Brittle Nails
In the grand scheme of menopausal symptoms, brittle nails may not seem like the most serious symptom but can absolutely still be bothersome. The term brittle nails refers to nails being noticeably thinner, softer, uneven-colored and more prone to flaking and breaking (splitting). Despite it happening to a high proportion of women, most don’t realize that the underlying cause may be hormonal.
The odds of getting brittle nails are 3.23 times higher when getting a professional manicure.
There is no absolute consensus on what causes brittle nails but, lower levels of collagen, decreased water retention and structural change in Keratin are likely strong contributors. These are all related to low levels of estrogen, and therefore you are most likely to start experiencing this symptom in late peri-menopause or post menopause. As it is related to the absolute level of estrogen, it will not go away on its own once your hormones settle in post menopause and you will need to get treatment if it bothers you. There are effective and simple over the counter treatment options available, in addition to lifestyle changes that can help treat and avoid brittle nails.
Why is this happening?
As women advance through the menopause transition, their ovaries start producing less estrogen until production is in the low single digits. Estrogen regulates many physiological processes in our bodies, and for some women the decline may have a noticeable impact on the integrity and quality of our skin, hair, and even our nails.
The exact mechanism that causes brittle nails and why it only happens to some women is unclear at this point. However, the following factors are likely strong contributors to nails becoming more brittle:
- Reduction in collagen levels: As your estrogen falls, so does your collagen level. According to one study, after menopause, women lose about 25% of their body collagen, which may result in reduced skin elasticity and brittle nails.
- Reduced water content in the nail bed: estrogen plays a role in regulating body water and keeping you hydrated. When estrogen levels decrease through peri-menopause, your body finds it difficult to retain water and balance water levels, which makes your body more prone to dehydration. Although further research is required, the current working theory is that reduced water content in the nail bed is a possible cause of brittle nails. Some clinical studies have indicated that nails may become brittle if water level in the nail bed falls below 16% vs the normal 18%, underlying just how important hydration is.
- Changes in the structure of keratin: keratin is an important protein in nail development. When estrogen levels fall, it leads to structural changes in keratin, which may cause your nail to split, flake, or crumble.
One final note on brittle nails -
Women have enhanced their natural beauty with cosmetics throughout history, and this includes nail cosmetics. There are records of women in China, India and Egypt adorning their nails with henna going back to 5000 BC! Currently it is estimated that about 85 - 90% of women globally use some type of nail care products, and not surprisingly, a massive nail cosmetics industry ($45 billion in 2012 for nail polish alone!) has been built around this market. Why is this important? We have had patients who were initially embarrassed to ask for treatment thinking a doctor would think they’re vain or thought they wouldn't be taken seriously by a doctor. But you know what, it is completely understandable if brittle nails are bothering you from a functional and/or cosmetic point of view. And you are absolutely right in asking for a doctor's opinion and treatment. Nothing to be embarrassed about and going by these numbers, you are certainly not alone in caring about your nails!
Other impacted areas
-
Diagnosis
Your doctor will examine your nails for any changes and ask for your previous medical history. Before making a diagnosis of brittle nails, your doctor will first have to exclude other secondary causes like hypothyroidism that may be responsible for brittle nails. For women in menopause, hormone tests are not necessary.
Possible triggers or risk factors
- Hypothyroidism: One sign that your thyroid level is low is that your nails are thick, dry, and brittle. This is because hypothyroidism slows the body down, which may cause slow nail growth and brittleness.
- Nutritional deficiencies: studies have shown that brittle nails may also be caused by iron, folic acid, or protein deficiency.
- Dehydration: just like our skin, our nails need hydration. A reduction in the level of hydration in our nail beds leads to dry and brittle nails.
Want to speak with a Menopause doctor?
Treatments & remedies
Nail disorders like brittle nails can be challenging to treat because (1) finding the root cause of the problem may be easier said than done, and (2) due to the slow growth rate of a nail it may take a relatively long time before you see results of a treatment.
However, there is a range of good treatment options out there that with prolonged and consistent use will be effective. There are subscription strength medicines available, but as a first line of treatment supplements like biotin and other topical products may help improve the strength of your nail plate.
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Nutrition
- Increase your intake of food rich in omega-3 fatty: omega-3 fatty acid deficiency may cause the nail to become dry and brittle. Examples of food rich in omega-3 fatty acids include avocado, almond, flaxseed, fish, nuts, and chia.
- Increase your intake of iron: iron deficiency has also been associated with brittle nails. Incorporate iron-rich food such as oysters, beef, and green leafy vegetables.
- Increase intake of biotin (B7) foods: biotin is an important nutrient in nail growth. Eat foods rich in B7 such as almonds, liver, egg yolk, almonds, walnuts, and salmon.
