Menopause is notorious for causing hot flashes, mood swings, and dryness up there, but “the change” affects your skin, too. Just peek in the bathroom mirror and you’ll see the signs. Wrinkles? Check. Crepey skin? Yep. Acne? It’s back! And what is the deal with that hair sprouting from your chin?
If your skin is showing signs of menopause, you’re far from alone. By some estimates, around two-thirds of women have skin changes during this transition (1). And it’s all due to plummeting estrogen levels. The good news: your dermatologist and gynecologist have solutions to perk up aging skin. Boosting your estrogen levels with hormone replacement therapy (HRT) for skin is one of them.
About the Experts
Kecia Gaither, M.D., M.P.H., is double board-certified in OB/GYN and maternal fetal medicine and director of Perinatal Services/Maternal Fetal Medicine at NYC Health + Hospitals/Lincoln in the Bronx, NY.
Hannah Kopelman, D.O., is a dual fellowship-trained dermatologist who treats a wide variety of skin conditions. She practices at Kopelman Aesthetic Surgery and DermOnDemand in New York City.
Neelam Vashi, M.D., is an associate professor of dermatology at Boston University Chobanian & Avedisian School of Medicine, and director of the Boston University Cosmetic and Laser Center at Boston Medical Center.
How Aging and Menopause Affect the Skin
Dipping estrogen levels are to blame for all the super-fun menopause skin symptoms you’re experiencing—from Sahara-level dryness in your nether regions to skin that looks like the desert floor. This is because estrogen is used to stimulate cells in your skin called fibroblasts to produce collagen, a protein that makes it firm and plump. “During menopause, when estrogen levels decrease, so does fibroblast activation and collagen production,” says OB-GYN Kecia Gaither, M.D., M.P.H. “So skin becomes less firm and elastic.”
These are just some of the ways that menopause can affect your skin:
Dryness
Youthful skin comes equipped with a barrier that holds in moisture (1). Without estrogen, that barrier becomes weak and oil glands in the skin become less efficient. “One of the biggest concerns I hear about is dryness. When estrogen levels drop, the skin’s ability to retain moisture decreases significantly, which can leave it feeling tight, flaky, and sensitive,” says Hannah Kopelman, D.O.
Breakouts
Zits might have messed up your social plans back in high school, but they were a bit more expected in your teens. Little did you know, those pimples would be back to haunt you during menopause—nearly 15 percent of women in their 50s are still dealing with pimples, and hormones are to blame (2).
During menopause, estrogen levels drop quickly, but male hormones called androgens (yes, you have them, too) decline more gradually and can sometimes fall prior to estrogen. Put simply, that leaves you with an imbalance of androgens and estrogen, which can cause an increase in androgenic effects like hair loss on head, hair growth elsewhere, and acne. Add the fact that androgens make your body produce more pore-clogging sebum (2) and you have the recipe for mid-life acne, Gaither says.
Thinning
As you age, collagen and another firming protein called elastin diminish. Together, they helped keep your skin plump, firm, and healthy in your younger years. Their loss leaves behind thin skin that’s more susceptible to damage and slower to heal (3).
More wrinkles
If you’re noticing an uptick in smile lines, frown lines, and forehead wrinkles these days, you can blame collagen loss for that, too. Women lose about 30 percent of their collagen in the first five years of menopause, and that supply continues to diminish (at a slower rate) thereafter. Frown lines, jowls, and sagging skin are all evidence of lost collagen (4).
Skin flushing
Estrogen also helps your blood vessels work properly. Without it, these vessels widen and flood your skin with extra blood, making your face look flushed. Skin flushing is a common symptom of menopause, affecting three out of four perimenopausal and menopausal women (1).
Hairs that weren’t there before
Have you ever looked into a magnifying mirror, discovered a dark hair protruding from your chin, and wondered how long it had been there and who noticed? Androgens are behind the excess hair growth. Typically, you won’t see more than a stray hair here and there. “We don’t typically see women developing beards during menopause. That’s less common,” says Neelam Vashi, M.D. If you are seeing that much hair growth, it could be hirsutism, a spike in androgens that are linked to conditions like Cushing’s syndrome and acromegaly, or rarely, to an ovarian tumor (11). If you’re noticing more than a few hairs pop up, don’t be afraid to mention it to your doctor to rule out anything more serious.
Benefits of HRT for Healthy Skin
While menopause is inevitable, skin issues don’t have to be, Kopelman says. “With the right approach, women can feel confident in their skin, even through this transition.”
One off-label solution is hormone replacement therapy (HRT), which replaces the hormones (estrogen and progesterone) your body is no longer making (5). “By boosting estrogen levels, HRT can improve dryness and thin skin, and even help with the loss of elasticity that comes with menopause,” Kopelman says. Though technically not indicated for the use of skin conditions, HRT can help alleviate menopause symptoms like hot flashes, vaginal dryness, and joint pain, and yes, certain skin conditions that are part of the greater puzzle.
