Whatever your opinions on the nickname, ‘the change’ seems apt for what can be a time of mental and physical turmoil. While many of the symptoms of menopause can feel totally disorientating, the ways that ‘the change’ makes itself known on the skin can be easily addressed. Read on for the science and solutions to the most common menopausal skin concerns.
What is Menopause?
Menopause is defined as ‘the last menstrual period’ and a woman* is considered to be in menopause when 12 months have elapsed since their last period. Postmenopause refers to the period of time after menopause, when a woman has not had a period in over a year.
Menopause affects every person at a different time and in a different way, and there are a multitude of documented symptoms. The skin will have different requirements during perimenopause, menopause and postmenopause. However, there are common skin concerns that arise in each stage which are triggered by hormonal fluctuations, in particular the levels of estrogen and progesterone which begin to change in perimenopause and gradually decline as we age.
*It is important to note that it is not just women who experience menopause, but trans-men, non-binary and people with variations in sex characteristics may also experience menopause.
Perimenopause marks the beginning of the body’s natural transition towards menopause and occurs when the ovaries’ estrogen and progesterone production begins to decline. It is this depreciation in hormone levels that causes the symptoms typically associated with menopause.
Perimenopause can start as early as your thirties (or even earlier) and can last 4-10 years, although it usually occurs between the ages of ages 45-55, with the average woman reaching menopause at 51.
During perimenopause, overall estrogen levels will decrease. Within this period of decline, levels of this crucial hormone may fluctuate sporadically, resulting in irregular and missed periods along with other symptoms. During the final stages, estrogen levels fall significantly until menopause is reached. Estrogen is crucial for regulating skin health, which is why many women note a significant downturn in the quality of their skin during perimenopause.
Skin concern 1: Wrinkling
One of the biggest culprits of the acceleration of skin ageing noticed during menopause is due to a deterioration in collagen resulting from declining estrogen levels. Estrogen is crucial to the body’s process of collagen synthesis because it is a key component in the activation of fibroblasts. When activated, fibroblasts produce the key structural proteins of the extracellular matrix including collagen, elastin and fibronectin, as well as glycosaminoglycans (the family of compounds to which Hyaluronic Acid belongs).
Collagen is responsible for giving skin its strength and flexibility and makes up roughly 70-80% of the weight of the skin, whilst elastin is crucial for skin flexibility. In the first 5 years of perimenopause, it is estimated that the average woman loses about 30% of their collagen with the rate of loss averaging at 1-2% every year after that into postmenopause. The decline in collagen and elastin, triggered by dwindling levels of estrogen, leads to a loss of skin thickness, elasticity and plumpness, which increases the appearance of fine lines and deep wrinkles.
So, what can be done to combat the decline in collagen characteristic of perimenopause? The best ingredient to incorporate into your skincare routine during perimenopause is vitamin A, also known as retinol.
Retinol has a small molecular weight allowing it to penetrate deep into the skin and neutralise free radicals. Fighting free radicals, it acts on the regulation of melanocytes—the cells that pigment the skin, causing brown spots – and increases epidermal proliferation, stimulating the production of collagen, elastin and fibronectin. It increases the level of glycosaminoglycans and the number of Langerhans cells, and decreases the activity of enzymes collagenase and gelatinase, helping to decrease collagen breakdown. As such, retinol increases skin firmness and elasticity, reduces the appearance of fine lines and wrinkles, improves skin tone, and reduces age spots. It also has a mild exfoliating effect on the skin’s surface which can improve texture and tone by removing dead skin cells to stimulate cell renewal.
Dr Sebagh’s breakthrough Retinol Night Repair is perfect for perimenopausal skin as it was painstakingly formulated to suit even more sensitive complexions – a concern which often arises during ‘the change’ (more on this below). The formula contains a blend of nourishing oils and humectants including Olive Oil, Rosehip Seed Oil, Coconut Oil, Alfalfa Extract and Vitamin E. These minimise any risk of irritation, boosted by a soothing compound which mimics the aventhramidic properties of oats.
Dr Sebagh’s award-winning formula also contains ‘Crystal Tears’, or Lakesis, an active oil extracted from the resinous sap of the Pistacia tree shown to have a powerful effect on FOXO proteins. These anti-ageing, regulating protein factors are associated with cellular protection and longevity. They are crucial in maintaining skin homeostasis, healthy cell metabolism, DNA repair and opposing oxidative stress. FOXO proteins are also closely related to melanogenesis (the process by which the skin becomes pigmented).
For even more vitamin A, try Dr Sebagh’s Replenishing Cream, which contains Retinyl Palmitate. As a retinol ester, it is less efficacious than the retinol found in Retinol Night Repair. This can also be beneficial for those with sensitive skin types as it is less likely to cause irritation. Even for normal skin types, there is a benefit in choosing a retinoid that is comfortable for use consistently and continually.