- Add more collagen-rich foods to your diet: foods rich in collagen-like beef bone broth provides a form of collagen that your body can use right away. You can also add other collagen-rich food like chicken skin, egg white, and sardines.
- Hydration: dehydration is one of the major causes of brittle nails, so drink enough water to keep your nail bed healthy.
Exercise
While there is no hard evidence that exercise can improve brittle nails, exercise may help improve circulation, improving your nails' appearance.
Mindset
-
Supplements
- Biotin: Oral biotin is one of the most recommended treatments for brittle nails. Although the majority of studies on the efficacy of biotin have been small, most of the patients were successfully treated. It may take a few months of continuous use of this supplement before you start seeing results.
- Calcium: calcium deficiency has also been implicated in brittle nail development. Calcium supplements may help to strengthen nails and reduce ridges, but only if you have a deficiency.
- Zinc: zinc deficiency is known to cause soft and brittle nails. Prolonged treatment with zinc seems to improve brittle nails, but only if you have a deficiency.
- Collagen: in addition to skin and hair health, collagen also supports healthy nails. However, there is no hard evidence that taking additional collagen will have a positive effect on brittle nails.
OTC Products
- Moisturizers: Nail moisturizers containing petrolatum or lanolin are great for people with brittle nails due to their occlusive nature. You can also use alpha hydroxy acids, and urea can also be used to increase hydration in your nail plate; this will also improve the appearance of your nails.
- Over-the-counter hardeners: you can also use polishes that contain strengthening ingredients. However, they may cause brittle nails if you use them for a long time.
Prescription
Use of lacquer: lacquers containing hydroxypropyl chitosan (HPCH) and Poly-ureaurethane are two lacquers often prescribed to treat brittle nails and have been proven to be effective in improving nail appearance. When lacquers are applied to the nails, they form a flexible but strong film over the nails protecting it against physical injuries. An example of such lacquers is ciclopirox and it is available only on prescription.
Hormone Treatment
Hormone Replacement Therapy: HRT is not normally prescribed for treating brittle nails. However, women who are on HRT to treat other menopausal symptoms may also see an improvement in their nails through the additional collagen production that comes with increased levels of Estrogen.
Holistic Treatment
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FAQ
What are the symptoms of Menopause?
There are roughly 34 symptoms of Menopause with the most commonly experienced being:
- Irregular periods
- Vaginal dryness
- Hot flashes
- Night sweats
- Fatigue
- Sleep problems
- Mood changes and irritability
- Weight gain
- Thinning hair and dry skin
Medically reviewed and detailed symptom fact sheets can be found here, and a general overview of what (peri) menopause is and entails can be found here.
What are brittle nails?
The term brittle nails refers to nails being noticeably thinner, softer, uneven-colored and more prone to flaking and breaking (splitting). Despite it happening to a high proportion of women, most don’t realize that the underlying cause may be hormonal. The chances off getting brittle nails are 3.23 times higher when getting a professional manicure on a regular basis.
Does iron deficiency cause brittle nails?
An Iron deficiency may contribute or cause brittle nails but it is rare with it only occurring in about 5% of people with a (severe) iron deficiency. A woman aged 19-50 needs about 18mg per day, where a post menopausal woman only requires about 8mg daily. If you are eating a healthy and varied diet your body should be getting these amounts naturally.
What causes brittle nails?
The exact mechanism that causes brittle nails and why it only happens to some women is unclear at this point. However, the following factors are likely strong contributors to nails becoming more brittle: Reduction in collagen levels, Reduced water content in the nail bed, Changes in the structure of keratin, and a deficiency in certain vitamins.
References
Brosche T, Dressler S, Platt D. Age-associated changes in integral cholesterol and cholesterol sulfate concentrations in human scalp hair and finger nail clippings. Aging (Milano). 2001 Apr;13(2):131-8. doi: 10.1007/BF03351535. PMID: 11405386.
Chessa MA, Iorizzo M, Richert B, López-Estebaranz JL, Rigopoulos D, Tosti A, Gupta AK, Di Chiacchio N, Di Chiacchio NG, Rubin AI, Baran R, Lipner SR, Daniel R, Chiheb S, Grover C, Starace M, Piraccini BM. Pathogenesis, Clinical Signs and Treatment Recommendations in Brittle Nails: A Review. Dermatol Ther (Heidelb). 2020 Feb;10(1):15-27. doi: 10.1007/s13555-019-00338-x. Epub 2019 Nov 20. Erratum in: Dermatol Ther (Heidelb). 2020 Jan 22;: PMID: 31749091; PMCID: PMC6994568.
