Skincare and Menopause

Article by
Daria Sochacka.

Daria Sochacka is the skincare and massage therapist at thebeautysalon.ie. I've been going to her for many years and feel lucky to be able to bring you her wisdom and knowledge in this area. Daria has treated a great many women with various skin problems associated with menopause, in the article below she goes through some of the more common skin issues and offers solutions.

Why does our skin change at menopause?

The drop in oestrogen levels during menopause causes a reduction in collagen and elastin levels in the skin. It is estimated that 30% of the collagen is lost in the first five years after menopause. Since collagen contributes to thickness and elasticity of the skin, its depletion is responsible for thinning of the skin. Women may notice they have more wrinkles and that their skin is looser than before.

The main symptoms are discussed below together with their causes and treatment options:

Acne/Oily Skin

Cause: hormonal changes

Advice: gently exfoliate to unclog pores and improve overall complexion,

Use adult acne skincare  products containing Alpha Hydroxy Acids, Salicylic Acid, Azelaic Acid, Retinoids, Tea Tree Oil, Neem Seed Oil and Willow Bark Extracts

Dry Skin

Cause: less active sebaceous glands, drop in the production of the skin hydrating Hyaluronic acid

Advice: Moisturise all over

Rehydrate your skin  with a good moisturizer containing glycosaminoglycans, which naturally occur in the skin and help to bind moisture this includes Hyaluronic acid.

Vitamin E also hydrates the skin and prevents further water loss

Wrinkles and thinning of the skin

Cause: reduction of collagen

Advice: UV exposure causes further depletion of collagen. Use a SPF of at least 30.

Use skincare formulated with antioxidants such as Vitamin A, C and E which can slow down the process of aging or even reverse certain changes to the skin.

Whereas well-formulated skincare helps improve the appearance of menopausal skin it is also important to remember about a well balanced diet, comprising foods rich in antioxidants. Vitamin C can be found in berries, citrus fruits, dark green vegetables (spinach, asparagus, broccoli) and tomatoes. Vitamin E is present in olives, olive oil, nuts, seeds, avocado, grains and beans. Good sources of Beta Carotene (Vitamin A) are dark orange, red, yellow and green vegetables (carrots, mangos, apricots and spinach).

Sun damage and hyperpigmentation

Cause: Reduced production of  the pigment melanin, whose main function is to protect the skin from harmful UV rays making the skin more vulnerable to sun damage.

Sun damage is a significant factor in skin aging and skin cancer.

Age spots are a result of years of exposure to Ultra Violet rays from the sun.

Due to a lack of control by oestrogen in parts of the skin, melanin may be produced in higher concentrations creating brown spots.

Advice: use a broad-spectrum sun protection containing both UVA and UVB filters (SPF 30 or higher).

Antioxidant Vitamins A, C and E and Alpha-Lipoic Acid also play an important role in the photoprotection of the skin.

To battle existing sun damage and hyperpigmentation, treatments with Alpha Hydroxy Acids containing Glycolic Acid and Lactic Acid give great results in conjunction with at-home skincare preparations containing AHA’s.

Gentle exfoliation helps fade skin discoloration.

Other effective skin brightening ingredients are Azelaic Acid, Retinoids, L-ascorbic Acid (Vitamin C), Kojic Acid, Alpha Arbutin and Licorice Root Extracts.

Superfluous facial hair

Cause: while oestrogen and progesterone levels decline, the adrenal cortex continues to produce androgens, which may lead to excessive facial hair, especially on the lip and chin area.

Advice: I recommend waxing as a temporary method of hair removal. If the hair is dark enough a course of laser treatments may gradually reduce the hair growth over a period of time. Electrolysis is a permanent solution to get rid of the unwanted hair.

Spider veins

Cause: Hormonal changes as well as sun exposure contribute to the formation of spider veins on the face and legs. Spider veins are abnormally dilated small blood vessels located under the surface of the skin. Although they are harmless they may look unattractive.

Advice: Diet rich in vitamins, Vitamin K and Vitamin C in particular can help to improve spider veins. Vitamin K is found in kale, spinach, cabbage, broccoli and parsley.

Use SPF 30 or higher

To treat existing spider veins a course of IPL (Intense Pulsed Light), laser treatments or sclerotherapy are very effective.

Good make-up application with use of colour correctors and concealers can also cover the redness associated with the thread veins.

Varicose veins

Cause: Women are at a higher risk of developing varicose veins with the onset of menopause.

Advice: Varicose veins are unsightly and might be painful. In order to prevent the occurrence of this condition regular exercise is the best option. Walking, running, cycling and swimming help to increase circulation to the legs therefore minimizing the risk of varicose veins. It is also important where possible to elevate our feet while sitting and avoid standing still for a prolonged time.

If the varicose veins are already present, there are medical therapies that can treat the condition. Please consult your doctor to discuss the options.

Cellulite

Cause: Cellulite is not directly caused by the onset of menopause,  however due to thinning of the skin and loss of its’ elasticity, cellulite becomes more noticeable after menopause.

