Skin and Menopause

Skin and Menopause

Menopause, and the menopausal period in general, represents a time of significant change for us women, both psychologically and physically. Just as the first menstrual cycle has always been considered the moment when "you become a woman," menopause is another important transition.

Until about 15 years ago, there was fear and even a strong sense of embarrassment in talking about these changes. But now that life expectancy has increased, and we women lead much more active lifestyles and play even more important roles in both family and professional life, it is essential to talk about it and use every available strategy to feel better. Let us not forget that we spend approximately 30% of our lives in menopause.

First of all, what is menopause?

According to international guidelines, we speak of menopause to refer to that phase of a woman's life, usually over the age of 45, characterized by the absence of menstrual flow for more than 12 months. Perimenopause, on the other hand, is the preceding period, marked by changes in the menstrual cycle, often associated with bothersome symptoms such as hot flashes and night sweats.

Premature menopause is defined as menopause that occurs before the age of 40 and is confirmed by diagnostic lab tests (elevated FSH hormone).

But what happens to our skin?

Menopause causes an estrogen deficiency condition that is associated with a drastic change in skin health, negatively affecting its physiology and other important biological functions. Changes include the loss of collagen, elastin, fibroblast function, alterations in vascularization, and increased activity of degradative enzymes. As a result: dryness, wrinkles, laxity, atrophy, impaired healing, and reduced antioxidant and protective capacity—even from UV radiation.

The adrenal and ovarian glands of postmenopausal women continue to produce androgen hormones. In the absence or reduction of estrogen, these hormones can cause additional effects such as a deeper voice, the appearance of unwanted facial hair (think of those unsightly chin hairs!), oily or acne-prone skin. There is also a redistribution of adipose tissue, with a loss of the "supportive" subcutaneous fat in the face, neck, hands, breasts, and arms, leading to a sagging appearance. In contrast, fat becomes concentrated in the abdominal area, hips, and buttocks—typical male fat storage areas.

However, menopause does not occur overnight. In the first five years of the climacteric, there is a sharp decline in the skin's collagen component, resulting in a reduction in skin distensibility and elasticity, with the skin becoming thinner and almost translucent.

Dermal thickness decreases by 1% annually during the first twenty years of menopause, but it is in the first five years that women experience a loss of about 30% of the total collagen. Then the decline slows: on average, over the next twenty years, collagen fibers decrease by 2.1% per year, skin distensibility increases by 1.1%, and elasticity decreases by 1.5%.

Additionally, as time goes by, signs such as actinic and seborrheic keratoses, and solar lentigines begin to appear, because unfortunately, most skin damage is due to accumulation over time.

There is also a significant loss of bone mass (first called osteopenia, later osteoporosis), with an increased risk of fracture.

And what about the hair?

Again, everything can be explained by hormonal changes. Estrogens play a fundamental role in regulating the hair cycle, stimulating the anagen phase, which is the growth phase. A reduction in the anagen phase leads to a lengthening of the telogen phase, when hair falls out.

For the same reason, during the post-pregnancy period—when we are highly subject to hormonal fluctuations—there is a shortening of the anagen phase and a lengthening of the telogen phase. This condition is known as "telogen effluvium," a significant and acute loss of hair that usually resolves with the return of hormonal balance.

So, what can we do to feel better and face this change more calmly and consciously?

First and foremost, it is essential to rely on the appropriate specialists. Menopause mainly causes changes in the genitourinary system, cardiovascular system, nervous system, and skin: all of these specialists should be consulted.

The skin, in particular, should be monitored with regular dermatologic check-ups to promptly diagnose any new lesions that may arise. Early diagnosis and appropriate therapy are fundamental in dermatology.

And how can we counteract the signs on the skin and hair?

Today, we can do a lot. Let’s think of all the regenerative medicine treatments useful for maintaining skin health: biostimulation with hyaluronic acid, polylactic acid, PRP, and exosomes for the skin.

If volumetric restoration is needed (let’s not forget that facial fat, which gives support, decreases while fat accumulates in new areas like the abdomen or hips), fillers are extremely helpful: hyaluronic acid-based treatments that, when used wisely, do not “inflate” the face but allow volumes to be naturally restored, in what is known as a “liquid facelift.”

For hair, regenerative therapies such as PRP, carboxytherapy, or mesotherapy can be used.

As for the body, treatments for localized fat such as cryolipolysis or mesotherapy, and those to stimulate elasticity and tone like carboxytherapy, can be beneficial.