Menopause and the skin

Strictly speaking, menopause is defined as the day a woman has been diagnosed as not having a menstrual period for 12 consecutive months. This signifies the permanent cessation of menstruation. The period leading up to menopause is described several ways, menopausal transition, peri-menopause or climacteric. During this time, which may precede several years before menopause, fluctuations in menstrual cycles and hormonal changes occur. This is evident from the signs and symptoms that a woman may experience.

Common peri-menopausal signs and symptoms

Irregular periods (may not occur every month, may be light or heavy)
Hot flushes/night sweats (sudden warm feeling, possibly blushing)
Difficulty sleeping
Mood swings/depression
Vaginal dryness
Changes in skin (particularly around genitals but also in other areas) resulting in laxity, reduced body and scalp hair and dryness

What effect does menopause have on the skin?

On average menopause occurs as women reach early to mid-50 years. Leading into this time changes in hormone production occur, most notably a decline in oestrogen levels (hypo-oestrogenism).

It has been found that oestrogen affects every organ system of the body including the skin. It appears that oestrogen receptors are most abundant around the genital area, face and lower limbs. Therefore these areas are especially vulnerable to reduced amounts of circulating oestrogen and are the reason for certain skin conditions involving these areas to be more common in peri- and post-menopausal women than in women of other age groups.

Common skin conditions seen in peri- and post-menopausal women
Atrophic vulvovaginitis	Thinning (atrophy) of vaginal skin including the entrance to the vagina (vestibule). The vulva is less affected (It has fewer oestrogen receptors than the vagina) Symptoms include itchiness, tenderness, a burning sensation, painful intercourse and painful urination
Vulvovaginal candidiasis	Less common in this age group than in younger women Fungal infection around the vaginal region Possibly associated with the use of HRT or oral contraceptives
Vaginitis	There are several causes There may be a profuse discharge is present
Vulvar lichen sclerosus	Chronic, atrophic skin disease that affects mainly the anogenital area May be asymptomatic in some patients Signs and symptoms include: Itching & irritation White, thinned, wrinkled skin Fissures or tears Painful intercourse Possible association with autoimmune disorders
Dyaesthetic vulvodynia	Chronic vulvar burning, irritation, stinging and rawness (rather than itch) May also involve the thighs Cause is not known (thought to be neurological)
Hirsutism (abnormal hair growth in women)	Facial hirsutism is very common in post-menopausal women not on HRT
Alopecia (hair loss from areas where it is normally present)	Approximately a third of post-menopausal women may develop hair loss, usually at the front and on the top of the scalp (frontal)
Menopausal flushing	Occurs in 70-85% of women throughout the peri-menopausal stage Reddening of the face, neck and upper chest that lasts 3-5 minutes and subsides quickly May be associated with sweating, palpitations, anxiety and sleep problems
Keratoderma climactericum	Thickening of skin on the palms and soles Occurs more commonly in obese post-menopausal women May be itchy and painful cracking and splitting may occur

What treatment is available for menopausal symptoms?

Hormone replacement therapy (HRT) has been shown to have beneficial effects in preventing many of the signs and symptoms experienced in peri- and post-menopause, including urogenital and general skin and hair problems. HRT may consist of oestrogen tablets, patches, vaginal rings, implants or cream (particularly useful for atrophic vulvovaginitis), or a combination of oestrogen and progestogen as patch or tablet. However, HRT is no longer recommended for healthy women without specific problems caused by the menopause.

Other treatments for urogenital problems may include:

avoidance of soaps and harsh rubbing of the affected area to prevent further irritation of the skin
topical or oral antibiotics if infection is present
emollients and bland lubricants to keep the area moist
antidepressants, particularly if pain is neuropathic.

Related information

Self-help books:

References:

Wines N, Willsteed E. Menopause and the skin. Australasian Journal of Dermatology 2001;42:149-60. Medline

On DermNet NZ:

Other websites:

Hormone replacement therapy – rapid review; Prescriber update, Medsafe New Zealand

Author: Vanessa Ngan, staff writer