We need to talk about menopause
01 Sep 2021

Did you know that almost half of women experience challenges with their skin during the menopause1?

Every woman will go through the menopause, but before it happens, many find the process shrouded in mystery and anxiety. Openly discussing the physical and emotional challenges that the menopause and perimenopause can bring remains a rarity, yet understanding and discussing the subject is vital to help women to maintain wellbeing as they navigate the changes in their bodies.

The physiological changes that happen as part of the menopause and perimenopause have implications for physical and mental health, wellbeing and skin.

In the UK, there is a chronic lack of support for menopausal women. A recent study found that 67% of menopausal women believe there is a general lack of help and information around the subject2.

In a recent Advanced Nutrition Programme™ survey, it was revealed that 99% of those surveyed agree that when skin is in a healthy condition, they feel more confident.

Dr Gaby Prinsloo, medical director at the iiaa, explains that supporting this connection becomes particularly vital during the menopause. “The appearance of our skin has a significant impact on our emotions and how we feel about ourselves. If we can support our skin through menopause, it will make a big difference to how we experience this important time in our lives,” she explains.

“Menopause is a subject many people don’t completely understand and so may feel very anxious about – for skincare professionals and their clients it is empowering to know there are things we can do.”

What is the menopause?

Menopause refers to the time when women stop getting periods and can no longer get pregnant. The ovaries stop releasing eggs, and levels of hormones including oestrogen and progesterone fall. These changes have a knock-on impact on numerous physiological processes.

Often thought of as a prolonged experience, biologically the menopause refers to just one day – 12 months after a woman has her last period. Menopause affects every woman differently, but the NHS estimates that 8 in 10 women notice both physical and psychological symptoms3.

In the UK, the average age for the menopause is 51. The years running up to this point are referred to as perimenopause, this period often starts around age 45, but can begin 10-15 years before the menopause itself. The perimenopause is when symptoms of the menopause begin, as hormone levels begin to drop.

Some of the most common symptoms of the menopause include hot flushes, difficulty sleeping, lack of energy, muscular aches, brain fog, headaches, anxiety or depression, loss of confidence and low mood. Decreased oestrogen in the body also means that post-menopausal women are more at risk of osteoporosis and heart disease.

How does the menopause impact skin?

A recent study reviewing the impact of menopause on skin summarised the effects as follows: “[Menopause] decreases defence against oxidative stress; skin becomes thinner with less collagen, decreased elasticity, increased wrinkling, increased dryness and reduced vascularity. Its protective function becomes compromised, and ageing is associated with impaired wound healing, hair loss, pigmentary changes and skin cancer.”7

This primarily occurs from hormonal changes, specifically the drop in oestrogen. Oestrogen is involved with many of the functions that keep our skin healthy.

As such, when oestrogen levels fluctuate and drop, sometimes referred to as hypoestrogenism, we may see changes in the skin.

Dry skin, itching, sensitivity and compromised barrier function

Oestrogen helps to stimulate the normal production of hyaluronic acid – a substance that plays a vital role in ensuring the skin stays hydrated and comfortable.

Evidence suggests that oestrogen stimulates our cells to produce glycosaminoglycans (GAGs), a group of substances that includes hyaluronic acid8. Molecules of hyaluronic acid hold 1000 times their weight in water, binding moisture in the skin for a plump, hydrated complexion.

Oestrogen also plays a role in maintaining the barrier function of the skin9. The upper skin layers create the waterproof barrier of the skin that locks moisture in and keeps unwanted irritants out. Molecules such as ceramides and omega fatty acids are involved with maintaining this barrier.

Dry skin can also exaggerate the appearance of fine lines and wrinkles. Replenishing levels of hyaluronic acid and ceramides through topical and oral skincare is key to reversing discomfort and improving the health of the skin.

Replenishing the skin’s supply of vitamin A through topical and oral care also assists in reviving skin’s hydration levels In addition, Dr Gaby recommends including omega fatty acids to attenuate dry skin and discomfort.

