The exact menopause skincare routine you need to maintain your glow, according to dermatologists
What the heck is going on with my skin?
It's my firm belief that that this question will be uttered at some point by every woman going through menopause. That’s because issues like dryness, volume loss, adult acne, and wrinkles can all be happening during this time. I should know—I'm there myself.
I’ve been fortunate to sidestep the hot flashes, the breast pain, and the brain fog (all common menopausal complaints), but my skin has definitely changed during this life stage. I never considered my complexion to be particularly problematic, but when I turned 50, my outer layer became a super-sensitive desert of dryness from head to toe. Dune’s Arrakis has nothing on me.
So, what is going on with your skin at this time in life—and what can you do about it? Let’s break it all down, starting with the basics.
What's the difference between menopause and perimenopause?
Menopause is a threshold you cross, rather than a phase you go through over time. What do I mean by that? You're officially in menopause after twelve consecutive months of having no menstrual periods, and the average age this occurs is 51. The transition time leading up to menopause is called perimenopause, and that can last three to seven years or more. 'Perimenopause is like puberty in reverse, with female reproductive hormones, oestrogen in particular, starting to decline,' says Ellen Marmur, MD, a board-certified dermatologist at Marmur Medical in NYC.
Like so much about this time of life, the timelines and symptoms are variable. While perimenopause typically starts after the age of 40, it can begin for some women in their 30s, and for others, it may not occur after they’ve turned 50.
How does perimenopause affect your skin?
The hormonal fluctuations during perimenopause are what trigger common skin problems such as acne breakouts and dryness, explains Dr. Marmur. The maddening part is that many of these issues often occur at the same time, with the double trouble happening because oestrogen is decreasing (which increases dryness), while male hormones such as testosterone remain status quo. But wait, wouldn't an increase in dryness cause a decrease in acne, a condition often associated with oilier skin? Not so fast, says Mona Gohara, MD, a board-certified dermatologist and Women’s Health Advisory Board member. 'Sebum is just one factor in the acne equation,' she explains. 'Hormonal acne triggered by perimenopause results in cystic lesions that are deep in the skin and less reliant on oil production.'
What about menopause?
Like winter, menopause is coming (eventually), and that’s when your body’s oestrogen levels remain at an all-time low—and this can do a number on your skin. As oestrogen begins to dip and then steeply drops off at menopause, a lot of ‘aging’ issues start to show up on your skin. Why? 'Oestrogen hormones stimulate so many kinds of skin cells to get into action, such as the fibroblasts that make collagen and elastin proteins,' says Gohara. 'When oestrogen decreases there’s less collagen, elastin, hyaluronic acid (HA), and ceramides being produced, and this triggers dryness, wrinkling, and sagging.' In fact, studies show that collagen, the foamy natural filler that keeps your skin plump and firm, can decrease by up to 30% in five years immediately following menopause.
It’s not just the loss of oestrogen, but a collision of factors that’s messing with your skin in mid-life. Besides menopause, there’s cumulative UV damage, which shows up as brown spots, and the natural aging process that slows skin cell turnover and makes it look dull.
What we’re dealing with is a perfect storm for your complexion, but the good news is that it’s one you can prepare for.
Five menopausal skin woes (and what to do about them)
'The key to a vital, healthy-looking complexion in perimenopause and menopause is to have an approach that blends counteracting existing damage and preventing new damage from occurring,' says Dr. Gohara.
Hormonal acne
These aren’t the zits you had in high school. Dr. Marmur calls these pimples, which typically pop up on the jawline, ‘dry skin acne’ because they're accompanied by a reduction in hyaluronic acid and ceramides. 'Oestrogen is going down so testosterone is dominating, and this hormone imbalance during perimenopause triggers hormonal acne breakouts,' she says.
What you can do: The challenge is to clear pimples without drying out your skin further, so it's important to blend pore-clearing active ingredients with hydrating ones to keep your skin balanced. Dr. Gohara is a fan of topping off these actives with an HA-based moisturizer.
