In the United States, nearly 6,000 women enter menopause every day. Our hormones are constantly in flux—especially as we age—experiencing a roller-coaster ride of highs and lows that impact not only our minds and bodies, but also our skin.
The Hormone Equation
Though there are more than 50 hormones in the body, hormonal effects on the skin can be linked specifically to estrogen, progesterone and testosterone. “Estrogen ensures the functionality of our reproductive organs and preserves bone mass and the elasticity and moisture content of the skin,” explains Newport Beach, CA endocrinologist Jane L. Frederick, MD. Scientific studies have demonstrated a clear relationship between estrogen levels and the age women appear due to their overall skin health, says Newport Beach, CA dermatologist Zenovia Gabriel, MD.
Progesterone functions as the supporting actor, but is a crucial figure: “Progesterone is a precursor of many other hormones, and therefore also has a global impact on the body’s various physiologic systems, but estrogen is the key player in maintaining youthful, healthy skin,” says Bloomfield Hills, MI dermatologist Linda C. Honet, MD. “It is the fine balance of estrogen and progesterone in relation to each other and other hormones, that help keep skin healthy.” Testosterone plays a skin-care role too, as it stimulates sebum (oil) production and can trigger acne or dryness as hormone levels change.
Dr. Honet tells her patients that every decade presents “a new you in a new skin,” in the sense that a woman’s hormones are in constant physiologic fluctuation. Some of the most marked ebbs and flows occur before, during and after menopause, including these three common changes.
Issue 01: Acne Can Increase
It appears as though more middleaged women are experiencing acne than ever before. Though some of this perception is attributed to social media sharing, Dr. Zenovia says the patterns of female life are also different than they were 50 years ago. “Women are using oral contraceptives for decades now, and this may impact the hormone receptors on the tissue and the hormonal changes we experience.”
When breakouts manifest later in life, New York dermatologist Doris Day, MD says they’re typically seen along the chin and jawline, and most often during perimenopause (the winding down of a woman’s biological clock in her 40s when her menstrual cycle starts to change). “If this happens, you shouldn’t dry out your skin like you did as a teenager—that’s too irritating for someone with mature skin,” adds Dr. Zenovia. “You still need tried-and-true ingredients like benzoyl peroxide, but they should be mixed with emollients and antioxidants that will also nourish the skin.”
Dr. Honet says prescription retinoids like tazarotene and adapalene can help when over-the-counter topicals aren’t enough. “The key is to start low and slow, moisturize regularly and be patient with your skin.”
Issue 02: Collagen Dwindles
Research shows we can lose up to 30 percent of our collagen Types 1 and 3 in the first five years after menopause, which can cause skin to appear less firm and taut. “Once a woman enters menopause—the average age in the U.S. is 51—her ovaries stop producing estrogen completely, but a precursor to estrogen, dehydroepiandrosterone (DHEA) secreted by the adrenal gland, continues to supply the body with some estrogen,” says Dr. Hamori. “Studies reveal that skin thickness decreases 1 percent per year and collagen content decreases 2 percent per year.”
To stimulate collagen production, opt for skin-care products containing retinoids, peptides, phytoestrogens, vitamin C, and/or growth factors, as well as in-office treatments such as fractionated lasers, dermal fillers and microneedling.
Issue 03: Hydration Levels Drop
Along with the loss of collagen comes a reduction in hyaluronic acid, which affects the skin’s ability to produce and retain moisture. “The drop in estrogen during perimenopause and menopause causes transepidermal water loss, leading to dehydration,” Dr. Hamori says. “As a result, skin feels drier and rougher, and appears more wrinkled.”
Dr. Day says our oil-producing glands get some of the blame, too. “As we age, these sebaceous glands diminish or become less active and skin gets drier.” To replenish moisture, look for products with ceramides, humectants such as lactic acid, hyaluronic acid and glycerin, and phytoestrogens.
What Are Phytoestrogens?
Natural compounds found in some plants and plant-based foods, phytoestrogens have a chemical structure that is similar to the human estrogen molecule, but not identical. “Facial skin contains a very high density of estrogen receptors, and scientific data proves that phytoestrogens can bind to these receptors and initiate important signal pathways in the skin,” Dr. Zenovia explains. “Phytoestrogens basically mimic the effect of human estrogen on the skin, without systemic effects.”
Duxbury, MA plastic surgeon Christine Hamori, MD says two phytoestrogens in particular— daidzein and genistein—have been shown to improve skin elasticity and reduce wrinkle depth. “When taking orally as supplements or consumed in foods like soybeans, the production of hyaluronic acid, collagen and extracellular protein matrix is increased,” she adds.
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