Your Skin's Structure & Function

Your skin is your body's largest organ, composed of three primary layers. From outer to inner, they consist of the epidermis, dermis, and subcutaneous tissue. Each layer plays essential roles in protecting your body, regulating temperature, and sensing touch. Let's dive a bit deeper:

Epidermis

This is the outermost layer of the skin. It acts as a barrier against environmental toxins and microbes. It contains the cells that produce melanin, which gives your skin its color and helps protect against UV rays.

Dermis

Beneath the epidermis, lies the dermis. The dermis is rich in collagen and elastin fibers that give your skin strength and elasticity.

Subcutaneous Layer

The subcutaneous layer is the deepest layer of skin and contains both fat and connective tissue. The subcutaneous layer provides insulation and cushioning.

Menopause Skin Changes

Menopausal hormone changes impact skin aging. It is an important factor that influences the intrinsic aging process.

Although estrogen levels start to decline from age 30, menopause marks a significant shift in hormone levels, including estrogen. Estrogen plays a vital role in maintaining skin health.

Estrogen is a pivotal signaling molecule in the skin. Estrogen receptors are most abundant around the vulva and vagina, face and legs, so you may experience the greatest skin symptoms in these areas.

Estrogen deficient skin experiences a number of changes.

Loss of Elastin & Collagen

Elastin is  the protein responsible for giving skin its elasticity, while collagen provides structure and support. Up to 30 percent of the collagen in the skin is lost in the first 5 years after menopause.

Impaired Fibroblast Function

Fibroblasts are cells that produce collagen and elastin. With decreased estrogen levels, fibroblast function is impaired, leading to reduced production of these vital proteins.

Reduced Blood Supply

Blood vessels in the skin  play a crucial role in delivering nutrients and removing waste. As estrogen levels drop, blood flow to the skin decreases, resulting in reduced vascularity, loss of nutrient and antioxidant delivery.

Increased Matrix Metalloproteinase Enzyme Activity

Matrix metalloproteinase (MMP) enzymes are responsible for breaking down old or damaged collagen. In estrogen deficient skin, their activity increases, leading to faster breakdown of collagen and elastin.

Reduced Hyaluronic Acid

Hyaluronic acid binds water in the skin, keeping it hydrated and plump. It is capable of holding 1000 times it's weight in water. As estrogen levels decrease, so does the production of hyaluronic acid, resulting in dryness and loss of volume in the skin.

These combined changes in the skin contribute to an increase in the breakdown of skin cells and supporting structures leading to dryness, wrinkles, impaired wound healing, impaired skin barrier antioxidant capacity and increased risk of sun damage.

Common Menopause Skin Conditions and Skin Changes

Let's explore the skin conditions you may experience during menopause in more detail.

Dryness and itching skin

Estrogen enhances hydration via production of hyaluronic acid, mucopolysaccharides, and sebum (oil) production. As estrogen levels drop, increased skin dryness occurs, as the skin's ability to retain moisture diminishes. This leads to itching and discomfort.

Thin and Sagging Skin

Thinning skin is another common effect. With reduced collagen production, the dermis becomes less dense, making the skin more prone to bruising and injury. Both collagen and elastin help skin to remain firm, the loss of these results in skin that sags with the effects of gravity.

Fine Lines and Wrinkles

This change also contributes to the appearance of fine lines and wrinkles, as the skin loses its plumpness and elasticity.

Increased Sensitivity

As estrogen decreases, skin becomes more sensitive and prone to irritation. This is due to decreased barrier function and changes in the skin's microbiome.

Pigment, Melasma and Sunspots

Signs of photoaging can start to appear around menopause. This can include sunspots, increased freckles, and melasma.

Don't forget to get any large or changing moles checked out as the risk of skin cancers such as squamous cell cancers, basal cell cancers and melanomas increase with age. 

Hormonal Acne

Menopause acne is often seen as the skin's response to decreased estrogen levels in conjunction with testosterone levels which are comparatively higher. This hormonal situation can promote acne prone skin -  stimulating an increased production of sebum, oily skin and clogged pores. Breakouts may flare cyclically at times of lower estrogen.

Rosacea Flare-ups

Rosacea is a chronic skin condition that causes redness, flushing, and small bumps on the face. It is more common in women and fair skin types. Flare-ups may be triggered by hormonal changes during menopause.

