Skin Issues
It is common for women to experience skin issues during the menopausal transition with dry/ itchy skin and acne being the terms used most commonly to describe the issues. Hormonal skin issues may include any of the following: dry and itchy dryness (crepey feeling to it), decreased firmness, reduced elasticity, appearance of fine lines/ wrinkles, acne, worsening of eczema/ rosacea and hirsutism (hair growth).
The prevalence of Acne in women of 40 years an older is estimated to be between 20 - 40%
There are many factors that impact how your skin feels and looks at this point in your life - sun exposure, climate and season, dietary decisions, alcohol consumption, genetics and even the skin products you have or haven’t used up until this point. But low(er) levels of estrogen and general imbalance of hormones that start during peri-menopause and last well into post menopause seem to strongly contribute to the new onset or recurrence of these issues. It tends to become more prominent during the later stages of peri-menopause, and may last well into post menopause. With the exception of acne that tends to lessen in post menopause, these skin issues will persist and it is generally recommend that you seek treatment. There are a range of effective products available from OTC skin care, to lifestyle changes and prescription based topical products.
Why is this happening?
The two types of skin problems that are most commonly reported during the menopause transition are: a dry itchy skin and acne. However, these two umbrella terms generally also include: skin dryness, decreased firmness, reduced elasticity, appearance of fine lines/ wrinkles, acne, worsening of eczema/ rosacea and hirsutism (hair growth). Although it is not fully understood what causes these issues and its likely all have other contributing factors, there is clinical proof that the menopausal fluctuation in hormones, decline of estrogen and the resulting imbalance of hormones play a major role in onset or recurrence of all of these.
- Collagen helps in the elasticity and hydration of our skin. Studies have found a strong association between collagen loss and estrogen deficiency. So as estrogen levels drop during peri-menopause, your body will start producing less collagen, which leads to dry, thin, and wrinkled skin. Dry skin can lead to intense itching that may leave permanent scars. In the first five years of post menopause a woman is expected to lose as much as 30% of skin collagen. After this the decline in skin collagen will continue but at a more gradual pace averaging about 2.1% per year.
- Sebum is an oily substance that is best described as a protective layer on your skin’s surface that together with collagen helps your skin retain water. When estrogen levels drop, so does the production of Sebum and collagen. This in turn will make it difficult for your skin to retain water, and not surprisingly often results in dry skin in multiple areas of your body (skin, back of your elbows, hands etc). It may also initiate a series of inflammatory reactions that may in turn result in hormonal acne predominantly on your face.
- Increase in Androgens: from the onset of peri-menopause your hormones levels all start to decrease but Estrogen and Progesterone do so at a much faster rate than the Androgens (male hormones). Even though additional research is required, studies have shown that relatively high levels of Androgens can result in new onset or recurrence of acne for some women. The hormonal imbalance of relatively higher levels of Androgens will last well into post menopause, but the difference is the biggest in the few years around Menopause and thats when you’re most likely to experience symptoms.
Other impacted areas
- Hirsutism. If relatively high levels of Androgens are the cause of your hormonal acne you are also at an increased risk of experiencing Hirsutism. Hirsutism causes women to grow thick and dark hair in places like your face and neck (especially your chin), chest and belly area, lower back and your buttocks.
- Skin problems like acne, especially when severe, may have some women consider not leaving the house as much, or withdrawing from social obligations. This can in turn impact one's self esteem and confidence, over all mental wellbeing. If this is happening to you - completely understandable but know that there are effective treatment methods available if you want them.
- Poor sleep - itchy skin can make it more difficult to fall asleep and cause sleep problems.
Diagnosis
Menopausal acne and other skin problems are usually diagnosed based on your presentation and medical history. If you present signs of elevated levels of estrogen-like facial hair and hair loss, it will prompt lab investigation of your hormone levels. Your healthcare provider will also assess contributory factors like
- Current medication
- Stress and sleep habits
- If you smoke or use other illicit drugs
Possible triggers or risk factors
- Stress: Some studies have found that emotional stress can worsen acne.
- Dietary changes: Foods that spike blood sugar like white rice, pasta, white bread, and sugar can increase IGF-1 in your blood. Studies have found that increased levels of IGF-1 lead to increased production of sebum, which may cause acne and inflammation.
- Sleep deprivation: Lack of sleep may lead to an acne flare-up. Although additional research in this area is needed, one very small study published in 2019 found that poor sleep quality may increase the severity of acne for people that already have it. As of now, there is no research showing that poor sleep quality can cause Acne.
