Acne/Pimples

Acne isn’t just for teenagers. Like teenagers though, the menopausal transition is a time of hormonal fluctuations. Women experience not only a drop in estrogen levels but they may also experience an increase in male androgen hormones including testosterone, due to the imbalances created by the loss of estrogen. 

You may still experience menopausal acne even if you’re using hormone therapies (HT) to ease your menopause symptoms. This is because some HTs use an influx of the hormone progestin to replace the estrogen and progesterone your body loses. Introducing this hormone to your system can cause your skin to break out. [10] 

Age spots, skin growths

Being out in the sunlight feels good to most people. While some sunlight is healthy, the sun gives off ultraviolet (UV) radiation and this radiation has both health risks and some health benefits. On the benefits side, it is this radiation that gets converted by our skin into vitamin D. The health risks, explained in more detail in the Science section, are directly affected by how much exposure to UV radiation you experience. It is this exposure to UV radiation that causes skin damage – the more exposure you have, the greater the damage will be and the earlier it will show up on your skin. Sun damage that shows up during the menopausal transition includes the presence of brown spots, formally called solar lentigo. These are also called age spots or liver spots. Skin growths may be forms of skin cancer, and they usually result from long-term exposure to UV radiation. If you see any growths or moles on your skin that look different or are changing rapidly, immediately consult your healthcare provider.  [1] [2] [3]

Bruising

Many women find that they bruise more easily after they enter the menopausal transition. A bruise is simply blood trapped under your skin. Most minor bruises disappear after a day or so, as the body heals, but the length of time to heal from a bruise is variable. Any bump or impact against your skin that impacts the blood vessels below can cause a bruise. The increase in noticeable bruises as you go through the menopausal transition is due to the thinning of your skin and the decrease in the protective layer of fat (subcutaneous fat) that is found right under your skin. Both of these happen because of lower estrogen levels in your body. [4] 

Be aware that bruising easily can be the result of an underlying condition other than the menopausal transition, such as a blood-clotting problem or a blood disease. If you start to see large bruises, especially on your trunk, back or face, or bruises that seem to appear for no known reasons or suddenly begin bruising after starting a new medication, see your healthcare provider immediately. [4]

Dry skin, itching, flakiness

Estrogen is responsible for the production of collagen, a protein that is very important to the structure and function of your skin, and estrogen stimulates the production of the natural oils that keep your skin smooth and hydrated. As estrogen levels begin to decrease, the production of your natural oils starts to diminish. When this happens, it immediately affects your skin, making it feel dry and itchy. [5] [6]

Jowls, slack skin, and wrinkles, large pores

In menopause, skin quickly loses collagen. Collagen is a protein that is essential for your overall body health, and especially for the look and feel of your skin, hair and nails. Studies show that women’s skin loses about 30% of its collagen during the first five years of menopause. After that, the decline is more gradual. Women lose about 2% of their collagen every year for the next 20 years. 

As collagen diminishes, our skin loses its firmness and starts to sag, resulting in jowls and large pores.  Wrinkles, such as laugh lines, are visible all the time. Other creases become permanent, including frown lines and other lines around the mouth. The slower production of natural oils in your skin, also a result of lower estrogen levels, adds to the visible wrinkles,  [1] 

Rashes and easily irritated skin

The pH level of our skin changes with age, and this can cause associated changes in the skin’s appearance and sensitivity. Women in the menopausal transition may find that their skin is more irritable and that they develop rashes more easily and frequently. As well, women with existing skin conditions, such as eczema or rosacea, may find that those get worse and flare-ups become more frequent. 