Slow Wound Healing

The decline in estrogen levels slows skin cell turnover, which impacts wound healing. Lower estrogen and therefore collagen production, impaired fibroblast function and decreased vascularity contributes to slower healing of wounds or injuries.

Vulva and Vaginal Skin Symptoms

It is common for decreased estrogen and testosterone levels to cause changes in the vulva and vaginal skin. The loss of collagen and elasticity can cause thinning of the epithelial layer of skin, loss of lactobacilli, those healthy bugs that keep the vagina acidic.

Estrogen deficiency also reduces vaginal discharge so there is often vaginal dryness, irritation, and even pain during intercourse.

There can also be changes to the skin of the urethra and bladder contributing to urinary incontinence, urgency in emptying the bladder and urinary tract infections.

Skin Hydration For Managing Dry Skin in Menopause

Hydration is the foundation of healthy skin at any age, but it becomes especially crucial during menopause. With decreased oil production, and lower levels of hyaluronic acid, the skin struggles to maintain its natural moisture barrier. This often results in dry, flaky skin that feels itchy and uncomfortable.

Anyone with a history of eczema needs to work hard to maintain the hydration of the skin, especially with hormonal changes of menopause.

Moisturizers: Protecting Against Dry Skin

Moisturizers play a crucial role in combating this by forming a protective barrier on the skin’s surface. They can lock in moisture and prevent water loss.

Look for moisturizers containing ingredients like ceramides and glycerin, which help strengthen the skin’s barrier and improve its hydration levels.

Applying a rich, emollient moisturizer twice per day can keep menopausal skin supple and smooth while alleviating the discomfort associated with menopause itchy skin and dryness.

Drinking Water for Healthier Skin

Internal hydration is just as important as topical treatments when it comes to managing skin dryness during menopause. Drinking adequate water throughout the day supports the body’s natural hydration process and keeps the skin’s cells plump and healthy.

To further boost hydration, incorporate water-rich foods like cucumbers, watermelon, and leafy greens into your diet, and minimize caffeine and alcohol. Caffeine acts as a diuretic so can contribute to dehydration and skin dryness if care is not taken to consume additional water.

Hyaluronic Acid: The Hydration Powerhouse

Hyaluronic acid is a skincare superstar when it comes to fighting menopausal dryness. This naturally occurring substance has the ability to attract and retain up to 1,000 times its weight in water, which makes it a powerful hydrating ingredient for the skin.

Incorporating skincare products that contain hyaluronic acid—such as serums, creams, or gels—into your daily routine can help replenish moisture, improve skin texture, and reduce the appearance of fine lines.

Ceramides:  The Essential Building Blocks

Ceramides are a key ingredient for hydrating menopausal skin. These fatty acids play a crucial role in maintaining the skin’s barrier function and preventing water loss. Look for products containing ceramides to help restore moisture and improve overall skin health during menopause.

Skincare Basics for Aging Skin

Wrinkles and fine lines are natural signs of aging, which occur due to loss of collagen, elastin, hydration, skin thickness and antioxidants.

There are ways to minimize their appearance and maintain youthful-looking skin during menopause. Besides, ensuring adequate hydration there are some key topical serums to know about.

If you're new to skincare or just looking to simplify your routine, Australian cosmetic chemist Terri Vinson suggests starting with the ABCs of skincare—three essential steps that will keep your skin looking its best:

A - Vitamin A (Retinoids)

• What it does: Vitamin A derivatives like retinol are a powerhouse ingredient for reducing wrinkles, improving skin texture, and promoting cell turnover. Retinoids act as regulators in the skin by regulating new cell production, helps making collagen, and evens out skin tone, reducing darker spots.

• How to use: Start with a lower concentration and apply at night. It should be followed by a good moisturizer to avoid irritation and always apply sunscreen during the day.

B - Vitamin B3 (Niacinamide)

• What it does: Vitamin B3 (Niacinamide) helps regulate oil production, reduce redness, improve hydration, and brighten your complexion. It also increases ceramides in the skin to give that luminous look.

• How to use: It's gentle and can be used morning and night, often layered under your moisturizer. However, if you are using any acid products, they should not be applied at the same time as B3.

C - Vitamin C (Antioxidant)

• What it does: Vitamin C is a potent antioxidant that brightens skin, reduces redness and pigmentation, and protects against environmental damage like pollution and UV exposure.

