Menopause & Skin

Oestrogen is a power house hormone. Every organ in our body has oestrogen receptors and the skin is no exception. Our skin is a large organ, and weighs about 15 kg. It has many functions, it does more than keep our bodies contained. It serves in our immune system, keeping bacteria out and has lots of immune cells responding to any pathogens that do get in. It has many nerve cells, allowing us to feel pressure, heat and cold. It has a temperature control function for our bodies, as well as producing vitamin D which is essential for healthy bones. Within the skin we have a number of types of skin cells, immune cells, blood vessels and nerves and they all have oestrogen receptors. It’s no wonder than fluctuating oestrogen levels of perimenopause and low oestrogen levels of menopause have an impact on our skin.

One of the most common symptoms of perimenopause is dry, itchy skin. This makes sense as oestrogen stimulates sebum, hyaluronic acid and ceramide production in the skin. Sebum is a natural grease, which helps reduce water loss form the skin. Hyaluronic acid is our body’s natural moisturiser and you will see it featuring in many aesthetic injectable treatments and moisturisers. It is produced in our dermal layer of our skin and here it helps to keep the skin plump and supple. Ceramides are proteins that act like the mortar in between the skin cells. A reduction in these natural greases leads to a reduction in the skin barrier function, the skin cycle slows down, skin becomes more dull and scaly, feels dry and itchy, and will often become more sensitive as the barrier function is weaker.Specific skin conditions such as rosacea can become more problematic with hot flushes, and acne can also have a hormonal component and can flare in menopause. Our hair and nails can also be affected by fluctuating oestrogen levels.

Skin care.

The reduced skin barrier function can lead to more sensitive skin. Often we try many different actives, cleansers, exfoliants, PHAs, BHAs, retinoids, and these products on a weaker skin barrier can cause more irritation, redness and dryness. We often need to change our skin care regime, but beware, you don’t need any products that claim to be for people of a certain age or “menopause” specific products. These often have a high price tag, and offer no additional specific treatments for menopausal skin. If a cream is good for dry skin, its good for men and women of all ages, so don’t be made to feel like you need the more expensive or specific products as none exist!

Ideally, you will want to be adding ceramides and proteins (amino acids) into your skin to build up the skin barrier. You will want to moisturise the skin well, and add a high factor SPF that has effects against UVA and UVB. Vitamin C is a great antioxidant and also essential in the production of collagen, so is always a great addition to any skin care regime. Here at The Clinic by La Ross, the team are experts in skin care and can help your specific skin concerns offering bespoke medical grade skin care recommendations and prescriptions.

The gender gap.

Men and women age equally until menopause, then women have an accelerated ageing process. Our collagen drops by 30% in the first 5 years after menopause. Not only the amount of collagen, but the quality of the collagen drops. Collagen is a protein that creates structure and support to the skin. It affects the elasticity of the skin too. There are many aesthetic treatments aimed at promoting collagen production. You can speak to your clinician at the clinic to find out which treatment would work best for your skin.

How we can help.

Here I can support your skin through perimenopause and menopause. I am a BMS accredited advanced menopause specialist and also an aesthetic doctor, so have good idea about how menopause affects our health and skin. I have been treating the effects of menopause on the facial structures in her aesthetic clinic, and being a GP, my patients often talked about their menopause. I was surprised at what poor care they were often being given. This sparked my interest in training as a menopause specialist. I now works for the CQC registered clinic, The Clinic by La Ross, once per week offering holistic menopause appointments. These are one hour long to allow plenty of time to understand you needs and create a bespoke treatment plan. If you can’t make it to Rochester in person, I can see you for a remote video consultation.

Menopause & Bones

The other elephant in the room for women, is the risk of osteoporosis, or bone thinning in menopause. We know that oestrogen protects from osteoporosis. Women with an early menopause or surgical menopause are recommended HRT to protect their bones and hearts. A fractured neck of femur affects approximately 1/3 women and 1/5 men over 80. 10% will sadly die within 1 month and about 1/3 will die in the first year following from a fractured neck of femur, and we know that HRT for even a few years around menopause reduces the risk of having a fractured neck of femur. Oestrogen dropping, does not just affect our spines and hips, but also the bones in the face. If women have an MRI scan aged 20, 40 and 60, we can see the bones of the face, jaw and chin get smaller. This means that we actually have less scaffolding and support for the soft tissues of the face, and the soft tissues present as a heaviness along the jawline, known as jowls, and as deeper lines from nose to mouth (nasolabial folds) and from mouth concerns to jaw (Marionette lines).

How to help

I recommend all of my patients to take Vitamin D supplementation as we do not have enough sunlight to produce the amount we need to protect our bones in the UK. It is worth assessing your diet to be sure you have enough calcium intake too.

Weight bearing exercises such as walking, jogging, jumping all help put impact through our skeleton which encourages bone strength.

Strength training, even with just body weight with squats, and press ups can also help your musculoskeletal system.

If you are at risk of osteoporosis, so have had an early menopause, have a family history of osteoporosis, have suffered from fractures or been on several courses of systemic steroids then you should ask your GP to consider testing you for osteoporosis with a DEXA scan.