Changes in body odour

You have sweat glands covering almost every inch of your body. Your sweat glands excrete a fluid that primarily works to regulate body temperature. Body odor happens when bacteria break down this secreted fluid that is mixed with the natural oils on your skin. Excessive sweating during hot flashes and night sweats increases the amount of sweat that women produce, but this doesn’t directly affect your body odour – the amount of sweat is not actually correlated to the strength of your body odour. Your changing hormone levels are more likely to impact your body odour because they affect the production of your natural oils, or change the pH of your skin which affects the type and amount of bacteria living on your skin. Common areas where your odour can noticeably change include under your arms and in the creases of your groin. [7] [8] 

Acne, pimples

• Wash acne-prone skin twice a day with a cleanser that contains salicylic acid as this will help unclog pores.
• Avoid acne products that dry your skin. Drying your skin can worsen acne. If you are using acne products, limit them to no more than a pea-sized drop to help avoid drying your skin.  [4] 
• Some plant-based, natural treatment options may be used to clear up mild hormonal acne but be aware that credible research on natural options is lacking and none of these treatment options have been proven to produce results. If you are planning to try these, talk to your healthcare provider to discuss possible risks or interactions with your medications. 
• Tea tree oil is a natural product that works by decreasing inflammation that can contribute to acne. Tea tree oil is often added to skin care products including cleansers and toners. Tea tree essential oil can be used on its own as a spot treatment, but it should be diluted with a ‘carrier oil’ such as coconut, jojoba or olive oil. Generally, use 12 drops of carrier oil for every one to two drops of tea tree essential oil. Before using tea tree essential oil, do a patch test inside your forearm to check for reactions. If you don’t see anything within 24 hours you should be ok using it on your face. 
• Alpha hydroxy acid (AHA) is a naturally-occurring plant acid that comes mostly from citrus fruits. AHAs work to help remove excess dead skin cells clogging pores. AHA is an ingredient in many over the counter face masks and creams – look for products that identify the concentration of AHA on the label as they are more likely to be a safe product. The best approach is to discuss the use of AHA with your dermatologist to get a recommendation for a safe product. AHAs are known to make your skin sensitive to the sun, so ensure that you wear adequate broad spectrum sunscreens if using them. 
• Green tea is used to decrease inflammation in the body, so it can be used to help with the inflammation that contributes to acne. In addition to products that contain green tea extract, you can also drink several cups of green tea daily in addition to your skin care routine. 
• The exact relationship between diet and hormonal acne isn’t fully understood but some foods are thought to prevent acne. For example, plant-based foods that are high in antioxidants, such as broccoli, spinach, and blueberries, may help reduce inflammation and promote clearer skin. Foods containing omega-3 fatty acids, such as fatty fish and some nuts and seeds, may also decrease skin inflammation. Despite the common understanding, there is no scientific support to indicate that junk food and fast food cause acne directly. However, they are not healthy foods and can indirectly cause inflammation that leads to acne. Try to limit sugar, dairy products, refined carbohydrates (white breads and pastas), and red meats specifically, as these foods can trigger inflammation. 
• Make a dermatology appointment if you cannot get acne under control at home. There are other treatments, including hormonal treatments and anti-bacterial face creams that can be prescribed.  [10]

Bruising

To prevent minor bruising, take steps to avoiding falls and injuries:

• Use good lighting in your home.

• Avoid clutter and throw rugs, especially on stairs.

• Arrange furniture and electrical cords so that they’re not in your way when you walk.

• Find out about the side effects of medications you take. Tell your healthcare provider or pharmacist if a medication makes you dizzy or sleepy.

• Have your vision and hearing tested. Even small changes in sight or hearing can cause you to fall.

Unfortunately, once a bruise has formed, not much can be done to treat it. Most bruises eventually disappear as the body reabsorbs the blood, although healing might take longer as you age. It might help to elevate the affected area and apply ice. [4]