Advice: Cellulite is more visible on dehydrated skin. It is important to stay hydrated and drink sufficient amounts of water to help flush out the toxins from the body. Regular exercise and healthy balanced diet help to reduce the appearance of ‘orange peel’.

Regular massage, in particular lymphatic drainage massage techniques improve blood and lymph circulation throughout the body as well as breakdown of fat, stimulate collagen and elastin thus reducing the dimpling appearance of the skin.

Other symptoms

Stress, anxiety, depression and insomnia may also be menopause symptoms. Holistic therapies such as massage and reflexology can help relax and decrease the negative effects of stress. Indian head massage and aromatherapy massage are particularly effective in alleviating insomnia as well as inducing deep relaxation.

When it comes to managing the skin during and post menopause it is important to consult your skincare therapist, so an optimum treatment programme can be prescribed to treat the skin conditions that might be caused by the hormonal changes.

News for Acne sufferers

A Second Springer who is having problems with Acne at menopause forwarded this useful article by Dr Irwin recently. Have a read if you're having issues with acne, she had never had any issue with acne until she hit perimenopause.

Acne and Menopause

So many of us women are in or approaching that menopausal, or maybe we should call it period-free (sounds much better, don't you think) time of life, that I wanted to give you some information on acne, oily skin, and mature or perimenopausal skin.

Change of life acne is pretty common.  It often starts a year or two prior to actual cessation of our periods. Acne evolves during our lifetime, and the acne we have in our 40s-50s is usually concentrated around the jawline, chin, and sometimes the upper neck - a normal pattern for this age. It is less "T-zone. 

Also, acne around menopause tends to be deeper, i.e., not surface plugs (comedones), small pustules, or red bumps. Neither is it the big cysts (nodulocystic) that teens have. Instead it is usually deep, small, often tender cysts and sometimes called microcystic acne. And, no surprise, it is related to hormones. 

For more information on skin care and menopause or perimenopause, see Dr. Irwin's article Menopause and Your Skin.

For more information on acne in general and at all ages, see Dr. Irwin's detailed article Acne in Depth.

Here is a good general rule when deciding on acne treatment options:  the more superficial the acne, the more likely topicals are to be effective. The deeper the acne (as in the small tender cysts), the more likely you are to need something to take orally, either alone or in combination with topicals. 

If you have mostly the deeper cysts, topical treatment won't help much because the creams, lotions, etc can't really get down to the level of the problem.

Treatment Options for Acne and Menopause

The main treatment options for acne in perimenopause are:

Topicals that are over-the-counter
Prescription topicals
Oral prescription medications

Let's take non-prescription or over-the-counter topicals first.  

Most of the non-prescription drugstore medications for acne are formulated for oily, teenage skin and tend to be too irritating or drying for mature skin.  If you have very oily skin still, they might be fine.  

If you'd still like to try the drugstore route first, then look for the acne products that say they are for sensitive skin.  Also, many of these products contain benzoyl peroxide which can work well but also stains pillow cases and clothing, so be careful.  If your skin tends to be dry, you might want to test any product that has benzoyl peroxide, or save it for spot treatments.

Now for prescription topicals.

I still think the gold standard is Renova or the generic tretinoin. Renova is better, in my opinion, even though it's more expensive, because it's formulated in a moisturizing base that doesn't irritate mature skin. But if you're very oily, you might do fine with generic tretinoin, which is cheaper. Renova unplugs clogged pores, causes natural exfoliation, and has an anti-wrinkle and anti-skin cancer effect. It's hard to beat. 

Also well tolerated by mature skin are creams/gels based on azeleic acid like Azelex or Finacea. Clindamycin (a topical antibiotic) tends to also be friendly to mature skin. You'll see lots of acne medications with benzoyl peroxide in them. For mature skin, I would save anything with benzoyl peroxide in it for spot treating. 

Take Dr. Irwin's Skin Care or Acne Quiz to see which products might be best for you.

And last, oral medicatons available by prescription.  

Because these are available only by prescription, you'll need to discuss these with your doctor.

Really there are 3 options - oral contraceptives, oral antibiotics, and spironolactone. In general, oral contraceptives aren't recommended for women over 35. But your doctor can discuss this with you because there are now some very low dose options for some perimenopausal women. 

I don't usually recommend long-term oral antibiotics use for the reason that it changes the balance of our healthy intestinal bacteria and can also breed antibiotic resistance. 

Spironolactone can be a good choice. It has been around for 30+ years and has a good safety profile. It reduces our "male" hormones (androgens) just slightly but keeps them in the normal range still. This is often enough to control the acne. It has the nice side effects of lowering blood pressure a little and preventing pre-period bloating. You won't be happy on this if your blood pressure runs very low. Talk to your doctor to see what might be best for you.

Take Dr. Irwin's Skin Care or Acne Quiz to see which skin care products might be best for you.

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