Menopause and the Skin
Why your skin is affected during the menopause and when to seek help.
Dr DeGiovanni is a national expert in how the menopause affects the skin. She is a Consultant Dermatologist in Brighton, Sussex. She has published several articles and has been an invited speaker for several meetings for health professionals as well as collaborating with IG live and podcasts on the topic. She is passionate about supporting women during this transition and is keen to raise the importance of the impact of the menopause on the skin to expand the current evidence base and ensure that women are diagnosed and receive appropriate treatment in a timely fashion.
The skin is the largest organ in the body and if often reflects the systemic condition of the body, developing symptoms and rashes with certain systemic conditions. Oestrogen receptors are found in the skin especially in the face and genital regions . It is therefore not unsurprising that the skin is adversely affected through the menopause.
Oestrogen deficient skin has impaired barrier function meaning that the “bricks and mortar” holding the top layers of the skin together aren’t as strong as they once were. This leads to increased water loss through the skin, sensitive skin and increased inflammation. Additionally, the skin loses about 30% of its collagen stores in the perimenopausal period. This can cause symptoms like dryness, red skin, sensitive skin and itchy and irritated skin and many women struggle to manage these symptoms especially if they have never suffered with skin symptoms before.
Other systemic features of the menopause, eg hot flushes can aggravate conditions such as rosacea and the relative hormonal imbalance of androgens/ oestrogens can also impact some skin conditions such as acne and female pattern hair loss. We also see some scarring conditions of the scalp at this time of life which need to be diagnosed as early as possible to minimise the damage.
The impact of the menopause on skin conditions is under appreciated and under reported. Dry skin conditions such as eczema and psoriasis can flare. Acne affects 25% of perimenopausal women and scarring and pigmentation changes are a significant issue for these women. Autoimmune conditions are more common post menopause because oestrogen and progesterone inhibit development of inflammatory cytokines in the body. Many women suffer with dry mouths and painful mouths which can be difficult to manage. Genital symptoms are particularly problematic in menopausal women with symptoms such as dryness, itching burning and urinary symptoms leading to a significant impairment in quality of life. The recent position statement on genitourinary syndrome of menopause recognised that 70% of women suffer with symptoms but only 7% receive treatment. About 70% of health professional admit that they don’t routinely ask about genital symptoms in this patient group. It is also recognised that early intervention for genital menopausal symptoms with topical oestrogen is important to improve the outcomes so we really do need to bridge this gap more effectively.
Many women also do not seek medical help for new skin symptoms in the menopause and this can lead to further suffering, delays in diagnosis of skin conditions and in some cases (e.g scarring or genital conditions), can affect the prognosis of the condition. The flooding of the market with products marketed towards menopausal women, some with limited evidence base and including possible irritants makes management of skin conditions at this time even more challenging. It is really important that women and health professionals are aware of the potential skin changes that can happen during the menopause so that women feel able to see help and advice in a timely fashion and that their skin conditions can be diagnosed and managed early.
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