Dry Skin, Itching, Flakiness

• Wash with a mild cleanser instead of soap as soap can be drying. Make sure you completely avoid any perfumed, anti-bacterial, or deodorizing soaps as they can be very drying. 
• Slather on the moisturizer, especially after bathing and during the day if you feel dry. Look for moisturizers that contain hyaluronic acid or glycerin.
• The sun can make your already dry skin even dryer. Make sure you liberally use a broad spectrum sunblock (that protects against both UVA and UVB rays) with an SPF of 15 or higher. Remember that UV radiation penetrates clouds and fog, so sunscreen is needed even on overcast days. 
• Avoid hot showers and enjoy shorter warm-water showers. Hot water can dry skin out because it strips off the natural oils that your skin produces. 
• Reduce the use of soap by only using it where you really need it – your underarms, your groin and your feet. Other parts of your body (like your back and arms) don’t actually get that dirty on an average day, so they will be fine and maintain their moisture better if you don’t use soap directly. If your scalp is dry, consider switching to a gentle, non-medicated shampoo and washing your hair less frequently. 
• Follow a diet that supports skin health. Essential fatty acids such as omega-3 acids are found in fish (especially cold-water fatty fish such as salmon and herring), nuts and seeds (such as flaxseed and walnuts) and plant or algae oils. Omega-3 acids help produce the natural oils in your skin that keep your skin hydrated.  [4a] [4b] [4c]
• See your dermatologist if your skin still feels dry. Exfoliation or microdermabrasion may help, but you want to see your dermatologist before trying one of these. At menopause, skin becomes thinner and trying one of these at home may cause more harm than good.

Jowls, slack skin, and wrinkles, large pores

• Always protect your skin from the sun by regularly applying a broad spectrum sunblock (that protects against both UVA and UVB rays) with an SPF of 15 or higher. This helps reduce visible wrinkles and works to prevent new wrinkles from forming.
• Consider using a skin care product that contains retinol or peptides. These ingredients can increase collagen in your skin. There are so many new ‘fad’ products that promise to boost your skin health, but peptides are the real deal. They are naturally occuring amino acids found in your skin and they work to stimulate collagen production. Peptides are also a key ingredient in elastin fibres, a type of protein that improves the elasticity of your skin and makes it firmer. [12] The benefits of using retinol have scientific support. Retinol is absorbed deep into the lower layers of the skin (the dermis) where it neutralizes compounds called free radicals. These free radicals are directly responsible for breaking down collagen in your skin, so retinol helps to increase the levels of collagen, which in turn helps keep your skin smoother. Retinol reacts with sunlight – so be careful if you are using any products containing retinol and apply abundant sunscreens if you are going out into the sun. [4a] [4d]

Rashes and easily irritated skin

• Use fragrance-free moisturizer and soaps to help reduce irritants contacting your skin. 
• Visit a board-certified dermatologist, especially if your rash does not go away, or continues to worsen as you may have a bacterial infection or other underlying issue. [4a]

Changes in Body Odour

Body odour has multiple causes, so if your odour has changed significantly you should talk to your healthcare provider to assess the cause. Home treatments you can try include:

• Take a daily bath or shower using a gentle soap on the areas where you sweat the most, like your armpits and groin area. Your doctor may prescribe specific antibacterial soaps that can directly act to remove bacteria responsible for your odour. 
• Shave your armpits to help sweat evaporate more quickly, minimizing the time it interacts with bacteria.
• Wear clean, loose-fitting clothing, preferably made of cotton which allows your skin to breathe. Wash your clothes regularly. 
• Use a topical antiperspirant (not a deodorant), which works by pulling sweat back into your sweat glands, sending the signal to your body that your sweat glands are full. Sweat production decreases when your body receives a signal that your sweat glands are full. These are available over the counter but you can also ask your healthcare provider for a prescription antiperspirant.  
• Pay attention to the foods you eat, and track if any foods seem to stimulate an increase in odour. Garlic, onions, cabbage, broccoli, red meat, some spicy foods and alcohol are known to affect body odour, but the impacts are variable among people and there may be others that impact you.
• Apply a paste made of baking soda and water under your arms or wherever you notice the strongest smell such as your groin. Let the paste dry before rinsing it off. Baking soda can balance pH changes due to hormone fluctuations. 
• Make a solution of apple cider vinegar and water and, using a spray bottle, apply the mixture to areas where your odour has changed. The acid in the vinegar can kill the bacteria responsible for your odour. 
• Make a solution of lemon juice and water and spray it to areas where your odour has changed. The citric acid in the lemon juice can kill the bacteria responsible for your odour. 
• Find methods to manage your stress, as stress activates the sweat glands. [8]

