SKIN CARE 41


Analysing the menopause and skin


n Helen Orpin, Daniel Whitby - Lake Personal Care, UK


Once perceived as taboo subjects, the twenty first century has rightfully seen many barriers being broken down around women’s health and, in particular, menstruation and hormonal change. The International Menopause Society started the first World Menopause Day on 18 October 2009 to raise awareness and support of options on health and wellbeing. Recent campaigns by both Bodyform and Tampax with regards to feminine hygiene products have been described as “taboo- busting” and are driving a wider discussion in this area.1


Alongside this, increased


human life expectancy and the change in the global age demographic has seen an increase in openness around the menopause and its effects, including mental health, with research showing that almost one in four women suffer anxiety during menopause.2


A variety of excellent


resources are now available on line and celebrities such as Meg Mathews, along with her Meg’s menopause website, and Jenny Eclair have engaged with mainstream media to bring the subject to the fore. The menopause is defined as the


timepoint when a person stops having periods and is no longer able to get pregnant through natural means (due to loss of ovarian follicular function). Prior to this there is often a term where periods become less frequent, but the timing and surroundings of the menopause are complex so it can also be the case that periods stop suddenly. The menopause is a natural part of ageing and usually occurs between the ages of 45 and 55 years, for example in both the US and the UK, the average age at menopause is 51 years old. However, around 1% of women will enter menopause before 40 years of age, this being termed “premature menopause”. Menopause can be classified into three key stages which occur in the following order: Perimenopause, the years before


menopause when hormonal changes begin, as oestrogen levels begin to decrease. This stage lasts until the menopause and during this stage the levels of oestrogen production generally fall but this can be erratic.


November 2020 Menopause, complete cessation of egg


release, this is usually classed as the time frame 12 consecutive months since the subject last had a menstrual period (amenorrhea). It is possible to confirm menopause by measuring the levels of follicle-stimulating hormone (FSH). If the subject’s FSH level is consistently elevated to 30 mIU/ml or higher it is generally accepted that menopause has been reached. Postmenopause, the years after the


menopause has taken place, generally 24 to 36 months after menopause when symptoms have started to subside. The menopause and its associated large


hormonal changes result in systemic level effects around the body. The skin, as one of the largest endocrine organs in the human body, is profoundly affected by these changes and is the focus of this article. Hormonal changes which occur during menopause include an increase in the levels


of FSH and Luteinising Hormone (LH), both gonadotropins involved in egg production and fertility. At the same time levels of Oestradiol and Inhibin B fall as do the levels of oestrogen and progesterone. General symptoms of the menopause are well documented and can include hot flushes (which may cause reddening of the skin of the face and are also known as hot flashes in some countries), hair thinning, night sweats and difficulty sleeping. All of these symptoms can occur at varying degrees and can have an impact on quality of life. Because of this, there are a variety of what are described as treatments for the menopause, though they should be viewed more as ways of relieving the symptoms to make life more comfortable. The main treatment proposed is Hormone Replacement Therapy (HRT), which involves using oestrogen


supplementation to overcome the decline in the body’s own levels of the hormone.3


Menopause and the skin As mentioned above, oestrogen levels fall dramatically during menopause and, while there may be a decline in the levels of androgens such as testosterone, there is a shift in the ratio of oestrogen to testosterone which may cause a predisposition to androgenic symptoms including an increase in facial hair, increased sebum production and acne. It is now known that oestrogen has a role well beyond that of being a female sex hormone having an impact on tissues as diverse as those found in the brain, skeletal muscle, bone, the vascular system and skin. The decline of oestrogen during menopause has a detrimental effect on these tissues contributing to osteoporosis and heart disease.4


This also causes chronic changes


in the skin and an increase in the signs of skin ageing. Oestrogens have an important role in regulating some key aspects of skin physiology targeting keratinocytes, melanocytes, sebaceous glands, hair follicles and most importantly fibroblasts. This results in a subsequent decrease in


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