- Thyroid abnormalities, hyperprolactinemia and insulin resistance are also known contributing causes of hormonal acne.
Want to speak with a Menopause doctor?
Treatments & remedies
Treatment of acne in menopause can be a bit challenging as fewer acne products, especially topical therapies, in the market are suitable for the sensitive and aging skin of menopausal women.
When selecting suitable products you need to take the following factors into account;
- The cause and severity of your acne
- Your skin type: dry, oily, or sensitive
- Your response to past treatment
Generally speaking, it typically takes about 8 to 10 weeks to see the full effect of a new acne treatment plan. It is best to treat acne at the first sign of a breakout to prevent it from leaving permanent scarring that can further worsen your self-esteem.
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Nutrition
- Reduce food that can cause inflammation, such as: refined carbs (white bread and pasta), processed meat, sodas, fried foods, and gluten
- Limit your intake of alcohol as even in the short term alcohol can lead to dry skin and lose its elasticity.
- Hydrate: increasing water intake improves your skin appearance. Hydration improves skin dryness and elasticity.
To aid collagen production. Eat a well-balanced diet to support the production of collagen. Foods that may help improve collagen production include
- Amino acids found naturally in eggs, bone broth, beans, and meat
- Vitamin C - found in citrus fruits, berries, and bell peppers
- Zinc & Copper - found in meat, shellfish, nuts, whole grains, and beans
Exercise
Exercise helps improve blood flow to different parts of the body, including the face, which can help improve the appearance of the skin. It can also help reduce stress-induced acne. You can engage in 15-30 mins of mild to moderate exercise at least three times a week. However, always remember to shower after every workout session to prevent your skin from breaking out.
Mindset
-
Supplements
- Curcumin : Curcumin has antimicrobial properties that may make it useful in acne treatment. Studies show that it may help kill a type of bacteria called Propionibacterium acnes (P. acnes), which plays an important role in acne development. However, more research needs to be done on the use of this supplement to treat acne.
- CoQ10: Coenzyme q10 is packed with antioxidants that help protect the skin from environmental stressors like air pollution and Uv radiation that influences aging. CoQ10 also energizes your skin, helps keep your skin hydrated and reduce the appearance of wrinkling and acne.
- Collagen: Preliminary studies have found that collagen significantly improved skin hydration, elasticity, roughness, and density. However, more studies are required to confirm its effectiveness.
OTC Products
- Hyaluronic Acid: can help retain skin water which keeps your skin hydrated and plump, thus reducing the appearance of wrinkles and fine lines. In addition to hydration, some research suggests that hyaluronic controls sebum production, which may help reduce acne.
- Topical retinoids (available as a prescription for higher dosage): Topical therapies like retinoids are the mainstay of acne treatment. They help to unclog your pores by removing dead skin cells, which reduces acne outbreaks. However, it is important to always apply sunscreen when using this product, as retinoids can increase your risk of sunburn.
- Thin gloves: if you itch your skin while sleeping (which can lead to scars!) try sleeping with very thin gloves on, and of course keep your nails short and smooth.
Prescription
- Antibiotics: both oral and topical antibiotics are a well established and effective treatment method for inflammatory acne.
- Tretinoin: this medication helps to improve signs of aging and photoaging. However, it can really irritate the skin, causing skin peeling or redness. You can minimize this irritation by using the microencapsulated forms that release tretinoin slowly.
- Dapsone for acne: Dapsone 5% gel has antimicrobial and anti-inflammatory properties that may make it useful in treating acne. Clinical studies show that dapsone is effective in treating mild to moderately severe acne, but it is not commonly prescribed to treat acne.
Hormone Treatment
- Low dose birth control for acne: Birth control pills , which contains low-dose ethinyl estradiol combined with progestins with antiandrogenic activity, is recommended for treating mild to moderate acne. However, before using this medication, discuss all possible side effects or if you are eligible to use it.
- Spironolactone for acne: due to its antiandrogenic effect, spironolactone is the treatment of choice for patients with acne due to increased levels of androgen.
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 is the average age of Menopause?
The average age for menopause in Asian women (including women in Singapore) is 50 - 52. The onset of peri-menopause is usually in a women's mid 40s, with 3.7% of women experiencing it before the age of 30.
What are the symptoms of Menopause?
There are 34 different symptoms associated with the Menopause transition impacting women on a mental, emotional and physical level. Symptoms range from the well known Hot Flashes & Night sweats, to depression, anxiety and a dry itchy skin. For and overview of all symptoms and detailed symptoms fact sheets please click here.