Use an acne product with salicylic acid to keep pores unclogged. This BHA acid is oil-soluble, so it cuts through oil-blocked pores to clear out oil, dead skin cells and dirt. It also has anti-inflammatory properties to help prevent irritation.
Try a retinoid. If the salicylic acid isn’t clearing your skin, dermatologists recommend a prescription retinoid to keep pores clear by regulating skin cell turnover. (Plus, it builds collagen over time too.) 'I prescribe topical tretinoin to improve everything from skin laxity and wrinkles to breakouts,' says Amy Wechsler, MD, a board-certified dermatologist in New York City. 'Differin 0.1% also works well, but I don’t think OTC retinol is as effective to treat hormonal acne.'
Opt for Rx meds. To step up treatment of stubborn hormonal acne, dermatologists prescribe an oral medication called spironolactone, which works by blocking the male hormones that trigger hormonal breakouts. A piece of good news about menopause: once you’re in it, the breakouts tend to go away, says Dr. Wechsler.
Fine lines
As many women begin to notice, wrinkles first make an appearance during perimenopause due to collagen loss. 'My patients who are in perimenopause have two main complaints: pimples and wrinkles,' says Dr. Wechsler. 'This is a very common combo at this time of life.' That mix of low oestrogen, UV damage, and natural aging is the culprit.
What you can do: If you have a proactive skin routine in place, including daily SPF to prevent the UV damage that destroys collagen and creates wrinkles, then stay the course. If not, read on. There are excellent in-office treatments to soften fine lines, too.
Try retinol. If you’ve been prepping for perimenopause by using a retinol to help build up collagen and elastin, keep up the good work. Retinol, the over-the-counter (OTC) vitamin A derivative that stimulates fibroblasts to get into gear and produce more collagen and elastin, also regulates skin cell turnover (which slows with age). This keeps pores clear and makes skin smoother too. 'A lot of newer formulas with retinol also include hydrators like hyaluronic acid and glycerin to counter dryness and irritation, and these humectants help to plump skin and soften wrinkles too.'
Use peptides. If you can’t tolerate a full retinol routine, then use a collagen-boosting peptide product instead, suggests Dr. Gohara. These products work similar to vitamin A derivatives like retinol and prescription retinoids, but tend to be gentler.
Consider injections. Dr. Wechsler typically uses an injectable neuromodulator like Botox Cosmetic to smooth lines temporarily, and injectable fillers to add volume and soften wrinkles. If you’re unsure about taking this route, consider talking to your dermatologist, and ask for a consultation to help you decide.
Hair thinning
Hair and skin are two separate things, but considering scalp health is directly related to you hair health, it's only right to call this one out. 'Hair loss is probably one of the biggest issues that I see during perimenopause,' says Dr. Gohara. (About half of women experience accelerated hair loss at this stage in life.) It’s a condition called ‘androgenetic alopecia’ or ‘female pattern baldness,’ and like hormonal acne, it’s triggered by dropping oestrogen levels that leave male hormones unopposed. 'In addition to causing breakouts, androgens may make you lose strands at the hairline and the crown of your head,' says Dr. Gohara
What you can do: There are cosmetic fixes to mask the problem, from volumizing shampoos to spray-on color concealers, but there are preventative measures and effective medications you can take to stop the shedding.
Keep strands strong. Unfortunately, you may have to slow down or cut out some hair styling practices that cause damage. 'To prevent more hair loss, think about not over-processing the hair with bleach, or overusing hot tools like blow-dryers,' says Dr. Gohara. All that heat, pulling, and processing can weaken vulnerable strands by causing dryness, breakage, split ends, dullness, and more.
Try an OTC medication. Derms universally recommend topical minoxidil, like the brand Regaine, to curb hair loss. 'I suggest using the 5% solution, as opposed to the lower 2% version for women. It’s more effective, and just as safe,' says Dr. Gohara. 'You apply this to your scalp twice a day, every single day to help grow hair locally.' One caveat: Once you stop using the product, your hair will start shedding again. This also might not treat other forms of hair loss, so make sure you run this option by your doctor before committing.
