by Paolo Giacomoni
Understanding Menopause and Its Impact on the Skin
Menopause is one perceptible consequence of aging that affects women in their body as well as in their spirituality. On the skin, the effects of aging are unmistakable: the thickness of the dermis gradually decreases and, at the onset of menopause, the thinning of the dermis is dramatically accelerated. The initial slow thinning is the result of the gradual disorganization of the elastic fibers consequent to the permanent micro-inflammatory status. At the onset of menopause, the dermis is no longer able to retain water and a sudden increase of the rate of thinning is observed.
Hormonal Influence on Skin Thickness
Hormonal Imbalance and Skin Changes
The accelerated thinning of the skin after menopause is perhaps the consequence of hormonal imbalance. Indeed, women who undergo ovariectomy have thinner skins whereas women who follow an estrogen therapy have thicker skins (1). In fertile women the thickness of the skin depends on the level of sex hormones (2) as if it were the consequence of hormone-induced retention of water. Post-menopausal women with Hormone Replacement Therapy (HRT) do not undergo the steep increase in skin extensibility that is observed in untreated peri-menopausal women as if HRT could prevent skin slackness (3).
Biochemical Changes and Skin Sensations
Dryness and Itchiness After Menopause
After menopause, dry and itchy skin are also observed. This is because of the biochemical changes that occur in the stratum corneum such as the reduction in the level of Filaggrin and the increase of Small Proline Rich Proteins (SPRP). Filaggrin is the source of the Natural Moisturizing Factor (NMF), and its scarcity provokes the dry feeling. SPRP are components of the cornified envelope, and their abundance makes the stratum corneum stiff. These two concomitant phenomena provoke the itchy feeling.
Visible Signs of Postmenopausal Skin
Wrinkles, Sagging and Loss of Radiance
Postmenopausal skin displays wrinkles and loss of radiance, glow and luminosity. Having lost thickness and increased its surface, the skin "hangs down" from its attachment points to the muscles and wrinkles are formed. The loss of glow, radiance and luminosity is also the consequence of the thinning of the skin. Skin molecules absorb, reflect and scatter the light. The light that is neither absorbed nor reflected penetrates the dermis down to the fat tissue. Thinner skin scatters to a minor extent the light that is not absorbed by hemoglobin in the blood vessels and allows more photons to reach the yellow adipose tissue. Therefore, more yellow light will come back, and the skin will assume a yellowish complexion.
Estrogen Treatments and Their Effects
Topical and Hormonal Therapies
The topical application of estrogen increases the thickness of the skin by 10% and modifies the biophysical characteristics of post-menopausal skin (4, 5). Topical estrogen is commonly used to limit the increase in alkalinity of vaginal secretions that modify the local micro-flora and might favor infections of the urinary tract. It has been observed that estrogen therapy lowers vaginal pH and that HRT normalizes vaginal pH and vaginal micro-flora after menopause. For example, the intra-vaginal administration of estradiol in postmenopausal women devoid of vaginal Lactobacillus, resulted in colonization by lactobacilli after one month while the pH decreased from 5.5 to 3.8 and the infections by Enterobacteriaceae were remarkably reduced (6). Women and doctors will likely discuss the problems and the solutions associated with hormonal treatments. A point of discussion is perhaps the fact that increasing the thickness of the dermis might help reducing wrinkles as well as the yellowish color of postmenopausal skin. Estrogen, though, must be used under strict medical control.
Questions and Answers
What happens to the skin during menopause?
During menopause, the dermis becomes thinner and loses its ability to retain water, leading to dryness, reduced elasticity and visible aging signs such as wrinkles and sagging.
Why does the skin become dry and itchy after menopause?
This is due to biochemical changes, including reduced Filaggrin levels and increased SPRP, which affect moisture retention and skin flexibility.
How do hormones affect skin thickness?
Skin thickness is influenced by sex hormones, especially estrogen, which helps retain water in the skin and maintain its structure.
Can hormone therapy improve skin condition?
Yes, Hormone Replacement Therapy (HRT) and topical estrogen can improve skin thickness and elasticity, but they must be used under medical supervision.
Why does postmenopausal skin appear less radiant?
Thinner skin changes how light interacts with it, allowing more yellow light from deeper tissues to reflect back, giving the skin a yellowish tone.
References
(1) Tur E. (1997) Physiology of Skin Differences in Men and Women. J. Clin. Dermatol. 15 : 5-16
(2) Eisenbeiss C et al (1998) The influence of female sex hormones on skin thickness: evaluation using 20 MHz sonography. Brit. J. Dermatol.139: 462-467
(3) Piérard GE, et al (1995) Effect of hormonereplacement therapy for menopause on the mechanical properties of skin. J Am Geriatr Soc. 43:662-665.
(4) Creidi P, et al (1994) Effect of a conjugated estrogen (Premarin) cream on the facial skin. A comparative study with a placebo cream. Maturitas 19:211-223
(5) Guinot C, et al. (2005) Effect of hormonal replacement therapy on skin biophysical properties of menopausal women. Skin Res Technol. 11:201–204.
(6) Farage M.A., et al (2015) The Vaginal Microbiota in Menopause. In: Farage M., Miller K., Maibach H. (eds) Textbook of Aging Skin. Springer, Berlin, Heidelberg