Perimenopause Challenge

As a British Menopause Society accredited advanced menopause specialist, I'm incredibly passionate about helping women navigate the often turbulent waters of perimenopause. There's nothing more rewarding than seeing someone's quality of life dramatically improve after finally understanding what's happening to their body and finding effective treatment.

But here's a frustrating truth I see all too often: by the time women reach my clinic, they've often been through the diagnostic wringer. Multiple appointments, countless tests, and still, no clear answers. Why is perimenopause so often missed or misdiagnosed?

The 10-Minute Time Trap

One of the biggest hurdles is the time constraints in many healthcare settings. In the NHS, GPs often have just 10 minutes per patient, and one problem per consultation. Perimenopause is a complex process with a wide range of symptoms, from subtle to debilitating. Trying to connect all the dots in a 10-minute appointment is a tricky task, especially when many doctors haven't received adequate menopause training.

Let's paint a familiar picture:

Palpitations: A woman presents with heart palpitations. She undergoes ECGs, possibly more extensive cardiology tests, only to be told it's likely anxiety and prescribed antidepressants or beta blockers.
Joint Pain: Another visit, this time for persistent joint pain. X-rays come back normal, leading to physiotherapy and painkillers, but no lasting relief.
Itchy Skin: Yet another appointment, this time for itchy skin. Emollients are prescribed, and blood tests screen for underlying diseases, but the itching persists.
Heavy Periods: Then there are investigations for heavier periods, scans, and referrals to gynaecology.

It's a cycle of symptom management without addressing the root cause. This can be incredibly frustrating and disheartening for patients.

The Blood Test Bind

Many women understandably suspect their symptoms are hormonal, and often request blood tests. The doctor orders the blood tests. The patient feels happy that something is being done. The blood tests are taken. The patient won't hear back as the results are normal. They phone the reception, and are told bloods are normal. How does that feel? It's not a relief, it's a feeling that your body is gaslighting you. How can they be normal when you have so many symptoms affecting your every day functioning? She may book another appointment, and may be lucky that she sees a doctor who recognizes her symptoms, or she may be told she's too young, bloods are normal, and she's not got vasomotor symptoms of flushes and night sweats so therefore this isn't menopause.

But here's the crucial point: blood tests aren't always the answer.

Many rely on the FSH (follicle-stimulating hormone) test, which indicates menopause (the cessation of periods) – not perimenopause (the symptomatic time leading up to menopause where hormones fluctuate). FSH levels fluctuate wildly during perimenopause, so a "normal" result doesn't necessarily rule it out. As your ovaries gradually decline, sometimes they might have a surge, and other times have low levels, this is why we cannot rely on the tests.

Furthermore, there's no established standard for oestrogen levels during perimenopause. Symptoms don't correlate with specific blood levels, and blood tests don't dictate treatment dosage.

Ageism in Action

Another frustrating issue is the assumption that perimenopause only affects women in their late 40s and 50s. While that's the most common timeframe, it's important to remember that:

* 1 in 10 women experience menopause before the age of 45 (early menopause).
* 1 in 100 experience menopause before the age of 40 (premature ovarian insufficiency or POI).

Considering that perimenopausal symptoms can last for an average of seven years, some women may start experiencing them in their late 30s. Too often, these women are dismissed as being "too young" for it to be perimenopause. I have seen this in my own practice. I have had a 45 year old patient who has had a change in her periods for 3 years, many severe perimenopausal symptoms, but her GP said she was too young and was very reluctant to prescribe her hormones.

When Do Blood Tests Matter?

While perimenopause is primarily a clinical diagnosis (based on symptoms), blood tests do have a role in certain situations:

Aged under 40: If a woman under 40 is experiencing perimenopausal symptoms, an FSH test is crucial to rule out premature ovarian insufficiency (POI). Early menopause or POI requires HRT to protect the bone and heart health.
Women aged 40-45: FSH testing can be considered for women in this age range, but ultimately, if a woman is symptomatic and safe to start HRT, a trial of treatment is often more informative than the blood test.
Monitoring High-Dose Transdermal Oestrogen: If a woman is using high-dose transdermal oestrogen (patch, gel, or spray) and not responding as expected, testing oestrogen levels can help determine if she's absorbing the medication properly. In this case, we may change the route to tablets.
Testosterone Levels: We always test testosterone levels before starting testosterone treatment. It is important to know the baseline. Also, if someone has a high level of testosterone, then they tend not to respond so well to treatment so the level can affect management.

A Clinical Diagnosis, Not a Lab Result

The key takeaway is that perimenopause diagnosis is primarily based on a woman's symptoms and medical history. We need to understand that "normal" blood test results don't invalidate their suffering.

We treat the symptoms, monitor the response to treatment, and adjust the plan accordingly. It's about individualised care, empathy, and a willingness to think outside the box.

If you suspect you're in perimenopause, we can help at the clinic. You can book in with me for a full assessment of your symptoms, and for a personalised, bespoke treatment plan, based on evidence based medicine.

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