What does perimenopause do to our skin?

For the past four years, I’ve managed to alleviate the raging eczema on my hands by doubling my daily dose of Vitamin D coupled with diligent use of hand cream. Doing so has meant no more scratching my hands maniacally at night, wincing through washing my hair with irritated palms and fingers, or gobbling antihistamines as a last resort for relief. But lately, the itch has crept back despite all my best strategies. And as I’m learning, if there’s a body issue impacting your quality of life and you’re a woman of a certain age? It’s likely related to your hormones.
I suspect my skin irritation is flaring up because I’m deep in perimenopause, defined as the years leading up to your final period. During this time, estrogen gradually declines, which can cause a wide range of symptoms from disrupted sleep to tinnitus to, yes, eczema.
“Eczema tends to be more like an autoimmune [disease] so we do see a flare in those diseases because estrogen is a systemic anti-inflammatory hormone,” confirms Dr. Mary Claire Haver, a Texas-based board-certified OB/GYN and author of “The New Menopause.” “When the levels drop, we lose that blanket of protection. And so, all of a sudden, these diseases just start flaring.”
There are plenty of other skin changes you might notice during this time. “Estrogen plays a vital role in keeping skin healthy and youthful,” said Paula Begoun, founder of skin care brand Paula’s Choice, who began looking into perimenopause when she learned how early it can start, and has kept up with the research for decades.
When estrogen drops, the production of collagen and elastin — the proteins that keep our skin plump, strong and flexible — starts to decrease, causing skin to thin. “Not to mention the slowdown of ceramides and hyaluronic acid, which leads to a reduced ability for skin to hold in water, making it drier and negatively impacting joints,” added Begun.
Not surprisingly, a lot of women entering this phase of their life are just figuring it out as they go. “There continues to be a general lack of awareness about estrogen loss and its impact — not just on skin, but on overall health,” said Begoun. Though estrogen is mostly associated with sexual and reproductive health, it’s vital in so many other ways. Along with skin health, it has a protective effect on the heart, brain, bone density and blood sugar balance. It’s little wonder perimenopause’s symptoms can be so wide-ranging.
The first line of defence in managing estrogen loss is estrogen therapy, via patches or oral medication. While forms of hormone-replacement treatment (HRT) used to be controversial due to a widely publicized 2002 study that linked it to higher rates of breast cancer, stroke and heart disease, many experts have since said that the study was flawed, and the impact of HRT on these risks was overstated. Proponents of HRT also point to research showing it may mitigate the risk of serious health issues such as osteoporosis and dementia.
When it comes to skin, Begoun said that estrogen helps produce more collagen and hyaluronic acid — both crucial for hydration and plumping. For me, the biggest difference since I started on patches a few months ago is that my eczema flare has calmed and I can now sleep through the night again. That said, it’s important to consult with your doctor first, as not everyone is a candidate.
Lately, there’s been hype online around estriol (a form of estrogen) creams, which are prescribed for vaginal dryness, used off label a few times a week on small areas of the face. “You not only see improvement in collagen but you also see the elastin fibres respond really well topically,” said Haver, citing two American companies, Alloy and Musely, which sell it mixed with moisturizer. But they’re not available in Canada and there is some skepticism within the medical community about using them on your face.
“Estriol face cream has been making noise on social media because of a study released by Alloy that demonstrated the benefit of theirs in post-menopausal women over a 12-week period,” said Dr. Amy Louis-Bayliss, who has been inundated with questions about it from patients at her menopause clinics in Mississauga, Ont. “While it’s unlikely to cause harm, I just don’t think there is robust evidence yet to universally recommend it.”
What you can do to offset the decrease of estrogen in your skin is adopt preventative habits, which Begoun insists “will be life changing if women adhere to them.” Wear sunscreen every day, without exception. “Compromised skin is even more vulnerable to environmental damage, making daily UV protection with a broad-spectrum SPF 30+ sunscreen that much more important,” she said.
Never smoke, which deprives skin of vital nutrients and causes irreversible damage. Nourish yourself with an anti-inflammatory diet of healthy fats, lean meats and antioxidant-rich fruits and vegetables. And in terms of skin care, look for ingredients like ceramides to strengthen the skin barrier, antioxidants to fight free radicals, hyaluronic acid to boost moisture and retinol to encourage collagen production.
“I can’t undersell how important lifestyle is,” said Haver. She recommends “protecting our skin, using good-quality moisturizers, not letting it get dried out — all the usual things to keep skin healthy. And then remembering that menopause is at play here.”