By the time we reach our 40s and 50s, we've likely settled on a skincare routine that works for us. It can feel as if the rules have been changed unfairly when we start nearing menopause.
Previously resilient skin might become sensitive to rough textures and harsh chemicals. We find ourselves needing a more intense moisturizing routine, when light moisturizers sufficed before. Fine lines and wrinkles begin to appear, and the skin begins to lose some of its elasticity. Some of us reckon with skin conditions that never bothered us before, such as rosacea and eczema.
It can't be denied; menopause, which begins a year after your last period, ushers in a new era of change. Estrogen levels plummet rapidly, while androgen (e.g., testosterone) levels taper off more gradually. This imbalance has wide-ranging effects on our skin.
Fortunately, science has advanced our understanding of how menopause affects the skin, which has led to impressive product development. Never before have we seen so many options for skincare during menopause. Here are a few skincare needs that you might experience with menopause, as well as some tactics to address them.
Falling Collagen Levels
Collagen loss is one of the most noticeable effects of menopause. Collagen is a protein found in the connective tissues of our skin and other organs. It’s a tough fiber that gives our skin strength and elasticity. It also plays a role in the generation of new skin cells and the replacement of old skin cells–this is part of what allows our skin to retain moisture.
For most of our lives, we produce collagen almost as rapidly as we break it down. After menopause, however, collagen production slows. We experience a 30% loss of collagen in the first five years of menopause. Collagen loss slows after this period, but we continue to lose around 2% of our collagen every year.
Lowered collagen production is one of the greatest causes of skin changes associated with menopause. As collagen production slows, you may notice fine lines, wrinkles, and sagging skin. Our skin bruises more easily and is more susceptible to sun damage, and healing takes longer than it once did. Lowered collagen levels also lead to rapid loss of moisture, causing our skin to be dry and dull.
Applying collagen to the skin doesn't seem to help, and the jury is out on supplemental collagen. Not to despair! Vitamin A and C both stimulate collagen production. Diets high in these vitamins give us a leg up in combating collagen loss. Leafy greens, carrots, beef, eggs, and milk are some common foods rich in vitamin A. Vitamin C is found in citrus, tomatoes, and foods in the cabbage family, such as broccoli.
Be sure to give your skin a direct helping of these nutrients, also. Retinoids are compounds derived from vitamin A–applied to the skin, stimulating collagen production, reducing the appearance of fine lines (You’ll find that retinoids are all-around MVPs for skin during menopause). Products containing vitamin C restore the skin’s luminosity and softness.
Moisturizers are vitally important, and a good moisturizing routine will rehydrate the skin and prevent moisture loss. The best products include humectants, such as hyaluronic acid, which draw moisture into the skin. They should also include occlusives like dimethicone, petrolatum, and lanolin to prevent moisture loss, and emollients such as squalene or shea butter to penetrate the skin cells and fill in the spaces around them.
Glycerin juggles the roles of humectant, emollient, and occlusive at once. It is a common and effective ingredient in skincare products.
The way you moisturize your skin is equally important. If you’re using a hydrating serum, you may need to apply it when the skin is still damp from cleansing. Wait a minute or two, then add your moisturizing cream. If you are using an extra occlusive for intense moisturization, it will typically go on last. Read your product information carefully; some serums are only meant to be used at night, while some creams are formulated specifically for daytime use.
Don’t expect immediate results when you change up your regimen. Give your products a week to two weeks.
Hyperpigmentation and Melasma
Hyperpigmentation is another frequent skin issue during menopause. You might notice more “age spots” or “liver spots”--flat, brown spots darker than the surrounding skin–in places that are frequently exposed to the sun, such as the hands. They are a sign of sun damage.
Melasma refers to a darkening of the skin with a blotchy pattern, usually around the nose, cheeks, and mouth. Like age spots, melasma occurs on skin that is exposed to the sun.
Daily use of sunscreen with a sun protection factor (SPF) of at least 30 is an important part of skincare during menopause; this is your key defense against uneven darkening.
There are options for reducing the appearance of melasma and other kinds of hyperpigmentation.
Azaleic acid is highly effective and almost universally tolerated. It’s found in many skincare products now, as well as prescription-only treatments. Skin-lightening creams (not to be confused with skin-bleaching creams, which often contain toxins such as lead and mercury) can help even out discoloration. Inquire about these products with your dermatologist; if you’ve used skin-bleaching creams, inform your doctor and monitor your skin for damage.
