Everything you want to know about menopause and skin ageing .

Ageing is an inevitable factor in life, we can't avoid it, nor should we try to, but the process is accelerated when we enter the peri-menopause. Oestrogen exerts numerous effects throughout the body and, with the skin being the body's largest organ, it is unsurprising that it is profoundly affected by the falling levels of oestrogen during peri and post-menopausal states.

Menopause is associated with low levels of oestrogen as a consequence of declining ovarian function, and this seismic hormonal shift is associated with dry skin, photo-damage, fine lines and wrinkles, as well as thinning skin.

Menopause and skin ageing - Dry Skin

As women enter the perimenopause, they notice the appearance of dry, itchy skin. This is multifactorial and is due to not only the overall decline of circulating oestrogen, but testosterone as well.

Oestrogen promotes hydration - It does this by elevating levels of mucopolysaccharides to keep the skin lubricated and moisturised. It promotes the production of hyaluronic acid, which is hydrophilic (water loving) within the dermis, which keeps the skin hydrated and maintains skin turgor and fullness. Oestrogen also encourages the production of epidermal lipids known as ceramides. These help retain moisture within the skin and maintain a health skin barrier.

Female testosterone promotes the production of sebum from sebaceous glands, and so the overall decline of this important hormone during the menopause results in the skin being deprived of its natural hydrating agents, resulting in very dry and itchy skin.

Menopause and Thinning skin

Another consequence of waning oestrogen is epidermal thinning. This can largely be attributed to reduced collagen syntheses and increased collagen degratation. Evidence shows that up to 30% of dermal collagen may be lost during the first five years following the menopause, with collagen content further decreasing by approx 1-2% each year thereafter. The end result is a combination of thin, sagging, and dry skin

Fine lines and wrinkles

The appearance of fine lines and wrinkles is significantly influenced by hormonal factors, with the post-menopausal state being associated with increased wrinkling.

It has been shown that low levels of oestrogen during the menopause increases the tendency to form wrinkles, but it is imortant to note that increased formation of wrinkles is also associated with (and exacerbated by) a decrease in skin elasticity. Studies show that skin elasticity reduces by approximately 1.5% per year in post-menopausal women (not taking HRT). They have also shown that the application of oestrogen cream appears to thicken elastic fibres in the dermis, increasing their quantity, and improving their orientation - thereby having the potential to significantly improve the appearnace of fine lines and wrinkles.

Interestingly, a large study performed in America found that the use of oestrogen replacement therapy prevented the dvelopment of wrinkles, which can be explained by the increase in skin collagen content and glycosaminoglycans in the presence of oestrogen.

Photo damage

Chronic exposure of UV rays is the greatest souce of extrinsic facial ageing, and it hapens due to the creation of free radicals and reactive oxygen species ('ROS') which cause oxidative stress and damage to the proteins and cells of the skin which are required to help keep the skin looking young and healthy.

ROS activate enzymes that degrade collagen and disrupt collagen synthesis, which leads to collagen loss and impairs the structural integrity of the skin.

Oestrogen has important antioxidant prperties which provide a protective role against this photo-damage assocaited skin ageing, and with the decrease in circulating oestrogen during peri and post menopause, post-menopausal skin is much more susceptible to skin damage and hence, photo ageing. This is due to an increase in an enzyme-mediated degradation of elastin and collagen fibres within the dermis. Furthermore, oestrogen has the capacity to switch off enzymes, known as matrix-metalloproteinases (MMPs) which accelerate skin cell damage, thereby counteracting the potential damage inflicted by 'ROS' generated by UV rays from the sun.

As a result, post-menopausal skin tends to exhibit increased formation of deep wrinkles, skin sagging and skin elasticity as a direct consequence of oestrogen deficiency and UV exposure.

Treatment options

1. Skin care.

As collagen loss is associated with oestrogen deficiency, it is important to incorporate ingredients that promote collagen synthesis into your skin regime.

Vitamin A; Benefits include boosting skin cell turnover, improving skin texture and tone, as well as stimulates collagen production.

Vitamin C; Stimulates collagen production and stabilises the collagen molecule by a process called hydroxylation. It also helps to protect against skin damage.

2. Injectables.

Oestrogen stimulates the production of HA within the deeper layers of the skin, and hence, with the decrease in circulating oestrogen comes the natural depletion of intrinsic levels of hyaluronic acid. There is a plethora of hyaluronic acids available on the market, including creams and serums however, topical application of HA will not have the same effect as intrinsic or injectable forms as it sits on the top fo the outer surface of the skin. Replenishing intrinsic levels of hyaluronic acid however by means of dermal filers and skin boosters (such as Profhilo) will have a deeply moisturising effect as well as restore skin fullness, tugor and reduce fine lines and wrinkles.

The benefits of HA based dermal fillers go byond enhancing HA levels within the dermis. Dermal fillers can also be used to address the bony resorption process which is seen at an accelerated rate in the menopause

3. HRT

When considering how to best combat the signs of ageing associated with the menopause, addressing the underlying cause first (i.e oestrogen deficiency) would make a lot of sense. Therefore, the most important preventative and restorative treatment option for ageing skin is the replacement of oestrogen in the form of HRT. There are many routes to administer HRT, including oral tablets, transdermal via gel patch or spray, and local applicaton of oestrogen pessaries and creams. The use of oestrogen is associated with increased collagen content, increased dermal thickness, improved skin elasticity, reduced wrinkle formation, and a reduced propensity to develop dry skin. There is significant bone loss associated with the menopause, including from the facial skeleton, and the early use of HRT prevents bony resorption and thereby helps to maintain skeletal structure which has the potential to counteract premature facial ageing.

Studies have shown that women who used HRT continuously within one year of the last menstrual period had significantly fewer wrinkles and less skin rigidity.

Menopause is a fact of life, and its brilliant how its now being talked about so openly - where once upon a time, women had to just 'deal' with the variety of symptoms, now there are so many options to help you have the best experience possible. Facial aeing is just one of the many symptoms of the menopause and I believe taking a hollistic approach to help deal with the signs and symptoms, from the inside out, will achieve the best results

Dr Sophie Gaskell BDS PGDip (Aesth med)

@drsophiegaskell