• How to use: Apply in the morning before sunscreen for maximum protection and radiance.

By incorporating the skincare ABCs into your daily skincare routine, alongside a good moisturizer, you’ll nourish your skin, protect it from damage, and promote a healthy glow.

Sun Protection and Skin Aging (Photo-Aging): Why SPF is Non-Negotiable

Sun protection is non-negotiable at every age, but it's especially important for menopausal skin. Thinning skin is more vulnerable to UV damage from sun exposure, increasing the risk of sunburn, age spots, and skin cancer.

UVA rays penetrate into the dermis, damaging cells that produce collagen and elastin. They contribute to extrinsic aging, directly accelerating aging and can cause DNA damage contributing to melanoma risk.

UVB rays make their presence known, high exposure will burn your skin. 

1️. Wear Broad-Spectrum Sunscreen Daily

Use an SPF 30 or higher that protects against both UVA and UVB rays. Apply generously every day, even when it's cloudy, and don’t forget to reapply every 2 hours when you're outdoors! Re-apply after swimming outdoors also.

Using mineral-based foundation containing zinc and iron oxides can also add further SPF protection.

2. Seek Shade During Peak Hours

The sun’s rays are strongest between 10 a.m. and 4 p.m. If you're outside during these hours, try to stay in the shade or wear protective clothing to reduce direct exposure. Get your UV exposure for vitamin D outside of these hours.

3️ Cover Up with Protective Clothing and Accessories

Opt for wide-brimmed hats, sunglasses with UV protection, and lightweight, long-sleeved clothing to shield your skin from harmful rays. This helps protect your face and neck, two areas prone to photoaging.

4️ Don’t Forget Your Lips and Hands

Your lips, ears, décolletage and hands are vulnerable to sun damage too. Use a lip balm with SPF and apply sunscreen to your hands regularly, especially after washing.

5️ Use Skincare Products That Contain Antioxidants and Bioceuticals

Antioxidants like Vitamin C, lycopene and Polypodium leucotomos extract (Oral Polypodium leucotomos Extract in Healthy Adult) are not sunblock, but can help protect your skin from sun damage and repair UV-induced damage. Regular use can minimize the signs of photoaging like wrinkles and dark spots.

Collagen Loss And Menopause

Collagen is a protein that provides structure and elasticity to the skin, but its production naturally decreases with age. During menopause, this decrease is more pronounced, leading to sagging and wrinkling. Fortunately, there are ways to support collagen levels through nutrition and skincare.

Eat Collagen-Rich Foods

Foods like bone broth, fish, chicken, and egg whites are naturally rich in collagen, helping to support your skin's elasticity and firmness from the inside out.

Eat fruit and veg containing Vitamin C

Vitamin C is essential for collagen synthesis. Load up on fruits and vegetables every day that contain vitamin C like oranges, grapefruit, tomatoes, bell peppers, and broccoli. Use a

Vitamin C serum to support your skin's collagen production from the outside as well.

Use Retinoids (Vitamin A)

Remember that retinoids are a regulator of collagen production and should be a staple of skin care for supporting collagen composition in your skin.

Menopause Hormone Therapy

Menopause hormone therapy (MHT) increases epidermal and dermal thickness, increases collagen content and improves skin moisture with fewer wrinkles (Dermatological Changes during Menopause & HRT). It can help improve the health of both facial skin and vulva/vaginal skin.

Consistent consumption of collagen enhancing foods and use of these products can help maintain your skin's firmness and elasticity, countering the effects of collagen loss.

Sensitive Skin and Menopause

Many menopausal women find they have more sensitive skin that requires gentle and attentive care. The fluctuating hormone levels can disrupt the skin's barrier function, leaving it vulnerable to irritants. Choosing products specifically formulated for sensitive skin is essential to minimize irritation.

Skin Cleansers

Avoid harsh soaps, they have a high pH which disrupts the skin barrier. Opt for a mild, fragrance-free cleanser that is pH balanced for skin.

Reduce Inflammation

Choose mild cleansers with soothing ingredients like chamomile, aloe vera, and oat extract, which calm inflammation and reduce redness. These ingredients can be found in serums, moisturizers, and masks that are designed for sensitive skin.

Be Gentle

Avoid over-exfoliating, using high concentrations of acids and retinols. Also avoid using too many active ingredients at once. Instead, focus on a simplified routine that prioritizes hydration and protection. By taking a cautious approach, you can help restore balance to your skin and reduce sensitivity.

