If you remember as far back as being a teenager then you might recall some of the symptoms of adolescence and in particular one of the major problems – your skin. What will have caused your excessively oily or embarrassingly dry skin at that age was the cocktail of hormones that comes with the territory of growing older. Thus it of course only stands to reason that you would suffer a similar problem when you reached older age and hit the menopause when you would also experience a rather large change when it comes to the hormones you produce. Skin changes then are common and expected and include wrinkles and a general thinning of the skin. However at the same time the changes to the skin also make a range of specific conditions and problems more likely which include:
- Atrophic vulvovaginitis
- Vulvar lichen sclerosis
- Dyaesthetic vulvodynia
- Ketaoderma climactericum
And all of these changes – both those that are a part and parcel of normal menopause and those that represent skin conditions triggered by the menopause – are a result of that alteration to your body’s hormones. Here we will look at what specifically causes the changes and problems, how it can be treated, and what each of these conditions entails.
Causes of Skin Changes During Menopause
Menopause is defined as the point at which a female has not had a menstrual period for 12 months – at which point it is assumed that the menstruation has permanently ended. At this time the body undergoes many hormonal changes and in particular this includes a decline in estrogen (hypoestrogenism). Estrogen has been found to affect all of the major organs and this includes the skin which is what causes the changes to the skin during the menopause. In adolescence the acne was caused by an increase in the male hormone ‘testosterone’, and now during the menopause the problems are caused by this decrease in the female hormone.
There are certain areas of the body that are particularly susceptible to this hypoestrogenism and these include the face, genitals and lower limbs (exactly where you don’t want it then… ). These areas are more vulnerable than others due to the larger number of estrogen receptors around those areas.
General Changes – Itchiness and Wrinkles
The mechanisms through which this decreased estrogen effect the skin are many. For instance as estrogen diminishes so too will the thickness of the skin and the collagen production that makes it more cushioned and flexible. This increases the appearance of wrinkles and lines around the face and particularly around the eyes and mouth. Meanwhile this will affect the body’s ability to retain moisture and that will in turn result in itchy skin, more visible lines again, flaking skin and potentially an alteration in the natural ‘flora’ of the skin.
This will result in the changes that are seen to the skin and this is why you will notice your skin appear more aged as well as itching more during and after menopause.
As you go through menopause the changes and the fluctuation in hormones, oils and collagen all can also cause a range of specific skin conditions as mentioned previously. Here we will list what some of those skin conditions are and will describe the symptoms and problems associated with them.
Atrophic Vulvovaginitis: This is the thinking of the vaginal skin in particular and especially the entrance to the vagina (the vestibule). The symptoms will include itchiness, tenderness, burning and possible pain during urination and intercourse.
Vulvovaginal Candidiasis (Thrush): This is a form of fungal infection which can also be associated with the use of hormone replacement therapy or oral contraceptives.
Vaginitis: This results in itchiness and profuse discharge.
Vulvar Lichen Sclerosis: This is a chronic atrophic skin disease in the anogenital region. In some cases it is asymptomatic and in others it will case irritation, whitened skin, fissures or tears and pain during intercourse. This is more likely in those with autoimmune disorders.
Dyaesthetic Vulvodynia: A chronic vulvar burning along with irritation and rawness (as opposed to an itch). This can also affect the thighs.
Hirsutism: This is abnormal hair growth in women around the face and particularly common in post-menopause for those not on HRT.
Alopecia: Conversely alopecia is hair loss from the scalp and potentially other areas. Most common on the front and on the top of the scalp.
Flushing: Flushing occurs in 70-80% of cases during menopause and results in a reddening of the skin along with sweating and potentially anxiety and palpitations. This can also result in difficulty sleeping and of course an uncomfortable feeling of heat. This is caused during menopause as estrogen is used to regulate the heat regulating areas of the brain which control the body temperature. Here then the body is tricked into believing the internal temperature is too high and it then attempts to lower it through increasing the blood flow to the skin (ironically making you hotter).
Keratoderma Climactericum: This is a thickening of the skin found on the palms and/or soles of the individual and is most common for obese individuals who have gone through menopause. This can cause itchiness and cracking also.
Management of Skin Changes
Some changes during and after menopause are expected. For instance the increased visibility of wrinkles and lines should be expected as should a general thinning of the skin and other problems. These can be treated and controlled however through a range of dietary and lifestyle changes on your part. These include:
• Consumption of fatty acids, vitamins and minerals (particularly vitamin B, D and E) and proteins. Omega-3 fatty acid is particularly important and can be found in foods like salmon, walnuts, tuna, flaxseed and soy.
• The avoidance of harsh soaps.
• Avoiding itching.
• The use of moisturizing creams that can replenish the skin’s lost moisture. Consider changing brands to something designed for your age group. You might also want to look for products including collagen, but be weary that the jury is still out on whether the topical application of collagen can have any effect (it may not be absorbed transdermally).
• Getting plenty of sleep.
• Good hygiene.
• Increasing water intake to help the skin replenish its natural moisture. Consuming cold water may also help to prevent hot flushes to some degree.
• Protecting your skin from the sun when going outside by using sunscreen.
• Avoiding stress (where possible).
• Quitting smoking.
• Avoiding hot showers which can dry out the skin. Conversely cooler showers may help to increase blood flow and can be therapeutic if you are experiencing hot flushes.
• Choosing makeup wisely – the intention is to both avoid irritating the skin with harsh chemicals and help to hide the signs of menopause such as wrinkles and lines and any dryness. You should use foundations and products with FPS protection and moisturizing effects.
• Of course additional hair can be treated with waxing and other such methods.
Treatments for Skin Conditions Associated With Menopause
In other cases if you have specific skin conditions associated with your menopause then there are a range of treatments. Hormone Replacement Therapy is perhaps the most widely used and can be used to address many signs and symptoms of menopause as well as the more serious conditions. These generally involve replacing the estrogen no longer produced, or progesterone by the body through the use of tablets, vaginal rings, patches, implants, cream and more. It is not highly recommended for healthy individuals going through menopause however, and as mentioned it can actually contribute to some conditions such as vulvovaginal candidiasis. Of course it is also not suitable for treating thrush in that case, and in most cases this will be addressed using antibiotics.
Transdermal HRT helps the skin enormously, reducing the loss of collagen, stopping hot flushes, keeping vaginal and urethral tissue healthy and helping sleep. Nature causes women to decline rapidly in many ways at menopause, HRT can reverse many of these symptoms. The latest guidelines are much more favorable for the use of HRT during peri-menopause and menopause, but must be started around the time of the menopause and not left until later years.
Thrush is not treated with antibiotics, it is treated with anti-fungal.
Menopause is part of women's natural journey through their life process. It is not a "disease" to be treated whose "symptoms" are to be avoided. The attitudes expressed in this article are clumsy and do not empower women with true knowledge of their physical/emotional/spiritual body, and so whole, being.