Retinoids come to the rescue again! Tretinoin in particular works well to counter hyperpigmentation. Studies suggest that it works better when used in tandem with skin-lightening creams. Once again, this is a question to direct to your board-certified dermatologist.
Peels, also called chemical peels and skin peels, refer to the use of chemicals to exfoliate the skin. Light peels use chemicals such as salicylic or glycolic acid to radically exfoliate the most superficial layer of the skin. These peels are not long-term solutions, but you can have light peels fairly regularly–every two to five weeks, depending on your dermatologist’s recommendation. One study reported that melasma responded best to a combination of salicylic acid peels, tretinoin treatment, and the use of a skin-lightening cream.
Other peels go into deeper layers of the skin. Some deep peels use phenol, which should only be administered by licensed physicians as it carries a risk of heart and kidney damage. Deep peels cannot be done as frequently as light peels.
**Warning: some skin cancers can present similarly to age spots. See your dermatologist regularly and discuss any new discolorations or moles you might find. Don’t attempt to lighten these spots on your own until you know what you’re dealing with.
It seems unfair to deal with a problem you thought you left behind in high-school, but acne sometimes reappears at menopause.
Acne occurs for a lot of us as estrogen levels no longer balance androgens. Don’t break out your old high school acne treatments if this happens to you. During menopause, our skin isn’t as tolerant of the brutal acne treatments we used as teenagers.
Don’t be dismayed, though; there are lots of products that treat acne without harshness. Our versatile old friends, retinoids, show up again. Tretinoin in particular is a favorite for acne treatment. Benzoyl peroxide is effective, but it's more drying as we age. It should be delivered in a cream based preparation (that’s important) of 2.5%, max.
Azelaic acid is marvelous for acne and skin brightening, and according to available literature, it’s tolerated by almost all skin types.
Antibiotics and systemic treatments exist for stubborn cases. These treatments require a prescription, and some can have unwanted side effects. Your dermatologist can discuss these options with you.
Eczema at Menopause
Atopic dermatitis, aka eczema, is caused by a confluence of factors. Changing hormone levels lead to decreased collagen and sebum production, which causes reduced barrier function. The skin’s pH balance changes, as well, and added to transdermal moisture loss, this can affect your skin’s microbiome unfavorably.
Your skin’s microbiome is like a community of microbes that inhabit the surface of your skin. If your skin’s microbiome is out of whack–let’s say it has more staph bacteria than is ideal–your skin is more susceptible to disorders like eczema.
Topical steroids are a common eczema treatment. They cannot be used long-term, as they can cause the skin to thin–definitely not something we want at this stage of life. They can also cause something called topical steroid withdrawal, or TSW; when this happens, patients have a rebound effect, with increased redness and itching when the treatment is discontinued.
Enter SmartLotion®. This cream was developed by Steve Harlan, MD, a board-certified dermatologist, to help his patients with recurring eczema flares. Of course, we think it's one of the best eczema creams out there, but there's a reason why. SmartLotion® contains ingredients that aid in repairing the skin barrier and restoring a balanced microbiome. This allows SmartLotion® to achieve fast results with a low dose of hydrocortisone (only 0.75% Hydrocortisone USP). This makes it ideal as a treatment for chronic skin disorders (it’s also useful for rosacea, another skin condition that frequently develops during menopause).
The Knowledgebase on Dr. Harlan's website is a veritable fount of information on eczema and other skin conditions; it’s a great place to learn more about SmartLotion®.
SmartLotion® is available without a prescription, but you should use it with the guidance of a board-certified dermatologist. It isn’t a substitute for medicines your doctor prescribes.
Remember to maintain your moisturizing routine during treatment! Rapid moisture loss is a feature of eczema, and you won't do it any favors by withholding moisturizers.
A New Beginning
Adjusting to your skin’s new needs during menopause can feel daunting, but you have tools at your disposal to help you. There are some steps you can take on your own to support your skin’s health as this new era begins:
- Use sunscreen with an SPF of at least 30 daily.
- Moisturize your skin with products that include humectants, emollients and occlusives twice a day.
- Add vitamin C, D, and A to your diet
- See your dermatologist regularly
- Handle your skin with care, avoiding harsh scrubs and rough washcloths. Rub gently when cleansing. Consider investing in a satin pillowcase to reduce friction against your skin as you sleep.
Menopause is often regarded as an ending. We can choose instead to regard it as a beginning–the beginning of acceptance of our bodies and respect for their needs. What better place to start than with your largest organ?
- Zula Elwood