Chiavetta A, Mazzurco S, Secolo MP, Tomarchio G, Milani M. Treatment of brittle nail with a hydroxypropyl chitosan-based lacquer, alone or in combination with oral biotin: A randomized, assessor-blinded trial. Dermatol Ther. 2019 Sep;32(5):e13028. doi: 10.1111/dth.13028. Epub 2019 Jul 31. PMID: 31344296.
De, D., & Seshadri, D. (2012). Nails in nutritional deficiencies. Indian Journal of Dermatology, Venereology, and Leprology, 78(3), 237. https://doi.org/10.4103/0378-6323.95437
Hochman LG, Scher RK, Meyerson MS. Brittle nails: response to daily biotin supplementation. Cutis. 1993 Apr;51(4):303-5. PMID: 8477615
Iorizzo M. Tips to treat the 5 most common nail disorders: brittle nails, onycholysis, paronychia, psoriasis, onychomycosis. Dermatol Clin. 2015 Apr;33(2):175-83. doi: 10.1016/j.det.2014.12.001. PMID: 25828710.
Olamiju, B. A. (2021, September 28). Brittle nail syndrome treatment & management: Approach considerations, treatment of brittle nail syndrome, prevention. Brittle Nail Syndrome Treatment & Management: Approach Considerations, Treatment of Brittle Nail Syndrome, Prevention. Retrieved July 9, 2022, from https://emedicine.medscape.com/article/2500113-treatment#d10
Stachenfeld NS. Hormonal changes during menopause and the impact on fluid regulation. Reprod Sci. 2014 May;21(5):555-61. doi: 10.1177/1933719113518992. Epub 2014 Feb 3. PMID: 24492487; PMCID: PMC3984489.
Stern DK, Diamantis S, Smith E, Wei H, Gordon M, Muigai W, Moshier E, Lebwohl M, Spuls P. Water content and other aspects of brittle versus normal fingernails. J Am Acad Dermatol. 2007 Jul;57(1):31-6. doi: 10.1016/j.jaad.2007.02.004. Epub 2007 Apr 6. PMID: 17412454.
Studd J. Ten reasons to be happy about hormone replacement therapy: a guide for patients. Menopause Int. 2010 Mar;16(1):44-6. doi: 10.1258/mi.2010.010001. PMID: 20424287.
Manicure and pedicure safety. American Academy of Dermatology. Retrieved July 9, 2022, from https://www.aad.org/public/everyday-care/nail-care-secrets/basics/pedicures/manicure-pedicure-safety
Brittle splitting nails - American Osteopathic College of Dermatologist. (n.d.). Retrieved July 10, 2022, from https://www.aocd.org/page/BrittleSplittingNail
Brittle Nails
In the grand scheme of menopausal symptoms, brittle nails may not seem like the most serious symptom but can absolutely still be bothersome. The term brittle nails refers to nails being noticeably thinner, softer, uneven-colored and more prone to flaking and breaking (splitting). Despite it happening to a high proportion of women, most don’t realize that the underlying cause may be hormonal.
The odds of getting brittle nails are 3.23 times higher when getting a professional manicure.
There is no absolute consensus on what causes brittle nails but, lower levels of collagen, decreased water retention and structural change in Keratin are likely strong contributors. These are all related to low levels of estrogen, and therefore you are most likely to start experiencing this symptom in late peri-menopause or post menopause. As it is related to the absolute level of estrogen, it will not go away on its own once your hormones settle in post menopause and you will need to get treatment if it bothers you. There are effective and simple over the counter treatment options available, in addition to lifestyle changes that can help treat and avoid brittle nails.
Dr. June Tan Sheren
Why this is happening
As women advance through the menopause transition, their ovaries start producing less estrogen until production is in the low single digits. Estrogen regulates many physiological processes in our bodies, and for some women the decline may have a noticeable impact on the integrity and quality of our skin, hair, and even our nails.
The exact mechanism that causes brittle nails and why it only happens to some women is unclear at this point. However, the following factors are likely strong contributors to nails becoming more brittle:
- Reduction in collagen levels: As your estrogen falls, so does your collagen level. According to one study, after menopause, women lose about 25% of their body collagen, which may result in reduced skin elasticity and brittle nails.
- Reduced water content in the nail bed: estrogen plays a role in regulating body water and keeping you hydrated. When estrogen levels decrease through peri-menopause, your body finds it difficult to retain water and balance water levels, which makes your body more prone to dehydration. Although further research is required, the current working theory is that reduced water content in the nail bed is a possible cause of brittle nails. Some clinical studies have indicated that nails may become brittle if water level in the nail bed falls below 16% vs the normal 18%, underlying just how important hydration is.