Age Spots

Treatments are available to lighten or even remove age spots. These treatments work by treating the pigment of your skin, which is located at the bottom of the upper layer of skin. Decisions on which treatment(s) to apply should be made with your healthcare provider or your dermatologist as side effects are possible and some of these treatments can worsen other existing conditions (such as rosacea). All of the following treatments are done in a doctor’s office. Treatments can come in the form of:

• Prescription medications that essentially bleach the pigment to a lighter tone. Treatment can take up to several months to be noticeable and you may experience temporary itching, redness, burning or dryness.
• Laser and intense pulsed light treatments work by destroying the cells that produce melanin, which creates your skin’s pigment or colour. The laser or intense pulsed light treatment does not damage the surface of the skin when used by a licensed and properly trained dermatologist. Be cautious and ensure that whomever is treating you has proper qualifications. These treatments take multiple (usually two to three) sessions but this can vary based on the amount of pigment being treated. 
• Cryotherapy spot-treats your skin with liquid nitrogen that freezes and destroys the excess pigment. The liquid nitrogen can be applied to a small area with a cotton swab, or sprayed on to cover a larger area. The treatment may temporarily irritate the skin and there is a risk of permanent scarring or discoloration.
• Microdermabrasion uses a rotating abrasive brush to gently sand off (exfoliate) part of the top layer of skin. Multiple sessions may be required, sometimes over months, and you may need regular touch ups. There can be slight redness following the procedure, and it can make conditions such as rosacea worse.
• Dermabrasion is a more aggressive technique than dermabrasion that also uses a rotating brush to exfoliate the top layer of skin so new fresh skin grows in its place. It does cause bleeding and you may experience temporary redness, swelling, and the development of scabs. Multiple sessions may be required. The new skin may be tinted pink for months. 
• Chemical peel uses a chemical solution to remove the top layers of skin. When it heals, newer smoother skin will have grown in its place. There are risks with a chemical peel including scarring, infection and changes to the colour of the replacement skin (it may be lighter or darker than your original skin). Several treatments may be needed and redness can last for weeks.  [12] 
• Microneedling uses small, sterilized needles to prick the skin and trigger the body’s natural healing response. Following the microneedling, your skin will generate new collagen and skin tissue which grows in fresh and reduces or minimizes dark spots. Side effects include redness and irritation that may last for days.  [13] 

Wrinkes

Women and wrinkles. There is a great deal of individual variability in how bothered women are when their skin starts to change and show more and deeper wrinkles. We fully support the idea that we are all beautiful as we are, wrinkles and all, but we also support the idea that addressing signs of aging can be important and can make us feel good. It is important to remember that wrinkle treatments do not actually remove the wrinkles permanently, but they can reduce them, smooth them, or make them less noticeable. Decisions on which treatment(s) to apply must be made with your healthcare provider or your dermatologist as permanent side effects are possible. Treatments include:

• Prescription medications such as topical retinoids (medicine that contains retinoids, a substance that comes from vitamin A, applied directly to your skin) can reduce fine wrinkles and roughness. Vitamin A comes from many sources in your diet including leafy green vegetables, fish oils, and milk, and it can also be found in supplements if your healthcare provider agrees you need additional Vitamin A beyond what you get from your diet. These medications may need to be used for months before you see any difference, and you may experience temporary itching, redness, burning or dryness. Retinoids can make your skin more sensitive to the sun so a broad-spectrum sunscreen with a sun protection factor (SPF) of at least 30 must be used daily. 
• Ablative laser resurfacing uses a laser beam to destroy the top layer of skin, stimulating the growth of new smoother skin underneath. Note that ablative means wounding. It will not remove loose or sagging skin. If you are having a smaller area treated it will likely occur in the dermatologist’s office, often with a local anesthetic or painkiller. Laser treatment on larger areas may require full sedation. The healing time can be up to several months and risks include scarring and changes of skin color (lightening or darkening) .
• Non-ablative laser fractional resurfacing is not as invasive as ablative laser treatments, so the healing time is shorter and the risk of scarring is smaller. However, the treatments may need to be repeated more frequently to see the same results as with ablative laser treatment.
• Microdermabrasion uses a rotating abrasive brush to gently sand off (exfoliate) part of the top layer of skin. Multiple sessions may be required, sometimes over months, and you may need regular touch ups. There can be slight redness following the procedure, and it can make conditions such as rosacea worse. 
• Dermabrasion is a more aggressive technique than dermabrasion that also uses a rotating brush to exfoliate the top layer of skin so new fresh skin grows in its place. It does cause bleeding and you may experience temporary redness, swelling, and the development of scabs. Multiple sessions may be required. The new skin may be tinted pink for months. 
• Chemical peel uses a chemical solution to remove the top layers of skin. When it heals, newer smoother skin will have grown in its place. There are risks with a chemical peel including scarring, infection and changes to the colour of the replacement skin (it may be lighter or darker than your original skin). Several treatments may be needed and redness can last for weeks.  
• Botulinum toxin type A (Botox) can be injected into muscles underlying your wrinkles, such as your forehead and the corners of your eyes. The botox will ‘paralyze’ the muscles and keep them from contracting, giving the appearance of smoother, wrinkle-free skin. Repeat injections are required, usually every few months but this varies by individual. 
• Soft tissue fillers such as fat, collagen, or hyaluronic acid can be injected directly into wrinkles on your face. These fillers do exactly that – they plump up under the skin so that your wrinkles get smoothed out. Side effects include swelling, redness and bruising, and repeat treatments will be needed, usually every few months but this varies by individual. 
• A face-lift is a surgical procedure that tightens underlying muscle and tissues. Depending on the extent of the lift it can be done in a hospital or an outpatient surgical facility, using a local anesthetic, sedation or general anesthesia. Healing times are variable, based on what was actually ‘lifted’ and bruising and swelling are usually visible for several weeks after surgery. The results of your face-life are not permanent and some women undergo multiple face-lifts over time. 
• Microneedling uses small, sterilized needles to prick the skin and trigger the body’s natural healing response. Following the microneedling, your skin will generate new collagen and skin tissue which grows in fresh and reduces or minimizes dark spots. Side effects include redness and irritation that may last for days. 

[12]  [13] [14]

Hormonal acne

While over the counter products are available, they may not be adequate to treat your hormonal acne unless it is mild. If your hormonal acne is mild, over-the-counter (OTC) products may be successful, but often, hormonal acne results in cystic bumps that form deep under the skin and topical medications won’t reach them. Consult with your healthcare provider or your dermatologist to determine the best course of treatments for your individual situation. Medical treatments for hormonal acne include:

• Oral contraceptives containing ethinylestradiol plus one of either drospirenone, norgestimate, or norethindrone. These ingredients specifically target acne-causing hormones. You should not use these if you have any history of blood clots, high blood pressure, breast cancer, or if you smoke. 
• Anti-androgen drugs that work to decrease androgens, which are male hormones and are known to contribute to acne. These can also help to reduce the growth of facial hair. [10] 

Changes in Body Odour

There are medical treatments for body odour, focused on either reducing the amount you sweat or reducing the amount of bacteria on your skin. The following treatments can be used:

• Injections of Botulinum toxin (Botox) in your armpits will block the nerve signals that trigger sweating, temporarily stopping any sweat from being produced. Treatments need to be repeated every few months on average. 
• There are prescription medications that prevent sweating. Discuss this with your healthcare provider, as your body needs to sweat in order to regulate your temperature. 
• Prescribed antibiotics can be used to reduce the bacteria living on your skin. [8]

Skin

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Your skin has two layers – the outer layer called the epidermis, and the inner layer called the dermis. The epidermis is the outer shield for your body. When it is damaged or gets old it peels (you will likely be familiar with this if you have ever had a sunburn), with the new epidermal tissue growing up from below. The epidermis does not have its own blood supply – it uses the blood from the dermis to get its nutrients. 