Do men get Menopause?
The short answer is No. “Male Menopause” or “andropause” are terms that are being used by the media, but have no medical basis. Testosterone levels in men do decline as they age, but this is a very gradual process at less than 2% per year starting from their 30s/40s. There is no sudden drop in Testosterone around midlife causing severe symptoms as is the case with Menopause. In many cases the symptoms that are claimed to be part of “male menopause” have nothing to do with (a change in) hormones.
References
Bolke, L., Schlippe, G., Gerß, J., & Voss, W. (2019). A Collagen Supplement Improves Skin Hydration, Elasticity, Roughness, and Density: Results of a Randomized, Placebo-Controlled, Blind Study. Nutrients, 11(10), 2494. https://doi.org/10.3390/nu11102494
Brincat, M. P., Baron, Y. M., & Galea, R. (2005). Estrogens and the skin. Climacteric : the journal of the International Menopause Society, 8(2), 110–123. https://doi.org/10.1080/13697130500118100
Calleja-Agius, J., & Brincat, M. (2012). The effect of menopause on the skin and other connective tissues. Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology, 28(4), 273–277. https://doi.org/10.3109/09513590.2011.613970
Cao, H. J., Yang, G. Y., Wang, Y. Y., & Liu, J. P. (2013). Acupoint Stimulation for Acne: A Systematic Review of Randomized Controlled Trials. Medical acupuncture, 25(3), 173–194. https://doi.org/10.1089/acu.2012.0906
Chiu A, Chon SY, Kimball AB. The Response of Skin Disease to Stress: Changes in the Severity of Acne Vulgaris as Affected by Examination Stress. Arch Dermatol. 2003;139(7):897–900. doi:10.1001/archderm.139.7.897
Collier, C. N., Harper, J. C., Cafardi, J. A., Cantrell, W. C., Wang, W., Foster, K. W., & Elewski, B. E. (2008). The prevalence of acne in adults 20 years and older. Journal of the American Academy of Dermatology, 58(1), 56–59. https://doi.org/10.1016/j.jaad.2007.06.045
Jung, Y. R., Hwang, C., Ha, J. M., Choi, D. K., Sohn, K. C., Lee, Y., Seo, Y. J., Lee, Y. H., Kim, C. D., Lee, J. H., & Im, M. (2017). Hyaluronic Acid Decreases Lipid Synthesis in Sebaceous Glands. The Journal of investigative dermatology, 137(6), 1215–1222. https://doi.org/10.1016/j.jid.2017.01.017
Khunger, N., & Mehrotra, K. (2019). Menopausal Acne - Challenges And Solutions. International journal of women's health, 11, 555–567. https://doi.org/10.2147/IJWH.S174292
Lephart, E.D., Naftolin, F. Menopause and the Skin: Old Favorites and New Innovations in Cosmeceuticals for Estrogen-Deficient Skin. Dermatol Ther (Heidelb) 11, 53–69 (2021). https://doi.org/10.1007/s13555-020-00468-7
Misery, L., Wolkenstein, P., Amici, J. M., Maghia, R., Brenaut, E., Cazeau, C., Voisard, J. J., & Taïeb, C. (2015). Consequences of acne on stress, fatigue, sleep disorders and sexual activity: a population-based study. Acta dermato-venereologica, 95(4), 485–488. https://doi.org/10.2340/00015555-1998
Pampaniya, P. V., & Pandya, D. H. (2013). Effect of Shalmalyadilepa and Guduchyadivati in the management of Yauvanapidika (Acne). Ayu, 34(2), 174–179. https://doi.org/10.4103/0974-8520.119673
Pickert, A., & Raimer, S. (2009). An evaluation of dapsone gel 5% in the treatment of acne vulgaris. Expert opinion on pharmacotherapy, 10(9), 1515–1521. https://doi.org/10.1517/14656560903002097
Rzepecki AK, Murase JE, Juran R, Fabi SG, McLellan BN. Estrogen-deficient skin: The role of topical therapy. Int J Womens Dermatol. 2019 Mar 15;5(2):85-90. doi: 10.1016/j.ijwd.2019.01.001. PMID: 30997378; PMCID: PMC6451761.
Sauerbronn, A. V., Fonseca, A. M., Bagnoli, V. R., Saldiva, P. H., & Pinotti, J. A. (2000). The effects of systemic hormonal replacement therapy on the skin of postmenopausal women. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 68(1), 35–41. https://doi.org/10.1016/s0020-7292(99)00166-6
Skin care in your 40s and 50s. American Academy of Dermatology. Retrieved July 6, 2022, from https://www.aad.org/public/everyday-care/skin-care-basics/care/skin-care-in-your-40s-and-50s
Thornton MJ. Estrogens and aging skin. Dermatoendocrinol. 2013 Apr 1;5(2):264-70. doi: 10.4161/derm.23872. PMID: 24194966; PMCID: PMC3772914.
