How Menopause Affects Skin: Topical Skincare Solutions
1. Menopause and Peri-Menopause: the lack of solutions and the stigma
2. How does Menopause and peri-menopause affect skin
3. Hormone Replacement Therapy as a solution
4. Topical benefits of transdermal estrogen and phyto-estrogens
5. The Future of menopausal skin care
The impact of menopause and peri-menopause on the skin
1. Menopause and Peri-Menopause: the lack of solutions and the stigma
Sarah Silverman, the comedian and actress, was complaining about peri-menopause on her podcast, in January 2023, sharing that she had recently started taking Hormone Replacement Therapy (HRT). However, she wasn’t complaining about being peri-menopausal or her symptoms, she was complaining about her medication and how completely poorly thought out it was. From its name… VagiFem (why?) to the fact that she had to go to her local CVS once a month to pick it up (the inconvenience coupled with ritual embarrassment). It would seem like discretion is a luxury afforded to some drugs and not others (I still don’t know what Saxenda is)? She was embarrassed and frustrated about the lack of solutions for a problem that millions of women are facing- and she is not the only woman to get vocal about it.
The fact is that 6000 women in the US are becoming menopausal every day (Prevention Magazine, Jan 2023 issue). When you take into account that older millennials are becoming peri-menopausal, with Gen X entering menopause and Baby Boomers living longer as menopausal due to increased life span- you realize there is one of the largest cohorts of women who are entering this life stage. In fact, many are stumbling into this experience. Menopause is not discussed in schools as part of health education. We don’t celebrate it like other milestones. Most women are met with an onset of confusing and often dismissed symptoms before conferring with their mothers or other women in their lives. Did they have these symptoms? What was menopause like for them? How long did it last? The overall feeling is that there is a lack of resources and solutions and even diagnostic tools, with an abundance of stigma and poor outcomes.
However, there is the potential for a big change to come. TikTok of all places is seeing the rise of physicians and experts in menopause re-frame the story of therapies like HRT and symptoms. Women are finding a community in what was once shrouded and undiscussed. There is a new and vocal demand for new products and innovation and there are enough potential dollars on the table, that big Pharma and the wellness and skincare industry will be incentivized to start listening. Get ready for the Allergan’s (makers of Botox™️) and Goop to deliver their own take on menopause one day…this candle smells like menopause, anyone?
2. How does Menopause and peri-menopause affect skin
There is a clear consensus that estrogen fluctuation and eventual deprivation have marked impacts on skin. Even women who have eaten well, exercised, refrained from smoking and used a well balanced sunscreen will see dramatic changes to their skin with the onset of peri-menopause and menopause. Dryness, loss of collagen and therefore a decrease in facial volume and increase in laxity and facial wrinkling all become more pronounced. Wound healing is also impacted as does an increase in the likelihood of bruising.
As estrogen declines, skin will naturally produce less sebum making skin more prone to dryness and irritation. Your previous skin aging routine using topical retinoids (vitamin A derivatives like tretinoin) may not be as well-tolerated. Beware of listening to skin experts who say that daily retinoid use is required to ‘prime retinoid receptors’. The fact is that your skin may be dealing with additional inflammatory processes. Hydration and soothing should take an equal role in your skincare routine and it may be perfectly appropriate to use less (not completely eliminate) irritating anti-aging ingredients.
The decline in estrogen in can also lead to an imbalance with androgenic hormones giving rise to more acne (and chin hair). In these instances where you are dealing with hormonal acne breakouts and potential increased sensitivity, washes with lactic acid, glycolic acid or salicylic acid are a good way to introduce increased exfoliation and cellular turnover.
The fact is that the market opportunity is immense for doing a better job at catering to the needs of peri-menopausal and menopausal women. My prediction is that in 10 years time, the solutions are going to become much more varied and robust-from involved treatments like Hormone Replacement Therapy to more cosmetic ones like topical cosmetic and OTC products for skin related improvements. Studies have shown that up to 30% of dermal collagen may be lost in the first 5 years after menopause, and collagen decreases by approximately 2.1% per year (Archer, 2012). Menopause seems to be one of the biggest internal (endogenous) moments for skin aging in a women’s life.