- Changes in the structure of keratin: keratin is an important protein in nail development. When estrogen levels fall, it leads to structural changes in keratin, which may cause your nail to split, flake, or crumble.
One final note on brittle nails -
Women have enhanced their natural beauty with cosmetics throughout history, and this includes nail cosmetics. There are records of women in China, India and Egypt adorning their nails with henna going back to 5000 BC! Currently it is estimated that about 85 - 90% of women globally use some type of nail care products, and not surprisingly, a massive nail cosmetics industry ($45 billion in 2012 for nail polish alone!) has been built around this market. Why is this important? We have had patients who were initially embarrassed to ask for treatment thinking a doctor would think they’re vain or thought they wouldn't be taken seriously by a doctor. But you know what, it is completely understandable if brittle nails are bothering you from a functional and/or cosmetic point of view. And you are absolutely right in asking for a doctor's opinion and treatment. Nothing to be embarrassed about and going by these numbers, you are certainly not alone in caring about your nails!
Other impacted areas
-
Diagnosis
Your doctor will examine your nails for any changes and ask for your previous medical history. Before making a diagnosis of brittle nails, your doctor will first have to exclude other secondary causes like hypothyroidism that may be responsible for brittle nails. For women in menopause, hormone tests are not necessary.
Possible triggers or risk factors
- Hypothyroidism: One sign that your thyroid level is low is that your nails are thick, dry, and brittle. This is because hypothyroidism slows the body down, which may cause slow nail growth and brittleness.
- Nutritional deficiencies: studies have shown that brittle nails may also be caused by iron, folic acid, or protein deficiency.
- Dehydration: just like our skin, our nails need hydration. A reduction in the level of hydration in our nail beds leads to dry and brittle nails.
Treatments & Remedies
Nail disorders like brittle nails can be challenging to treat because (1) finding the root cause of the problem may be easier said than done, and (2) due to the slow growth rate of a nail it may take a relatively long time before you see results of a treatment.
However, there is a range of good treatment options out there that with prolonged and consistent use will be effective. There are subscription strength medicines available, but as a first line of treatment supplements like biotin and other topical products may help improve the strength of your nail plate.
Products
- Biotin: Oral biotin is one of the most recommended treatments for brittle nails. Although the majority of studies on the efficacy of biotin have been small, most of the patients were successfully treated. It may take a few months of continuous use of this supplement before you start seeing results.
- Calcium: calcium deficiency has also been implicated in brittle nail development. Calcium supplements may help to strengthen nails and reduce ridges, but only if you have a deficiency.
- Zinc: zinc deficiency is known to cause soft and brittle nails. Prolonged treatment with zinc seems to improve brittle nails, but only if you have a deficiency.
- Collagen: in addition to skin and hair health, collagen also supports healthy nails. However, there is no hard evidence that taking additional collagen will have a positive effect on brittle nails.
- Moisturizers: Nail moisturizers containing petrolatum or lanolin are great for people with brittle nails due to their occlusive nature. You can also use alpha hydroxy acids, and urea can also be used to increase hydration in your nail plate; this will also improve the appearance of your nails.
- Over-the-counter hardeners: you can also use polishes that contain strengthening ingredients. However, they may cause brittle nails if you use them for a long time.
Use of lacquer: lacquers containing hydroxypropyl chitosan (HPCH) and Poly-ureaurethane are two lacquers often prescribed to treat brittle nails and have been proven to be effective in improving nail appearance. When lacquers are applied to the nails, they form a flexible but strong film over the nails protecting it against physical injuries. An example of such lacquers is ciclopirox and it is available only on prescription.
Lifestyle
- Increase your intake of food rich in omega-3 fatty: omega-3 fatty acid deficiency may cause the nail to become dry and brittle. Examples of food rich in omega-3 fatty acids include avocado, almond, flaxseed, fish, nuts, and chia.
- Increase your intake of iron: iron deficiency has also been associated with brittle nails. Incorporate iron-rich food such as oysters, beef, and green leafy vegetables.
- Increase intake of biotin (B7) foods: biotin is an important nutrient in nail growth. Eat foods rich in B7 such as almonds, liver, egg yolk, almonds, walnuts, and salmon.
- Add more collagen-rich foods to your diet: foods rich in collagen-like beef bone broth provides a form of collagen that your body can use right away. You can also add other collagen-rich food like chicken skin, egg white, and sardines.
- Hydration: dehydration is one of the major causes of brittle nails, so drink enough water to keep your nail bed healthy.
While there is no hard evidence that exercise can improve brittle nails, exercise may help improve circulation, improving your nails' appearance.
-
Holistic
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