Seek a doctor’s help. Dr. Gohara recommends seeing a dermatologist (yes, they treat hair issues, too) to get started with a plan of action. 'A higher dose of oral spironolactone can treat perimenopausal hair thinning, as well as hormonal acne. And in-office treatments such as platelet-rich plasma (PRP) injections can help stimulate hair growth too,' she says.
Dryness
Getting back to my Arrakis-dry skin barrier. Plummeting ooestrogen not only impacts collagen and elastin, but the production of natural ceramides and HA. This means that the stratum corneum, the outermost layer of the skin, has a harder time keeping moisture in and irritants out. 'The epidermis becomes thinner because of less collagen and there are fewer lipids, so the skin’s protective function becomes drier and compromised,' says Dr. Marmur.
What you can do: You’ve heard of double cleansing? Now’s the time for double- and triple-moisturising. Look for hydrators like hyaluronic acid and glycerin, that bring water to the skin and emollient lipids like ceramides, squalene, or shea butter to help seal in that moisture.
Moisturise at every step. 'You need to transition to more hydrating and emollient formulas of everything—cleanser, body moisturiser, richer face creams, oils, and balms,' says Dr. Wechsler. And don’t be afraid to layer ‘em on. 'This is when you can slug and sandwich like crazy,' says Dr. Gohara. 'In menopause, you can’t moisturise too much.'
Consider hormone therapy. 'It’s important to realise that dry skin can happen everywhere,' says Dr. Gohara. One frequently talked experience that she calls out is vaginal dryness. And if you’re asking yourself what that has to do with the dry skin on the rest of your body…fair question. In short, talking to your gynaecologist about the pros and cons of hormone replacement therapy (HRT) can be a game-changer for treating menopausal symptoms like dry skin (in addition to vaginal dryness). So if you experience both, consider this a great option worth trying. What about those topical prescription oestrogen creams that are touted for anti-aging? 'While oestrogen creams are used to treat vaginal atrophy, I wouldn’t prescribe them for facial anti-aging,' Gohara says. 'These formulas use estriol, a weaker form of oestrogen, but right now, there’s not enough science to show that this ingredient, when used on the face, is safe or efficacious.'
Laxity and sagging
With less support from collagen and fat in the picture, your skin loses its firmness and begins to sag during menopause. 'There’s also less elastin, the rubber band-y connective tissue that holds collagen in place so everything can flex and move,' explains Dr. Marmur. The result is a loss of volume in the face, the neck, and the jawline (the dreaded jowls!) I hate to use this harsh analogy, but volume loss is slowly making my lower face look like saggy underwear. There, I said it.
What you can do: Keep up with your retinol, which stimulates more collagen and elastin production over time, and your sun protection–the derm-approved step that’s proven to help prevent more collagen and elastin degradation. These are your must-haves, but there are other skin firming-options to do at home or in a doctor’s office.
Apply antioxidants. Adding an antioxidant product, like a vitamin C serum, to your routine will help defend against collagen and elastin degradation, says Dr. Gohara. 'Oestrogen also acts as an antioxidant that protects against free radical damage, so now that it’s low, you should up your topical antioxidants, especially with vitamin C that’s proven to help build collagen too.'
Consider these treatments. If you’ve never done laser treatments, it can seem intimidating, but derms say it’s totally worth trying. 'I will do a series of fractionated laser treatments to help stimulate collagen and elastin formation over time,' says Dr. Marmur. 'This also works well on hyperpigmentation, dullness, and has a firming effect.' To firm skin on the lower face and neck, both experts recommend having an in-office procedure like Thermage, which uses radio frequency energy to stimulate collagen and elastin production and tighten skin. Sofwave is an ultrasound-based heat treatment that also stimulates the production of firming collagen deep in the dermis.
More resources for navigating menopause...
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