If a more intensive solution to depleting collagen levels is desired, Dr Sebagh recommends a visit to his eponymous Clinic for a few sessions of RadioFrequency with Microneedling. The treatment works by delivering precise columns of micro-fractional bipolar radiofrequency energy to the target area through the rapid penetration of insulated micro-needles, without causing extensive damage to the epidermis. A tiny column is created by the micro-needles triggering the release of epidermal growth factors as part of the body’s natural healing response.
The wounds are interspersed with intact epidermal tissue and surrounding dermal tissue which enables rapid re-epithelialization (wound healing) through the coagulation of collagen and elastin in the skin. This electrocoagulation helps to rejuvenate existing dermal tissue as well as produce new collagen and elastin, which improves skin tightening and texture.
Skin concern 2: Dryness
Another outcome of the declining estrogen levels associated with perimenopause is that skin can often become very dry and dehydrated. As aforementioned, declining estrogen levels lead to decreased activity of fibroblasts which are crucial to the production of glycosaminoglycans, including hygroscopic hero Hyaluronic Acid. As such, perimenopause brings a progressive degradation of Hyaluronic Acid in skin cells which is coupled with cells’ impaired ability to maintain moisture—again, something for which estrogen is crucial.
To combat the degradation of your body’s production of Hyaluronic Acid, replenish your skin with a topical Hyaluronic Acid such as Dr Sebagh Serum Repair which also contains Palmitoyl Pentapeptide-4 – a small, highly specific biologically active peptide reported to stimulate the production of elastin, fibronectin, glucosaminoglycan and collagen. Follow with emollients: either an oil-based serum or a thick cream, to prevent transepidermal water loss (TEWL).
For anyone not afraid of needles, Profhilo, available at the Dr Sebagh Clinic, will restore moisture levels in perimenopausal skin. A revolutionary, 'beneath the skin' hyaluronic acid moisturising treatment, it stimulates skin cell receptors to produce collagen and elastin whilst attracting water in the deeper layers of the skin. The unique hyaluronic acid injectable gel has one of the highest concentrations of HA available, which not only boosts and hydrates the skin but also remodels ageing and sagging tissue to counteract skin laxity and improve its elasticity.
Another culprit for skin dryness that some women experience during menopause is the changes in sebum production caused by hormonal fluctuations. Estrogen is typically considered sebosuppressive, so hormonal fluctuations during menopause often lead to a reduction in sebum output leading to dry skin. This can be compounded by the drop in progesterone, considered a stimulant of sebum production. The decline of progesterone is sharper than that of estrogen during perimenopause and it is this increased ratio of estrogen to progesterone that can be responsible for a lot of menopausal symptoms.
However, for others, menopause can be a time of sebum overproduction and resulting acne, which can be due to the influence of testosterone. The ‘male’ hormone testosterone is known for its sebum-producing capacities, and this is why men are more likely to develop acne in their teens as they don’t have high levels of sebosuppressive estrogen. In menopause, falling estrogen levels can make the influence of testosterone more dominant, increasing the activity of sebaceous glands which leads to blocked pores and breakouts.
Ultimately, oscillating proportions of estrogen, testosterone and progesterone can lead to acne or dermatitis, and sometimes a bit of both.
As such, it is important not to reach for your standard breakout clearing products and ingredients as this can be overly drying to already compromised, estrogen-deficient skin. Focus on finding products that are hydrating whilst also managing the excess oil on the skin. Dr Sebagh suggests the following:
Skin concern 3: Sensitivity
Another important role that estrogen plays in skin health is that of epithelialisation—the process by which the skin regenerates in order to heal itself after experiencing injuries. This process is hampered during perimenopause which, combined with a decline in sebum production and hyaluronic acid degradation, means that the integrity of the skin’s essential barrier is often compromised.
Whilst a weakened skin barrier not only increases transepidermal water loss, in turn dehydrating skin, it also makes skin more sensitive and susceptible to irritation, making previously tolerated skin care totally unusable. This sensitivity is often exacerbated by hot flushes, causing conditions such as spider veins (telangiectasia) and rosacea to develop.
Dr Sebagh formulated his Replenishing Cream as a direct response to the changing skin conditions that his perimenopausal clients were experiencing. It boasts a multitude of anti-inflammatory, soothing and moisturising ingredients that restore and repair the skin barrier and so protect the skin.
In particular, Dr Sebagh’s Replenishing Cream contains a natural Phytohormone complex to replenish skin weakened by depletion of hormones during perimenopause and menopause. The complex is made up of two key components: Isoflavones and Phytosterols.
