Your Skin After 45

Estrogen falls through perimenopause and menopause, and skin is one of the places where that shows. The Menopause Society counts changes to skin among the most common symptoms of the transition, and as many as 64% of women attending menopause clinics report skin problems. The research below is uneven, and this page says where it is thin.

What changes

Collagen

Collagen gives skin its structure, and its content falls after menopause. Reviews put the loss at up to 30% in the first five years, then about 2% a year. The older measured studies report a slower decline, of 1 to 2% a year, so the larger figure deserves some caution. Skin also thins, by about 1% a year, and thin skin bruises more easily.

Hydration

Skin loses some of its ability to hold water, and this shows most in dry air. Dryness is often among the first changes women notice. Sebum, the oil that keeps skin soft, falls steadily with age. The water measured in the surface layer moves less than the feeling suggests: in a study of 150 women aged 18 to 80, it varied only slightly with age.

The barrier

The outer layer of skin is sealed by lipids, about half of them ceramides. In a study of 28 women, those past menopause had fewer ceramides, and shorter ones, in this layer. The authors suggest that skin could then lose more water and react more readily to irritants. The study was small, sampled skin on the buttock and was funded by a skin care company, so it counts as a lead. The American Academy of Dermatology adds that the pH of skin changes around 50, and that skin tends to become more sensitive.

Renewal

The surface of skin renews itself more slowly with age. No study found for this page measures that renewal directly in menopausal women, so the link with estrogen remains open. One small study found a thinner living layer and a thicker outer layer after menopause, which its authors read as a change in the way skin sheds.

Firmness

Estrogen deficiency is reported to speed the loss of elasticity, and the published figures for that loss range from 0.55% to 1.5% a year. As collagen falls, skin loses firmness. Hormones explain only part of what shows: one review attributes the visible signs of skin aging almost entirely to the environment, above all to the sun.

What helps each day

Care for the barrier

The American Academy of Dermatology advises a mild cleanser in place of soap, warm water, and a bath or shower of five to ten minutes. Skin is patted dry, and a fragrance-free cream goes on while it is still damp, because a cream traps water better at that moment. One of its dermatologists advises a cream-based moisturizer for everyone in perimenopause and over 50. Hyaluronic acid, glycerin and ceramides are among the ingredients it names. Exfoliation at home can do more harm than good on thinner skin, so that question goes to a dermatologist first.

A retinoid, introduced gradually

The Academy suggests considering a product with retinol at menopause, and it advises the least intense formula, every other night at first, building up slowly. Retinoids go on at night with sun protection the next day, because they can make skin more sensitive to the sun. They should not be used during pregnancy, which remains possible in perimenopause. The Academy also considers people with dryness or skin allergies probably poor candidates, so very dry skin is better brought back to comfort first. Results are modest, and reviews describe the trials of cosmetic retinol as small and weak. The Journal looks at this in Can I use retinol during menopause?

Sun protection, every day

A broad-spectrum sunscreen of SPF 30 or higher goes on every day, on all skin that clothing leaves uncovered, in winter too. Up to 80% of the sun’s UV rays pass through cloud. Outdoors, it is reapplied every two hours and after swimming or sweating. The Academy notes that sunscreen cannot thicken skin and can prevent further thinning, and dermatologists count it, with moisturizer, as one of the two most effective products for aging skin.

What belongs to the doctor

Hormone therapy

Hormone therapy is a medical decision, taken with a healthcare professional on the basis of personal history, benefits and risks. The Menopause Society states that it should not be used for age-related skin changes or to prevent aging. Its 2022 position statement notes that estrogen appears to benefit skin thickness, elasticity and collagen when given at menopause, and it grades that evidence as limited. Reviews by skin specialists reach the same conclusion: skin alone is no reason to begin it.

A persistent skin problem

A board-certified dermatologist should see a rash that lasts, a skin condition that worsens, or dryness that persists after good care. The same goes for skin that cracks, bleeds, stings or becomes painful. Dryness can also come from diabetes, thyroid disease or kidney disease, and from medications that include statins and diuretics. A new dark spot is examined before anything is applied to it, because skin cancer can look like an age spot. The risk of skin cancer rises with age, and The Menopause Society advises a yearly full-body examination for women with a personal or family history.

What a cosmetic can do

No cosmetic, ours included, changes hormones.

A cosmetic acts on the look and feel of skin. The American Academy of Dermatology describes the results of skin care products as modest, and it says that a cream cannot lift sagging skin. Most products take at least six weeks to show their effect, and some take three months.

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