Menopause Hormone Therapy (MHT)** and Skin Health

Hormonal replacement therapy (HRT) is a treatment option that can alleviate many menopausal symptoms, including those affecting the skin. HRT is licensed and recommended especially to treat hot symptoms of menopause including skin health concerns of the vulva/vagina and urethra (genitourinary syndrome of menopause).

A number of small studies demonstrate positive changes in skin hydration, elasticity, collagen and thickness however more research is needed to determine long term benefits and risks (Menopause and the effects of Hormone Replacement Therapy on skin aging 2024). 

However, it's important to weigh the potential benefits against the risks, as HRT is not suitable for everyone.

If you're considering HRT, consult with a healthcare professional to determine if HRT is a  viable menopause treatment option for you.

Your health provider can provide personalized advice based on your medical history and individual needs. Combining HRT with a targeted skincare routine can maximize the potential benefits for your skin health.

Here are the key elements of skin health that hormone replacement therapy (HRT) can support:

Improved Skin Elasticity

Estradiol helps to support a more elastic, supple skin and slower rate of wrinkle development.

Enhanced Collagen Production

Estrogen plays a critical role in collagen synthesis, which maintains skin firmness and reduces wrinkles. HRT improves collagen production, and increases the collagen type III/type I ratio in the dermis, improving skin's structure and slowing the visible signs of aging.

Improved Skin Thickness

Estrogen-deficient skin leads to thin skin due to lower activity and proliferation of skin cells (keratinocytes). Studies show a thicker, healthier epidermis with only 2 weeks of topical estrogen application (Topical application of estradiol in aged human skin). This not only has aesthetic benefits, but also helps the skin barrier provide better protection against environmental damage.

Reduction in Wrinkles

HRT can lead to a reduction in the appearance of fine lines and wrinkles, especially around the eyes, mouth, and forehead.

Increased Hydration

Estrogen helps regulate skin's moisture levels. A decline in estrogen during menopause leads to dry skin, which is more prone to irritation. HRT can help improve hydration levels and support barrier function for healthier, more comfortable skin.

Increased Wound Healing and Skin Repair

Estrogen also supports the skin's ability to heal itself and regenerate, which means that HRT can accelerate skin repair and recovery from minor injuries, cuts, or blemishes.

Improved Vaginal Skin Health, Acidity and Microbe Balance

In the genitourinary region, estrogen, besides increasing the structure of the skin, it also increases lactobacilli colonization, increases acidity, reduces vaginal bacterial dysbiosis, reduces inflammation and risk of recurrent urinary tract infections.

In addition to these benefits, HRT can also improve overall skin tone. However some women who are prone to hyperpigmentation may experience issues such as melasma. 

It's essential to work closely with your healthcare professional when considering any hormone treatment for menopause.

Nutrition for Menopausal Skin Health

A healthy diet plays a crucial role in maintaining great skin, particularly during menopause. A well-balanced diet rich in vitamins, minerals, and antioxidants can support skin health from the inside out. Prioritizing whole foods, such as a Mediterranean-style diet, over processed options ensures you receive the nutrients necessary for vibrant skin.

In addition to collagen enhancing foods, these are some of the top foods for healthy skin during menopause that can help combat dryness, boost collagen, and support overall skin health:

Foods Rich in Omega-3 Fatty Acids

Choose Fatty Fish (Salmon, Mackerel, Sardines) Almonds, Chia seeds and Flaxseeds. These are rich in omega-3 fatty acids that help keep skin moisturized and reduce inflammation. Omega-3s also support collagen production, keeping skin supple and firm.

Foods High in Carotenoids

Carotenoids such as beta-carotene, found in sweet potatoes, carrots, pumpkin and squash help protect the skin from sun damage and boost cell turnover, keeping your skin looking fresh and youthful.

Lycopene-Abundant Tomatoes

Packed with lycopene, an antioxidant that helps protect skin from sun damage and promotes collagen production, tomatoes are a skin-friendly powerhouse.

Polyphenol Antioxidants Berries and Green Tea

Blueberries, Strawberries, Raspberries and Green Tea are high in antioxidants. They protect the skin from damage and support collagen.

Green Leafy Vegetables

Green leafy vegetables such as spinach, kale, Swiss chard, cauliflower and broccoli are rich in antioxidants like vitamin C and vitamin A and fiber. They help fight oxidative stress and promote cell turnover, aiding in skin regeneration.