Vaughn, A. R., Branum, A., & Sivamani, R. K. (2016). Effects of Turmeric (Curcuma longa) on Skin Health: A Systematic Review of the Clinical Evidence. Phytotherapy research : PTR, 30(8), 1243–1264. https://doi.org/10.1002/ptr.5640
Žmitek, K., Pogačnik, T., Mervic, L., Žmitek, J., & Pravst, I. (2017). The effect of dietary intake of coenzyme Q10 on skin parameters and condition: Results of a randomised, placebo-controlled, double-blind study. BioFactors (Oxford, England), 43(1), 132–140. https://doi.org/10.1002/biof.1316
Skin Issues
It is common for women to experience skin issues during the menopausal transition with dry/ itchy skin and acne being the terms used most commonly to describe the issues. Hormonal skin issues may include any of the following: dry and itchy dryness (crepey feeling to it), decreased firmness, reduced elasticity, appearance of fine lines/ wrinkles, acne, worsening of eczema/ rosacea and hirsutism (hair growth).
The prevalence of Acne in women of 40 years an older is estimated to be between 20 - 40%
There are many factors that impact how your skin feels and looks at this point in your life - sun exposure, climate and season, dietary decisions, alcohol consumption, genetics and even the skin products you have or haven’t used up until this point. But low(er) levels of estrogen and general imbalance of hormones that start during peri-menopause and last well into post menopause seem to strongly contribute to the new onset or recurrence of these issues. It tends to become more prominent during the later stages of peri-menopause, and may last well into post menopause. With the exception of acne that tends to lessen in post menopause, these skin issues will persist and it is generally recommend that you seek treatment. There are a range of effective products available from OTC skin care, to lifestyle changes and prescription based topical products.
Dr. June Tan Sheren
Why this is happening
The two types of skin problems that are most commonly reported during the menopause transition are: a dry itchy skin and acne. However, these two umbrella terms generally also include: skin dryness, decreased firmness, reduced elasticity, appearance of fine lines/ wrinkles, acne, worsening of eczema/ rosacea and hirsutism (hair growth). Although it is not fully understood what causes these issues and its likely all have other contributing factors, there is clinical proof that the menopausal fluctuation in hormones, decline of estrogen and the resulting imbalance of hormones play a major role in onset or recurrence of all of these.
- Collagen helps in the elasticity and hydration of our skin. Studies have found a strong association between collagen loss and estrogen deficiency. So as estrogen levels drop during peri-menopause, your body will start producing less collagen, which leads to dry, thin, and wrinkled skin. Dry skin can lead to intense itching that may leave permanent scars. In the first five years of post menopause a woman is expected to lose as much as 30% of skin collagen. After this the decline in skin collagen will continue but at a more gradual pace averaging about 2.1% per year.
- Sebum is an oily substance that is best described as a protective layer on your skin’s surface that together with collagen helps your skin retain water. When estrogen levels drop, so does the production of Sebum and collagen. This in turn will make it difficult for your skin to retain water, and not surprisingly often results in dry skin in multiple areas of your body (skin, back of your elbows, hands etc). It may also initiate a series of inflammatory reactions that may in turn result in hormonal acne predominantly on your face.
- Increase in Androgens: from the onset of peri-menopause your hormones levels all start to decrease but Estrogen and Progesterone do so at a much faster rate than the Androgens (male hormones). Even though additional research is required, studies have shown that relatively high levels of Androgens can result in new onset or recurrence of acne for some women. The hormonal imbalance of relatively higher levels of Androgens will last well into post menopause, but the difference is the biggest in the few years around Menopause and thats when you’re most likely to experience symptoms.
Other impacted areas
- Hirsutism. If relatively high levels of Androgens are the cause of your hormonal acne you are also at an increased risk of experiencing Hirsutism. Hirsutism causes women to grow thick and dark hair in places like your face and neck (especially your chin), chest and belly area, lower back and your buttocks.
- Skin problems like acne, especially when severe, may have some women consider not leaving the house as much, or withdrawing from social obligations. This can in turn impact one's self esteem and confidence, over all mental wellbeing. If this is happening to you - completely understandable but know that there are effective treatment methods available if you want them.
