The basics of treating menopausal skin
The menopause is a period of significant change that women go through. One of these changes is a decline in oestrogen, which causes patients to present with symptoms such as increasingly sensitive skin. Let’s discuss the considerations that practitioners should make when treating this patient group to improve the outcomes, as well as some non-surgical treatments that may help…
There are two things I hear in my clinic on at least a weekly basis – “I feel like I’ve aged overnight” and “my skin is so sensitive that it can’t handle anything it used to be able to.” What these patients have in common is that they’ve entered the menopause, a period of significant oestrogen decline that typically occurs between the ages of 45 to 55. Among other symptoms, these patients often present with hot flushes, weight gain, increased anxiety, and sudden debilitating changes to their skin.
It is common knowledge that during menopause and the preceding 3-5 years known as perimenopause, oestrogen levels decline. What many practitioners don’t realise is exactly how much of an impact this decline has on the skin. To understand this it is helpful to know that of the 3 types of oestrogen – estradiol, estriol, and estrone – estradiol is the largest piece of the puzzle when it comes to understanding and treating menopausal skin. It is important for aesthetic practitioners to understand this and be able to explain it to menopausal patients in order to provide the best possible care.
ESTRADIOL AND TOPICAL SKIN CHANGES
In a woman’s reproductive years, estradiol is produced in abundance. Upon entering the perimenopausal years, estradiol levels begin to reduce, and estrone becomes the predominant form of oestrogen instead. (Hall and Phillips 2005)
This reduction in estradiol is responsible for a change to the texture of the sebum that is produced in the skin. It becomes thicker and more viscous, which can cause patients to present with oily skin, enlarged pores, and sometimes acne. This is often a shock for patients who expected their skin to become less oily with age, and in this case, education of the patient is key. It is helpful to reassure them that their skin has not suddenly started producing more oil, and explain that changing oestrogen levels have simply created a change to the oil’s texture. Conversely, patients can also present with increasingly sensitive skin, which they often describe as feeling dry. I frequently hear from my patients that they “suddenly can’t seem to put enough moisturiser on.” This is because the aforementioned reduction in estradiol levels also triggers a change to the pH of the skin, resulting in impairment of the skin’s barrier function. Combined with increased photosensitivity often leading to a dull complexion and uneven pigment and skin tone, perimenopausal and menopausal patients frequently feel that their skin has completely changed overnight and the creams they’ve been using for years have suddenly become ineffective. This is where implementing an effective cosmeceutical skincare regime is of the utmost importance.
PRODUCTS AND INGREDIENTS
If the patient presents with oily skin, recommending products such as an exfoliating cleanser or a complexion clearing mask will help to remove dead skin cells and reduce surface oils. Look for ingredients such as salicylic acid and alpha hydroxy acids – particularly glycolic acid and lactic acid, as these are least likely to cause irritation. These ingredients also promote collagen and blood flow.
If the patient presents with skin that seems very dry, it is important not to simply recommend a heavy emollient moisturiser. Due to the patient’s compromised barrier function, I recommend introducing something that is hydrating instead of heavy – for example, a serum that contains hyaluronic acid or ceramides. Heavy emollients will only worsen the texture of the thickened sebum, inhibiting active ingredients from reaching the deeper levels of the skin.
On that note, it is important overall to stimulate the skin with active ingredients such as peptides and Vitamin A to increase cell turnover.
Lastly, SPF is always of the utmost importance, but even more so during menopause as the skin becomes more sensitive to damage. Practitioners understand the importance of their menopausal patients using a daily SPF, particularly when also using active ingredients in their skincare, but patients tend to think of this as an unnecessary expense. This is another area where education is key to successful treatment.
When a treatment plan for menopausal skin, it is important to implement an effective skincare regime as soon as possible. Patients often may say they feel topical treatments are a lost cause, but this is not the case. Effective, cosmeceutical skincare is the most important factor in a menopausal patient’s aesthetic treatment plan, simply because healthy skin is key to the efficacy of all other treatments.
OESTROGEN AND SKINCARE
Many studies have measured the effect of oestrogen on skin and have concluded that administration of prescribed topical and ingested oestrogen does in fact improve skin collagen levels, thus reducing skin thinning in postmenopausal women. (Svoboda et al. 2018) Of course, hormone administration needs to be considered carefully and prescribed oestrogen will effect more than just the skin.
One solution to this is a completely unique product called Emepelle, a brand for which I became an ambassador after being incredibly impressed with the results and clinical data. I have found that to specifically treat menopausal (along with peri- and post-menopausal) skin, Emepelle is one of the best things I can recommend to my patients. It is the only cosmeceutical product that contains methyl estradiolporpanoate, or MEP. It works by safely stimulating oestrogen receptors and creating resulting positive effects in skin texture and tone.
In addition to changes to the skin’s texture and tone, estradiol also has a key part to play in fat distribution in the body and face. Patients can present with volume loss, laxity and sagging of the skin, and lower face ageing, all of which can occur quite quickly.