Avoid Refined Sugars and Oils

To maintain healthy skin, it's important to limit your intake of refined sugars and oils. These can cause inflammation in the body and lead to premature aging. Avoid ultra processed foods like fast foods, chips, cookies, cereals and choose wholefoods instead.

Incorporating plenty of plant foods into your diet can help nourish and protect your skin during menopause, keeping it healthy and glowing.

Help Your Skin Repairs Itself While You Sleep

Your skin undergoes a natural repair process while you sleep, making nighttime skin care an essential part of your routine. During this time, your body produces more collagen and repairs damage from daily stressors. Taking advantage of this process can enhance your skin's health and appearance.

Night Skincare Routine

Invest in a nourishing night cream or serums formulated with ingredients like niacinamide, peptides and retinol. These compounds support cellular turnover and collagen production, promoting smoother, firmer skin.

Itching Skin at Night

Some women experience itchy skin on the lower legs and other locations that can be worse at night. Using a gentle moisturizer and avoiding hot showers or baths before bed can help alleviate this discomfort.

Adequate Sleep

Getting enough sleep is also crucial for skin health, as it allows the body to fully engage in its natural repair process. Aim for 7-9 hours per night to ensure your skin has ample time to rejuvenate.

Mindfulness/Meditation

Consider incorporating relaxation techniques into your nighttime routine, such as meditation or deep breathing. Reducing stress levels can support healthy skin by reducing inflammation and promoting better sleep. With proper skincare and self-care practices, you can wake up with radiant, refreshed skin each morning.

Supplements to Support Skin Health

Supplements can complement your skincare routine and provide an additional boost to skin health during menopause. While a balanced diet should always be the foundation, certain supplements can address specific concerns and support overall well-being.

Collagen

Collagen supplements are popular for promoting skin elasticity and reducing wrinkles. Collagen provide the amino acids necessary for collagen synthesis, helping to maintain a youthful appearance.

Bone broth is a collagen rich food source. You can also add a collagen supplement. Hydrolysed collagen contains collagen fragments known as collagen peptides.

A meta-analysis of 19 studies supports hydrolysed collagen supplementation for improvement in the firmness, suppleness, and moisture content of the skin, with wrinkles appearing less noticeable (Effects of Hydrolyzed Collagen Supplementation on Skin Aging). 

Ceramides

Ceramides are essential lipids that make up the skin's barrier, helping to retain moisture and protect against external irritants.

As we age, our natural ceramide levels decrease, making supplements a beneficial addition to combat dryness and maintain healthy skin supplements can also support skin hydration and barrier function, keeping your skin supple and smooth. You can also use moisturizers that contain ceramides.

Omega-3 Fatty Acids

Omega -3 fatty acids are found in fatty fish, algae and fish oil supplements. They enhance skin hydration and reduce inflammation.

Anti-Oxidants

Antioxidants like vitamins E and C protect against free radicals, preserving skin health. These supplements can be beneficial if your diet lacks sufficient antioxidant-rich foods. 

Before starting any new supplement regimen, consult with a healthcare professional to ensure it's appropriate for your needs.

Menopause Skincare Summary

By understanding the changes occurring during menopause and implementing targeted skincare practices, you can address dryness, sensitivity, and other common concerns to maintain radiant, healthy skin. 

Skincare should be personalized to your needs. Stay attuned to your skin's unique needs and adjust your routine accordingly. If you're seeking additional guidance, consider consulting with a dermatologist or skincare professional for personalized advice.

Your skin is a reflection of your overall well-being, and with the right approach, you can continue to glow and thrive.

Dr Deborah Brunt is a menopause doctor at Rebelle Health and would love to support you through the perimenopause and menopausal stages, supporting all aspects of your health and wellbeing.

Join our Menothrive Programs to feel great and love your life during peri and menopause.

Dr Deborah Brunt | Rebelle Health | Book Appointment

**Menopause Hormone Therapy should be prescribed by trained medical professionals. Ask your doctor about the benefits and risks of using MHT and whether it is right for you. If you have any side effects or concerns speak to your health professional. MHT has benefits and risks. Always follow your doctor’s instructions. For more information refer to the Consumer Medicine Information for estradiol/progesterone at www.medsafe.govt.nz