- Poor sleep - itchy skin can make it more difficult to fall asleep and cause sleep problems.
Diagnosis
Menopausal acne and other skin problems are usually diagnosed based on your presentation and medical history. If you present signs of elevated levels of estrogen-like facial hair and hair loss, it will prompt lab investigation of your hormone levels. Your healthcare provider will also assess contributory factors like
- Current medication
- Stress and sleep habits
- If you smoke or use other illicit drugs
Possible triggers or risk factors
- Stress: Some studies have found that emotional stress can worsen acne.
- Dietary changes: Foods that spike blood sugar like white rice, pasta, white bread, and sugar can increase IGF-1 in your blood. Studies have found that increased levels of IGF-1 lead to increased production of sebum, which may cause acne and inflammation.
- Sleep deprivation: Lack of sleep may lead to an acne flare-up. Although additional research in this area is needed, one very small study published in 2019 found that poor sleep quality may increase the severity of acne for people that already have it. As of now, there is no research showing that poor sleep quality can cause Acne.
- Thyroid abnormalities, hyperprolactinemia and insulin resistance are also known contributing causes of hormonal acne.
Treatments & Remedies
Treatment of acne in menopause can be a bit challenging as fewer acne products, especially topical therapies, in the market are suitable for the sensitive and aging skin of menopausal women.
When selecting suitable products you need to take the following factors into account;
- The cause and severity of your acne
- Your skin type: dry, oily, or sensitive
- Your response to past treatment
Generally speaking, it typically takes about 8 to 10 weeks to see the full effect of a new acne treatment plan. It is best to treat acne at the first sign of a breakout to prevent it from leaving permanent scarring that can further worsen your self-esteem.
Products
- Curcumin : Curcumin has antimicrobial properties that may make it useful in acne treatment. Studies show that it may help kill a type of bacteria called Propionibacterium acnes (P. acnes), which plays an important role in acne development. However, more research needs to be done on the use of this supplement to treat acne.
- CoQ10: Coenzyme q10 is packed with antioxidants that help protect the skin from environmental stressors like air pollution and Uv radiation that influences aging. CoQ10 also energizes your skin, helps keep your skin hydrated and reduce the appearance of wrinkling and acne.
- Collagen: Preliminary studies have found that collagen significantly improved skin hydration, elasticity, roughness, and density. However, more studies are required to confirm its effectiveness.
- Hyaluronic Acid: can help retain skin water which keeps your skin hydrated and plump, thus reducing the appearance of wrinkles and fine lines. In addition to hydration, some research suggests that hyaluronic controls sebum production, which may help reduce acne.
- Topical retinoids (available as a prescription for higher dosage): Topical therapies like retinoids are the mainstay of acne treatment. They help to unclog your pores by removing dead skin cells, which reduces acne outbreaks. However, it is important to always apply sunscreen when using this product, as retinoids can increase your risk of sunburn.
- Thin gloves: if you itch your skin while sleeping (which can lead to scars!) try sleeping with very thin gloves on, and of course keep your nails short and smooth.
- Antibiotics: both oral and topical antibiotics are a well established and effective treatment method for inflammatory acne.
- Tretinoin: this medication helps to improve signs of aging and photoaging. However, it can really irritate the skin, causing skin peeling or redness. You can minimize this irritation by using the microencapsulated forms that release tretinoin slowly.
- Dapsone for acne: Dapsone 5% gel has antimicrobial and anti-inflammatory properties that may make it useful in treating acne. Clinical studies show that dapsone is effective in treating mild to moderately severe acne, but it is not commonly prescribed to treat acne.
Lifestyle
- Reduce food that can cause inflammation, such as: refined carbs (white bread and pasta), processed meat, sodas, fried foods, and gluten
- Limit your intake of alcohol as even in the short term alcohol can lead to dry skin and lose its elasticity.
- Hydrate: increasing water intake improves your skin appearance. Hydration improves skin dryness and elasticity.
To aid collagen production. Eat a well-balanced diet to support the production of collagen. Foods that may help improve collagen production include
- Amino acids found naturally in eggs, bone broth, beans, and meat
- Vitamin C - found in citrus fruits, berries, and bell peppers
- Zinc & Copper - found in meat, shellfish, nuts, whole grains, and beans
Exercise helps improve blood flow to different parts of the body, including the face, which can help improve the appearance of the skin. It can also help reduce stress-induced acne. You can engage in 15-30 mins of mild to moderate exercise at least three times a week. However, always remember to shower after every workout session to prevent your skin from breaking out.
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