Dropping estrogen levels and the hormonal changes of menopause affect almost all aspects of women’s health, including a variety of unwelcome skin changes, ranging from accelerated aging and dry, itchy skin, to acne, flushing, hyperpigmentation, impaired wound healing and hair loss. This can cause a considerable further impact to the already significant psychological burden of menopause.
With the onset of menopause, there is a rapid decline in collagen production, with a 30% reduction in the collagen content of skin during the first five years of menopause. After this, the decline is more gradual, with approximately 2% loss skin collagen ever year for the next 20 years. There is also a substantial decrease in glycosaminoglycan (GAG) levels within the skin, molecules that help to draw water into the dermis and keep the skin hydrated, and in elastin production. This reduction in collagen and the structural components of the dermis leads to skin laxity and wrinkles which can be very prominent around the eyes, jawline, jowls and neck. This is compounded by loss of bone density in the cheek bones, jaw and temples, loss of subcutaneous fat and other soft tissues with a resultant loss of facial volume and shifting of the fat pads beneath the surface of the skin with hollowing of the cheeks and temples, and descent of the face. The jawline sags, jowls appear, permanent lines often deepen from the nose to the corners of the mouth (nasolabial folds), the tip of the nose dips and tear troughs or pouches may develop under the eyes. This happens gradually for some women while others feel that they have “aged by 10 years overnight.”
Dry, itchy skin is one of the most common skin issues reported by menopausal women. This is due to the decrease in glycosaminoglycan and sebum production, reduced cell turnover, diminished barrier function and reduced water retention. Thin skin with reduced collagen bruises and tears more easily, with delayed wound healing.
Irregular pigmentation and age spots become more prominent because the skin becomes thinner with melanin accumulation in ares of chronic sun exposure such as the face, chest, hands and arms .
Changes in hair distribution
While female-pattern hair loss can affect women of all ages, this accelerates in the perimenopausal period. At the age of 60, over 55% of women have thinning of the hair on their head. The first sign may be a widening parting while some women find that their hairline starts to recede. Unfortunately, the oppostite is true of facial hair. As levels of female hormones fall, thick coarse hair may appear on the chin, jawline or above the lip.
Even women who didn’t have acne as a teenager may break out with hormonal acne in the perimenopausal period with the activity of unopposed androgens with reducing estrogen levels. This can continue well into the 60s and sometimes 70s.
Night sweats & flushing
Night sweats and flushing are two of the most bothersome vasomotor symptoms of menopause. As many as 80% of women experience night sweats and flushing. Flushing generally occurs on the face, neck, chest, palms and soles and is linked to the effects of estrogen deficiency on the skin’s microcirculation.