? Health of our skin? Anti-ageing? Treatment of acne or rosacea? Glowing skin? Will we stay with products applied to the skin or approach an aesthetics company for botox injections or other facial treatments to help our skin. Are we thinking of surgery?
It is confusing, and so easy to spend a great deal of money on our skin and the way we look. We often worry about skin changes in menopause.
If we have acne or rosacea we may need a visit to the Dr for prescription medication.
Does HRT help? Yes, studies show it can increase skin thickness but there isn’t much evidence to show it reduces wrinkles, sadly! Can HRT reverse ageing changes? HRT appears to boost dermal collagen and improves skin health. Two HRT studies have shown it increases skin thickness by 7-15% and 30%. An increase in skin hydration was seen as estradiol also increases the level of hyaluronic acid. A number of studies have looked at its effect upon skin. Whether HRT use can improve wrinkle appearance on sun exposed areas is equivocal. Some studies show improvement in wrinkles but others do not. HRT has been shown to improve 50% of skin concerns in women.
There are many opinions on what skin care to choose! It doesn’t have to be expensive but certainly healthy skin is important.
Simple things like eating a healthy balanced diet rich in protein and colourful fruits and vegetables will help to ensure you have all the vitamins and minerals required for healthy skin. Drinking water to hydrate your body and exercising regularly help to ensure good health. Prioritising sleep, self care to reduce stress is so important for hormonal balance. Reducing alcohol and stopping smoking are important. There are many simple changes we can do to help, to give us a future with quality of life, so we can flourish and grow. Ageing skin is normal, with it comes wisdom and confidence, ready to embrace the next phase of life.
This advice is as accurate and as comprehensive as possible, it should not be used as a substitute for the individual advice you receive from your own doctor. It contains my own opinions and collated evidence from articles and books.
To make an appointment at Rowena Health Menopause Clinic to talk about all the changes happening in your body at midlife please click on the link. We offer care for women all over the UK online and in person at our Guildford Clinic.
Last updated September 2023 Dr Carys Sonnenberg