The dermis supports the epidermis and contains all of the structures of the skin, including the blood and vessels, nerves, sweat and sebaceous glands, hair follicles and the tiny erector muscles that pull your hair up when you get goosebumps. 

The hypodermis, also called the subcutaneous layer, is a third layer below the dermis that forms ‘padding’ between the skin and the organs beneath the skin. It is made up of adipose tissue (fat) and areolar tissue (loose connective tissue or LCT). This layer provides both cushioning and insulation, and is found all over the body. [7] 

Glands

Your skin contains four different types of glands – sweat glands, sebaceous glands, ceruminous glands and mammary glands. There are two types of sweat glands – eccrine glands and apocrine glands. Eccrine glands excrete a fluid directly to the surface of the epidermis, your skin, and as this sweat evaporates it cools your body and regulates your body temperature. This sweat doesn’t usually cause any smells. The second type of sweat gland, apocrine glands, excrete a sweat into your hair follicles, not directly to the surface of your skin. The sweat that these glands excrete doesn’t smell until it combines with bacteria on the surface of your skin. The bacteria break down this secreted fluid and it is this process that causes body odour. Apocrine glands do not become active until puberty, which is why children do not have body odour. Sebaceous glands are found in the pilosebaceous unit, so they are associated with a hair follicle and shaft. These glands secrete a substance called sebum that makes up the natural oils covering your skin in a thin film. This adds a protective layer on top of the epidermis and works to repel bacteria as well as keep your skin moisturized. [7] [8]

UV Radiation

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The sun produces a massive amount of energy and some of that energy hits the Earth in the form of UltraViolet (UV) light radiation.  On the electromagnetic or light spectrum, UV light has shorter wavelengths (measured in nanometers or nm) than visible light, so your eyes can’t see UV, but your skin can feel it. Tanning beds also emit UV light radiation.

Two types of ultraviolet light called Ultraviolet A (UVA) and Ultraviolet B (UVB) light are damaging to your skin. UVA has a longer wavelength, and is associated with skin aging and cancers while UVB has a shorter wavelength and is associated with skin burning. UVA accounts for up to 95 percent of the UV radiation reaching the earth.

Sunscreen products are all labeled with a Sun Protection Factor (SPF) that tells you how long it will take UVB (and some UVA rays) to redden your skin when using that product compared to the time it would take without using sunscreen. UVB rays can damage your skin all year long, not just in the summer. The greatest risk is late-morning to mid-afternoon from spring to fall in temperate climates like North America, but the risk is also high at high altitudes or on reflective surfaces like snow, ice, or water. UVB rays can be filtered out, for example, they do not penetrate through glass. 

Sunscreens were initially made to screen UVB rays but as understanding of the risks associated with UVA increased, sunscreens started to add ingredients to make them “broad-spectrum” and current products labeled broad-spectrum protect against both UVA and UVB rays. Note that UVA rays do not get filtered easily and can penetrate glass and cloud cover unless you purchase specialty film filters for the glass in your home and car. 

If your skin is not protected from exposure to UVA and UVB, they damage the DNA in skin cells and produce mutations that can lead to skin cancer as well as premature aging. They can also cause eye damage, including cataracts and eyelid cancers.

UV radiation is proven to cause skin cancer – either basal cell carcinoma and/or squamous cell carcinoma – both of which usually appear on skin that has been exposed to the sun. These types of cancers respond well to treatment if they are caught early so it is important to check any sun-exposed areas of skin for growths or moles that seem to be changing. 

Sunburn caused by UVB has been proven to be associated with developing melanoma, the most dangerous form of skin cancer. The UV rays that damage skin can also alter the gene that suppresses tumors increasing the risk that skin damaged by the sun will develop skin cancer.

While it all seems overwhelming and dangerous, protecting your skin against UVA and UVB exposure is easy. Broad-spectrum sunscreen and sun-safe clothing, hats and eyewear are easily available. All you need to do is use them! [3]