Isoflavones, from hydrolyzed soy protein, are well-known for their ability to address a variety of skin concerns that arise during perimenopause as a result of estrogen deficiency. Isoflavones come under the category of Phytoestrogens (plant estrogens), molecules that are found in the reproductive part of the plant, the seed or root. Mimicking the effects of oestrogen, they have a high affinity with estrogen receptors in skin cells which, when activated, boost the number of fibroblast cells and glycosaminoglycans. Studies have shown that the application of isoflavone-rich soy extract over a 6-month period causes significant increases in epithelial thickness, the number of elastin and collagen fibres, as well as blood vessels. As such, the application of isoflavones to the skin can improve skin elasticity, thickness, density, and hydration.
In addition, isoflavones are a potent antioxidant that can reduce the damage caused by UVB rays. This in turn can delay the onset of signs of premature skin ageing such as fine lines and wrinkles. It has also been shown to have soothing properties perfect for skin sensitised due to the hormonal changes that occur during menopause.
Phytosterols, or plant sterols, are naturally occurring molecules similar in structure to cholesterol, and which are renowned for their health benefits. However, a less well-known benefit of plant sterols is their ability to prevent collagen degradation and even stimulate regeneration of the structuring elements of the extracellular matrix, making them a powerful anti-ageing ingredient. Dr Sebagh uses Rapeseed oil in his Replenishing Cream as this is known to contain higher levels of plant sterols than other plant oils.
Phytosterols have been shown to inhibit substances, like collagenase, which degenerate collagen fibres, thereby slowing the loss of elasticity that comes with menopause. What’s more, phytosterols have been shown not only to prevent cell degradation but also to promote cellular regeneration, in particular boosting the synthesis of both collagen and hyaluronic acid. In doing so, plant sterols repair the skin barrier, reducing the amount of moisture lost through the epidermis (trans-epidermal water loss or TEWL). This in itself helps to reduce irritation but this benefit is boosted by phytosterols’ skin-soothing capabilities, making them a potent anti-inflammatory skin care ingredient.
Skin concern 4: Pigmentation
Crucial to the production of collagen, elastin and hyaluronic acid, the role of estrogen in skin health doesn’t end there. Estrogen is also important in the regulation of melanogenesis - the process by which our cells become pigmented. As we age, the number of melanocytes (pigment-producing cells) decreases and those which remain increase in size. At the same time, collagen degradation leads to thinner skin making the enlarged melanocytes appear more prominent in the skin.
Additionally, the extreme hormonal changes that occur during perimenopause – including the influx of cortisol (the hormone associated with stress) which can be common in menopause – are often considered to be the cause of the development of pigmentation and particularly melasma, which is also common during pregnancy (another period where hormones can fluctuate to extremes). In order to treat age spots that develop during menopause, Dr Sebagh recommends using retinoids - such as Night Repair and Replenishing Cream – as well as antioxidant Vitamin C, which boosts collagen production as an added bonus. We recommend mixing Pure Vitamin C Powder Cream into Replenishing Cream especially because the antioxidant properties of isoflavones in the cream can reduce the transfer of excess melanin to the skin’s surface, thereby visibly reducing pigmentation.
Want more information and advice on how to prevent and treat pigmentation? Read our dedicated edition of Skin Secrets here.
Postmenopause is defined as the period after menopause, when a woman hasn’t had a period in over a year. Whilst the ovaries have stopped producing oestrogen, the body still produces a small amount of oestrogen as it is converted from testosterone.
Skin concern 1: Sagging
While a loss of skin elasticity due to the degradation of collagen caused by oestrogen deficiency is one cause of skin sagging, this skin concern is exacerbated by a loss of bone density that begins in perimenopause but continues to decline long after menopause and on into postmenopause. This is due to the declining levels of a different hormone: testosterone.
For women, testosterone levels begin to decline in their mid-late twenties and by menopause, testosterone levels are typically at about half their peak. Testosterone levels continue to decline into postmenopause and it is this decline that can lead sagging to increase due to testosterone’s role in the growth and maintenance of bone as well as muscles, tendons and ligaments. As testosterone levels decline, the underlying facial skeleton and its supporting soft tissue begin to atrophy, causing loose skin to droop further.
The inevitable loss of bone density and muscle tissue that comes with ageing has been historically difficult to remedy. However, with the development of new ultrasound technology treatments like The Ultralift LP exclusive to The Dr Sebagh Clinic, patients can finally counteract this aspect of facial sagging.
Tightly and intensely focused, the Ultralift LP HIFU helps to lift the muscles in the face and neck by targeting the superficial musculoskeletal aponeurotic system of the face (SMAS), a deeper muscular layer in the face, which is key to achieving a lifting effect in the facial area and the neck. The ultrasound waves can target the muscle layer causing it to contract, strengthen and tighten. This achieves an immediate lift and, importantly, a gradual, progressive, long-lasting neck and face lift. The effect is accumulative and will improve session on session.
Read more about The Ultralift LP here