3. Hormone Replacement Therapy as a solution
Hormone Replacement Therapy (HRT) has historically been stigmatized as having the potential for increased risks of certain types of cancer, especially some forms of breast cancer. However, significant progress and research has taken place where which forms of hormones (estradiol and progesterone in most cases depending on whether the individual still has a uterus) are prescribed in specific forms (transdermal (through skin) vs. oral therapy) can lead to much better outcomes. Certain physicians and menopausal experts, like Dr. Mary Claire Haver, have become vocal about the potential benefits of HRT for symptom mitigation but also cardiovascular, cognitive and osteoporosis benefits . As a side note, Dr. Marie Haver also recently published a book The Galveston Diet that details specific supplements (like Vitamin D, omega 3s, turmeric and magnesium threonate or glycinate) and exercise and nutritional choices that can also be beneficial.
Many health experts point to the 2002 study from the Women’s Health Initiative that warned HRT could lead to increased chances of breast cancer as the reason for the steep decline in its use. Many physicians, including even OB/GYN’s, have stated being uncomfortable or feeling unprepared in prescribing HRT or providing general menopausal guidance. Even most on-line resources still list the initial 2002 findings as general warnings when you google specific HRT therapies. All of this still remains in effect despite the fact that the initial study has been hotly contested as having been done on older women who had stopped menstruating for over 10 years and in only using a specific form of progestin. Many have argued that its wide dissemination has left a generation of women and the medical field delayed in finding new solutions.
4. Topical benefits of hormone therapy and phyto-estrogens
It remains to be seen what the resurgence of HRT will look like for older millennials and even Gen Xen’s. However, it looks like we are also at the beginning of a movement where ‘softer’ more cosmetic interventions specifically tailored to estrogen deficient skin might start to come into play. There are estrogen receptors in the skin and there is some very promising data to show that topical solutions could help alleviate skin aging concerns. As a company with physician co-founders that respectively specialize in Obstetrics/gynecology and dermatology, we are uniquely positioned to start research which compounds might best help. Currently, it seems like phytoestrogens like soy isoflavones (like genistein) might be one possible route but it’s early days. There may very well be more specialized compounds or ways of increasing absorption (like encapsulation etc.) to make plant-derived solutions more effective. It’s our plan for our R+D team to put our heads together to see what we can do beyond traditional actives to offer a much more tailored solution.
There also seems like a very good chance that larger pharmaceutical companies that specialize in medical devices and/or drug-like products will be able to offer even more robust solutions, potentially with actual bio-identical hormones. Currently, you have physicians on social media suggesting the off-label use of vaginal estradiol creams like Estrace can be used on the face, often with the suggestion of using a small amount as an under eye cream or globally on the face up to 1x per week. However, while this is unlikely to be harmful, it’s also not clear how effective this is in the absence of clinical data for facial application. The appropriate dose, formulation of the cream and frequency of use will probably be clarified with better studies at some point. We might also see instead of other cosmetic injectables like fillers or Platelet Rich Plasma, we’ll have skin infusions of estradiol or something equivalent. It seems almost certain that dermatologists will be writing prescriptions for topical estradiol for their over 40 female patients with the same frequency that they prescribe retinoids.
While that all sounds tantalizing, on some level we will have to wait. In the meantime, don’t forget the benefits of daily sunscreen application and a robust skincare routine.
5. The Future
First and foremost, I predict peri-menopause and menopause are going to come out of the shadows. There is a discernible dissatisfaction with how this crucial women’s health issue has a lack of data. Anyone who has had their hormone levels checked will confirm the range of what is considered ‘normal’ is comically huge. It might be that hormone levels are incredibly individual to each person or that there has been a lack of research into what does a daily fluctuation look like for individuals going through perimenopause. We have the hope that one day we’ll be able to monitor female hormones in the way we have glucose monitors. Imagine the power in being able to offer individualized care for women when so many of them are currently in the dark about what their holistic hormonal picture looks like.
We could also potentially expect that it will be on trend to actually celebrate menopause. For most of us, getting our periods typically meant a trip to the mall and ice cream….so maybe we’ll start to see the beginning of menopause parties. Celebrations full of champagne and an industry that actually cares about the needs of its consumers. In five years, I’m sure we’ll see progestin gummies (not called VagiFem) and face masks with clay and estradiol. Until then, here’s to finding a community and at least knowing that you are not alone. With that in mind, please do leave your experience in the comments- we would love to hear from you. What are you looking for in terms of solutions? What’s your journey been like? What are your current pain points? It’s time we start building a community and sharing our experiences- vive la menopause.