Skin, Hair and Nails

Sometimes, during the perimenopause and menopause, it’s the small changes that can make us feel like a slightly different version of ourselves. Hormone levels can affect the quality of your skin, hair, and fingernails. For some women, these changes can lead to a negative self-image and reduced confidence.

Supplementing your declining estrogen levels with Hormone Replacement Therapy (HRT) often helps improve the condition of your skin, the strength of your nails, and the appearance of your hair. 

Here’s a more detailed explanation of these changes and practical tips to consider alongside HRT. 

Oestrogen plays a role in skin hydration, helping produce ceramides, hyaluronic acid, and sebum, the natural mechanisms that keep the skin moisturised. When oestrogen levels drop, the skin can lose water more rapidly, resulting in dehydration. This can lead to dry, rough, and itchy skin, eventually contributing to the development of lines and wrinkles.

What can you do? 

  • Avoid using soap, especially foaming varieties, as it can dry the skin. Instead, use a non-foaming cleanser or emulsifying ointment. You can even use moisturiser as a substitute for hand soap and shower gel.
  • Opt for short, warm showers, avoiding hot water that strips oil from the skin.
  • Apply a high-quality moisturizer twice a day, especially after bathing, to help the skin retain moisture. Consider using a lighter moisturiser during the day and a richer one at night if necessary.

Skin moisturiser needs may vary throughout the year. Cold, windy weather and indoor heating in winter can dry the skin, while a lighter moisturizer may suffice in the summer.

Lotions are lighter than creams, which are lighter than ointments, so try different options to find what suits you best.

Itchy skin can be a result of dryness, and the tips mentioned above can help restore moisture. However, there are other potential causes of itching, including histamine release in the skin and nerve irritation, which can create the sensation of “formication” (feeling like insects are crawling on the skin). Iron deficiency, liver issues, or thyroid problems can also lead to persistent itchy skin, so consult your doctor if the issue persists.

Tips for Itchy Skin:

  • Use lukewarm water for baths and showers instead of hot water.
  • Avoid bubble baths or bath bombs.
  • Steer clear of perfumed soaps, shower gels, moisturisers, and deodorants.
  • Gently pat the skin dry instead of rubbing.
  • Use a mild, non-biological laundry detergent and skip fabric conditioner.
  • Choose loose-fitting clothing and skin-friendly fabrics.
  • Apply a cold compress or flannel during itchy flare-ups.
  • Avoid spicy foods, caffeine, and alcohol.
  • Consider wearing cotton gloves at night if you tend to scratch in your sleep.

During menopause, blood vessels in the skin can become highly reactive, leading to flushing (sudden facial redness) and a burning sensation. Rosacea, an inflammatory skin condition, can also develop. It usually affects women aged 35-50, initially causing redness and spots on the nose and cheeks, with potential progression to the forehead, chin, and even the eyes.

What to do:

  • Protect your skin from sun exposure and UV light.
  • Reduce alcohol and caffeine intake and avoid spicy foods.
  • Simplify your skincare routine using a non-foaming cleanser and a moisturiser with ceramides.
  • Consult your GP about using agents containing azelaic acid, metronidazole, or ivermectin for rosacea.

Some women experience flare-ups of spots and acne during menopause, especially if they had acne as teenagers. Acne can be distinguished by the appearance of blackheads or other types of comedones.

What to do:

  • Ensure that skincare products you use do not clog pores (non-comedogenic).
  • Use a cleanser with salicylic acid to unblock pores.
  • Avoid excessive exfoliation, as it can irritate the skin.
  • Consider products containing retinol and niacinamide to prevent flare-ups, but allow 6-8 weeks for results.

Signs of sun damage may include an irregular, dull skin tone, flat brown sunspots, thread veins, and lines and wrinkles.

What to do:

  • Limit sun exposure and use SPF 50 sunscreen, reapplying every two hours.
  • Protect your skin with a wide-brimmed hat and cover your neck and chest.
  • Consult your doctor if you’re concerned about dark sunspots or changing moles.

During menopause, facial bones weaken, potentially leading to jowls and a less prominent jawline. Collagen loss, more pronounced at menopause, can result in fine lines and wrinkles.

What to do:

  • Protect your skin from sun damage.
  • Maintain a healthy lifestyle with minimal caffeine and alcohol, and avoid smoking.
  • Use skincare products containing vitamin C, vitamin A, and retinols to slow collagen loss.

Oestrogen helps produce the protein keratin, which keeps nails hard and strong. As oestrogen levels decline, nails may become brittle, soft, and prone to cracking and splitting.

What to do:

  • Apply cuticle oil 1-2 times a day.
  • Ensure your diet includes Omega-3 fatty acids, the B vitamin Biotin, and keratin (consider supplements if needed).
  • Moisturise your hands and the skin around your nails daily.
  • Stay well-hydrated.
  • Use rubber gloves when working with strong chemicals.
  • Incorporate a soft nail file and acetone-free nail varnish remover into your nail care routine.

Hair loss is common around menopause, typically manifesting as a general thinning over the entire scalp or, in some cases, more prominently at the front and temples.

Causes of hair loss:

  • Hair ageing and shrinking hair follicles.
  • Hormone changes, including a decline in oestrogen.
  • Female pattern hair loss, often hereditary.
  • Imbalanced hair cycle due to stress, illness, dieting, thyroid imbalance, or iron deficiency.
  • Certain medications, like antidepressants and blood pressure treatments.
  • Scalp conditions like alopecia or lupus.

What to do:

  • Use a gentle shampoo and quality conditioner.
  • Avoid tight hairstyles that stress hair follicles.
  • Be cautious with intense hair drying to prevent damage.
  • Protect your scalp and hair from UV damage with a hat.
  • Maintain a balanced diet with adequate iron levels.
  • Manage stress levels.
  • Consult a specialist if hair loss is distressing; treatments are available once the cause is identified.

Remember that colouring your hair usually does not worsen hair loss. If hair loss causes distress, consult a specialist for advice and potential treatments after identifying the specific cause.

With decreased oestrogen and hair loss, “male” hormones may become more prominent, potentially leading to increased facial hair growth on the upper lip, chin, and jawline. You can consider gentle facial hair removal methods if needed.