Thinning skin, fine lines and wrinkles

The drop in collagen and elastin that occurs as we age is a well-known mechanism behind the signs of ageing. Your clients are likely to be aware of the important role that these structures play in keeping skin strong, supple, healthy and resilient but they may not realise that our collagen and elastin levels are affected by oestrogen.

Type 1 and type 3 collagen levels begin to fluctuate during the perimenopause and decline by as much as 30% in the first five years after the menopause13. After this, they continue to decline by 1.13% per year, with skin thickness declining by 2% per year. Research shows these changes occur because of falling oestrogen levels in the skin.

Lower collagen and elastin levels equate to thinner, less firm skin and can exaggerate fine lines and wrinkles. To minimise the impact, incorporate vitamins A and C plus peptides and antioxidants into skincare regimes. When used orally and topically, these ingredients encourage the normal production of collagen, maintaining skin health and structure.

Acne

Frequently considered a teenage condition, acne is common in menopausal women. As with teenage acne, which frequently begins around puberty, menopausal acne is thought to be connected to the changing levels of hormones within the body.

“Acne becomes more likely in menopause as a result of the changing ratio of our hormones. As oestrogen drops, unopposed androgens [“male” hormones including testosterone] can increase the likelihood of developing acne,” explains Dr Gaby.

Changes to the skin’s pH, and to the levels of oil produced by the skin are also thought to contribute to the increased likelihood of developing acne during the menopause.

Educate to empower

When it comes to the menopause, skin care is not about erasing any hint of a change or trying to turn back time, but about ensuring that your clients’ skin ages in a healthy way, supported by topical and oral skin care. With enhanced skin health and an understanding of changes in the skin and the body, comes enhanced confidence.

“Education is empowerment,” says Dr Gaby. “It’s important that anyone experiencing the menopause can understand what is happening to them, and what they can do about it, to help remove the fear factor that menopause often triggers.”

Look out for more information around menopause and wellbeing coming soon from the iiaa.

READ THE FULL ARTICLE IN YOUR SEPTEMBER 2021 EDITION OF THE BULLETIN

Sources:

  • According to research from the charity My Menopause Doctor.
  • https://www.nuffieldhealth.com/article/one-in-four-with-menopause-symptoms-concerned-about-ability-to-cope-with-life
  • https://www.nhs.uk/conditions/menopause/symptoms/
  • Thornton, M Julie. “Estrogens and aging skin.” Dermato-endocrinology vol. 5,2 (2013): 264-70. doi:10.4161/derm.23872
  • Oe, Mariko et al. “Oral hyaluronan relieves wrinkles: a double-blinded, placebo-controlled study over a 12-week period.” Clinical, cosmetic and investigational dermatology vol. 10 267-273. 18 Jul. 2017, doi:10.2147/CCID.S141845
  • Uzuka, M et al. “The mechanism of estrogen-induced increase in hyaluronic acid biosynthesis, with special reference to estrogen receptor in the mouse skin.” Biochimica et biophysica acta vol. 627,2 (1980): 199-206. doi:10.1016/0304-4165(80)90321-9
  • Chen, Yue et al. “Physiological and functional changes in the stratum corneum restored by oestrogen in an ovariectomized mice model of climacterium.” Experimental dermatology vol. 26,5 (2017): 394-401. doi:10.1111/exd.13214
  • Oe, Mariko et al. “Oral hyaluronan relieves wrinkles: a double-blinded, placebo-controlled study over a 12-week period.” Clinical, cosmetic and investigational dermatology vol. 10 267-273. 18 Jul. 2017, doi:10.2147/CCID.S141845
  • SKIN MOISTURE LOCK™ Results based on a pilot study conducted on 12 participants aged between 30 – 61 (1 man and 11 women) over 12 weeks. Measurements were taken using Courage + Khazaka equipment and were taken at the beginning of the pilot study and at the end of the 12 weeks
  • Kober, Mary-Margaret, and Whitney P Bowe. “The effect of probiotics on immune regulation, acne, and photoaging.” International journal of women's dermatology vol. 1,2 85-89. 6 Apr. 2015, doi:10.1016/j.ijwd.2015.02.001