Some benefits of HRT for skin are:
More Moisture
Remember that weak skin barrier caused by a lack of estrogen? HRT can help strengthen it by boosting hyaluronic acid, a natural humectant that can hold up to 1,000 times its weight in water. In one study from the First National Health and Nutrition Examination Survey (NHANES I), postmenopausal women using HRT were less likely to suffer from dry skin than those not on hormonal replacement (6). When skin is properly hydrated, it looks and feels more supple, shows fewer signs of wrinkles, and fends off irritants that may lead to skin conditions.
Thicker Skin
HRT users also see an increase in skin thickness. Both the epidermal (outermost layer) and dermal (middle layer) plump up with hormone treatment thanks to estrogen and testosterone. The two hormones play a crucial role in the skin’s structure and function by stimulating collagen production for thicker skin overall (8).
The thicker your skin, the more protected you are from environmental factors, like UV rays and oxidative stress, aka stressors that break down collagen and damage the skin barrier. We know by now that UV rays lead to premature skin aging, so the number one preventative measure is sun protection—even if you’re on HRT (6).
Reduced Wrinkles
As collagen and elastin decrease, skin becomes less plump and bouncy, which is why wrinkles become even more prominent during menopause. However, as mentioned, HRT stimulates the growth of both collagen and elastin while increasing moisture. The combination thickens and plumps skin from the inside out, filling in fine lines as a result. In fact, HRT users in a single-blinded cross-sectional analysis on the impacts of menopause and HRT on skin reported improved skin elasticity and fewer wrinkles. The catch? You may have to stick with the treatment for a long time to see results—many of the improvements were noted only after women had been on HRT for four years (6, 7).
Faster Wound Healing
You might not suspect that estrogen helps your skin heal, but studies prove its effectiveness. The hormone promotes healing by reducing inflammation, stimulating the growth of new skin cells, and improving blood flow (6). All of this results in thicker skin, which heals more easily from cuts and injuries.
Types of HRT Treatment for Skin
Whether to take HRT, and which form is best for you, is a discussion to have with your doctor. “I always tell my patients that HRT isn’t for everyone, so it’s important to talk to your doctor to figure out if it’s a good option for you,” Kopelman says.
If you’re a candidate, your doctor will likely give you two options.
Systemic therapy
When looking for an overall solution to menopause symptoms, including those related to skin, systemic therapy options—pills, transdermal patches, gels, and sprays, or a vaginal ring—might be the best option, because they work throughout your entire body. This means they’ll also help with symptoms like hot flashes and night sweats, but not everyone is a candidate. Your doctor will determine if it’s right for you based on your symptoms and medical history.
Topical treatments
If you’re looking for something more targeted, topical treatments like estrogen and estradiol creams treat skin issues directly at the source. When taken at the proper dose, these products avoid serious side effects, because they don’t absorb into the blood—although they can cause mild ones like acne, hair loss, and skin reactions (1).
Other Tips for Aging & Healthy Skin
If you’re not a candidate for HRT, don’t fret. Hormones aren’t the only way to achieve younger-looking skin. Our experts also recommend incorporating these skincare practices into your daily routine for healthier, more radiant skin at any age.
Cleanse, moisturize, and wear sunscreen
You don’t need to go crazy or adopt a 30-step skincare routine. A gentle non-stripping and non-comedogenic face wash, hydrating moisturizer, and SPF 30 or higher are truly all you need.
“I recommend using a really hydrating moisturizer—something with hyaluronic acid, ceramides, or glycerin,” Kopelman suggests. “These ingredients are fantastic for locking in moisture and strengthening the skin barrier.”
And really, don’t skip the SPF. It’s crucial to help prevent further damage and hyperpigmentation. “As we age, we develop more sunspots, which can make a face look more aged,” Vashi says.
Eat (and supplement) for healthy skin
A well-balanced diet, complete with plenty of fruits and vegetables, is good for your skin (and everything else for that matter). And water is a must. “Staying well-hydrated and eating foods rich in antioxidants like vitamin C and vitamin E can support the skin from the inside out,” says Kopelman. “I also like to recommend omega-3 fatty acids—whether from fish oil or flaxseed oil supplements—because they help strengthen the skin’s lipid barrier, keeping it plump and hydrated.”
Collagen supplements might be worth adding to your shopping cart, too. While the research is still limited, there is some promising evidence that they might improve skin elasticity, hydration, and the appearance of wrinkles (9).
Reign in the stress
Stress, whether it’s from a demanding job, daily commute, or an argumentative friend, shows on your skin. It promotes inflammation and irritation, and it can worsen skin conditions you already have (10). Take a deep breath (or a few), zen out in yoga, or use whatever other stress-relief method calms you down—and make it a priority.
The Bottom Line
Menopause causes estrogen levels to decline, which can lead to skin-related symptoms like dryness, wrinkles, thinning, and breakouts. HRT recoups those hormone losses to restore collagen and elastin for plumper, tighter, and more hydrated skin. A good skin care regimen, sun protection, and a healthy diet can also help combat menopause-related skin issues. Talk to your doctor to figure out the best solution for you.
