TL;DR:
- A2 magazine article where Dr Nedic explains how menopause affects skin, driven mainly by falling estrogen levels.
- Reduced estrogen weakens collagen and glycosaminoglycan production, causing faster skin ageing, wrinkling and sagging.
- Treatments for collagen loss include Titan, Thermage, Tripollar, mesotherapy, BHRT and collagen or vitamin C supplementation.
- Skin dryness and wrinkling is treated with dermal fillers (Voluma, Volbella, Juvéderm), BonTA, fractional laser, peels and hormone therapy.
- Menopause also increases sun sensitivity, age spots, adult acne and facial hair, each needing targeted treatment.
- Declining growth hormone, aldosterone and cortisol also contribute to visible ageing signs and require their own hormone replacement approach.
- Best results come from combining aesthetic procedures with bioidentical hormone replacement, started early in the menopausal transition.
A2 magazine asked Dr. Nedic to give an overview of menopausal skin problems and how to treat them…
Menopause and your skin
Skin changes and treatments thereof. Menopause is a time of change – a natural biological process that signals the end of fertility. While women no longer have to worry about pregnancy, they do have to contend with unpleasant symptoms such as hot flushes, night sweats and mood changes. It also accelerates the ageing process, causing skin to wrinkle and sag… Dr Sly Nedic discusses aesthetic treatments for skin in menopausal women.
Menopause causes the skin to age more rapidly, inducing cosmetic changes such as wrinkling and sagging of the skin. Structural changes such as thinning of the epidermal layer and decreased amount of melanocytes are also prominent.
The dermal changes of menopause are generally caused by reduced estrogen levels. These are worsened by the effects of ageing from hormone decline, as well as lifetime UV light exposure.
Estrogen has profound effects on skin biology and function. It also protects skin from ageing by increasing skin thickness, reducing wrinkling and increasing hydration. There is extensive supportive evidence that certain structures in the skin have more estrogen receptors than others, such as: keratinocytes, fibroblasts, sebaceous (sweat) glands, hair follicles and blood vessels residing in the skin. As such, the functions of dermal cells (including metabolism), are influenced by the reduced levels of estrogen that characterize menopause.
Estrogen effect on the skin. Collagen, which is the key component of the skin, is very important for facial skin firmness. In the initial five years of menopause, a woman may lose as much as 30% of the collagen content of her skin. The rate of collagen loss then declines a further 2% annually in post-menopausal women. Decreased estrogen impairs the production of glycosaminoglycans in the dermal layer of skin. Over time, this causes collagen production to decline – thus leading to increased laxity. It is very important to start treatments during these five initial years in order to preserve and stimulate collagen production. Typical treatments are:
1. Aesthetic procedures to enhance collagen production such as:
- Titan (infrared tailored light),
- Thermage (monopolar radiofrequency),
- Tripollar (tripollar radiofrequency),
- Mesotherapy etc.
2. Anti-ageing treatments such as:
- Estrogen, BHRT,
- Collagen supplements,
- Vitamin C
Skin dryness and wrinkling
The concentration of blood vessels in the dermis also declines around the time of menopause. Reduced vessel concentration is associated with dehydration of the skin, less oxygenation and decreased turnover of the cells. This contributes to the thinning of the epidermis and a slower cell turnover rate – which is accompanied by a reduction in the barrier function of the epidermis. This leads to increased trans-epidermal water loss and dry skin. Glycosaminoglycans attract and absorb water, and their concentration directly affects the water content of skin. Together these changes cause skin wrinkles. Loss of underlying fat tissue that is partly controlled by estrogen levels causes certain folds to become more visible. All of these are worsened by the decline in growth hormone and lifetime UV exposure. Typical treatments are:
1. Aesthetic procedures such as:
- Fillers – especially designed fillers for different problems like Voluma (Juvéderm) for mid-cheek fat loss,
- Volbella (Juvéderm) for smoker’s lines,
- Juvéderm for nasolabial folds,
- BonTA for hyperkinetic lines,
- Fractional laser for skin texture improvement,
- Chemical peels,
- Mesotherapy etc.
2. Anti-ageing treatments with:
- Estrogen BHRT,
- Multiple hormone replacement therapies for long term results,
- Advanced antioxidants
Susceptibility to sun damage and increase of age spots
The maintenance of Melanocytes is partially under the control of estrogens. As menopause progresses, the number of melanocytes in the skin are reduced with less melanocyte.
We produce less of the protective melanin and skin appears lighter. Menopausal skin is, therefore, more prone to sun damage, making it more susceptible to wrinkles. Women normally notice paleness of the skin – and this appears as loss of youthfulness. There is also a lack of regulation of Melanocytes by estrogen, which leads to an increase in age spots.
Typical treatments are:
- Regular and dedicated use of sunblock and IPL for age spots
- Estrogen BHRT (Bio-identical Hormone Replacement Therapy)
Adult acne and increase of facial hair
Both of these conditions are mostly caused by an imbalance between estrogen and testosterone that happens during the early stages of menopause. As estrogen levels decrease, testosterone (produced by the adrenal glands) is no longer masked in the woman’s body. Testosterone stimulates the sebaceous glands, which in turn secrete thicker sebum. This reveals itself as adult acne in some women – as well as the development of excess facial hair (particularly in the chin area).
Typical treatments for these conditions are:
- Topical treatments to treat adult acne,
- Laser hair removal,
- Re-balancing Estrogen:Testosterone ratio with BHRT, Beta-sitosterol, etc.
It’s important to note that as soon as the first symptoms of menopause manifest, the majority of other hormones in the body are also declining. They all have different effects on the skin, making the aesthetic appearance more unpleasant – and treatments more complicated.
Growth hormone is another one that is particularly important for the overall look in facial ageing. This is due to increased atrophy and hypotonicity of the supportive underlying tissues and muscles. Deep forehead wrinkles, droopy eyelids, deep nasolabial folds, lip thinning with retracted gums, jaw bone atrophy and loose skin folds on the neck area are all signs of low growth hormone. However, IGF-1 is easily documented in the blood and could be treated with growth hormone replacement.
Other hormone deficiencies that increase the signs of ageing are:
- Aldosterone and Vasopressin deficiencies (sunken eyes in the orbit)
- Cortisol deficiencies (dark circles under the eyes)
- Aldosterone deficiency (sharp wrinkles)
These deficiencies need adequate hormone replacement therapy.
Menopausal women are very sensitive to their skin – as well as their physical and psychological changes (which are all caused by the decline of hormones). It’s vital to start with both aesthetic procedures and dedicated anti-ageing treatments from onset of menopause (even in peri-menopausal period).
Combining aesthetic procedures with bioidentical hormone replacement is necessary to achieve long-lasting results – as well as to preserve the skin and underlying tissue ageing.