This change is also related to the effect that estradiol has on collagen and elastin. The production of these two substances, which are essential to the appearance of youthful skin, slows down during the onset of menopause. This causes an increase in skin laxity, fine lines, and wrinkles. In fact, approximately 30% of skin collagen is lost in the first 5 years after menopause, with an average decline of 2.1% per postmenopausal year over a period of 20 years. (Archer 2012) This is a sharp decline in collagen which often comes as a shock to patients and must be handled sensitively. I find that this is often the most significant change for my patients, and equally as often the most challenging to treat.
A HOLISTIC APPROACH
It is important to note that a holistic approach is necessary to truly help a patient through this period of change. As described by an article in the Journal of Mid-Life Health, “Menopause syndrome due to estrogen deficiency can be classified as physical or psychological.” (Nair 2014)
Within my team, I am able to refer patients to a women’s health consultant and menopause expert, as well as several other independent practitioners including a nutritional therapist. The personalised hormonal and dietary changes these practitioners may recommend, from HRT to cutting out certain ingredients from one’s diet, can create play a large part in treating the patient from multiple angles.
For this reason, I recommend that all aesthetic practitioners cultivate a team of multidisciplinary practitioners to refer patients to when necessary. Furthermore, having a supportive team around the patient will help to alleviate other symptoms of the menopause that they may be experiencing, such as increased anxiety, mood swings or forgetfulness. According to Nuffield Health, “Almost half (47 per cent) of women with [menopause] symptoms said they feel depressed, while more than a third (37 per cent) said they suffer from anxiety. Despite this, more than two thirds (67 per cent) of UK women say there is a general lack of support or advice for those going through the menopause.” (Nuffield Health 2017) Practitioners must therefore remember that there are many different aspects to the menopause, and each menopausal person will experience different struggles. Therefore supporting these patients requires a variety of skillsets, which are often best spread across a multi-disciplinary team.
Topical skincare is a necessary step to improving anyone’s skin, but if a patient would like to go one step further there are many noninvasive in-clinic treatments that can be effective as well.
In particular, I’ve found that bioremodelling treatments such as Profhilo, which involves injecting a low-viscosity hyaluronic acid into the superficial layers of the skin using a 5-point BAP technique, have the most impact on patients who are entering the menopause. Profhilo directly combats the skin laxity that is caused by the menopause, and with results lasting around 6 months, patients often find the increased hydration and tightness to their skin to be an appreciated solution to their rapidly changing skin. Bioremodelling treatments are also a favourite due to their versatility and indication for not just faces but the hands, neck, and décolletage which also can show rapid signs of ageing during this time.
Other injectable treatment options are neurotoxins and dermal fillers, as these are used to improve static lines and restore lost volume respectively. However, it is important to point out to patients that the objective with dermal fillers is to restore the skin, attempting to replace the volume they have lost without adding product where they didn’t have volume before. The ideal clinical outcome is for the patient to look refreshed, but not changed.
If your patient is interested in in-clinic treatments but would prefer to stay away from injectables, a wonderful option for them could be skin tightening using laser technology or radio frequency. Radio frequency is an effective and comfortable means of facial tightening and wrinkle reduction which works by using heat to stimulate collagen and elastin fibre production deep within the skin. My patients particularly appreciate that it can be used to treat the face and neck during the same treatment.
It is important for aesthetic practitioners treating menopausal skin to remember that a patient’s overall well-being must be considered as much as the skin or facial rejuvenation on its own. Similarly, the skin as an organ needs to be considered in a holistic way, understanding the cellular changes happening to the skin and how they can be combatted on an ingredient by ingredient basis. For the best clinical result when treating menopausal skin, practitioners should ideally consider a multi-disciplinary approach combining cosmeceutical skincare, in-clinic treatments that the patient is comfortable with, and consideration for their overall health and wellness.
Archer DF. 2012. Postmenopausal skin and estrogen. Gynecological Endocrinology. 28(sup2):2–6. doi:10.3109/09513590.2012.705392.
Hall G, Phillips TJ. 2005. Estrogen and skin: the effects of estrogen, menopause, and hormone replacement therapy on the skin. Journal of the American Academy of Dermatology. 53(4):555–68; quiz 569-72. doi:10.1016/j.jaad.2004.08.039. https://www.ncbi.nlm.nih.gov/pubmed/16198774.
Svoboda RM, Rosso JQD, Zeichner JA, Draelos ZD. 2018. Revisiting the Beneficial Effects of Estrogen on the Skin: A Comprehensive Review of the Literature and a Look to the Future. SKIN The Journal of Cutaneous Medicine. 2(5). doi:10.25251/2.3.4. https://jofskin.org/index.php/skin/article/view/383.
1 in 4 with menopause symptoms worry about coping | Nuffield Health. 2017 Sep 14. wwwnuffieldhealthcom. https://www.nuffieldhealth.com/article/one-in-four-with-menopause-symptoms-concerned-about-ability-to-cope-with-life.
Nair P. 2014. Dermatosis associated with menopause. Journal of Mid-life Health. 5(4):166. doi:10.4103/0976-7800.145152.
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