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Menopause and the effect on Skin

Dec 06, 2015

Menopause and the Skin Barrier

Aging is associated with declining levels of several hormones, including estrogen.  Although the effects of estrogen on the skin are still not fully understood, it is known that, in women, declining estrogen levels are associated with a variety of cutaneous changes, many of which can be reversed or improved by estrogen supplementation. Estrogens are C-18 steroids synthesized from cholesterol in the ovary premenopausally and in the peripheral tissue in postmenopausal women.  Studies of postmenopausal women indicate that estrogen deprivation is associated with dryness, atrophy, fine wrinkling, poor healing, and hot flashes. Epidermal thinning, declining dermal collagen content, diminished skin moisture, decreased laxity, and impaired wound healing have been reported in postmenopausal women.

So exactly what is happening in the skin on a cellular level with menopause?

After menopause the skin becomes thinner [3,4]. The quality of the skin deteriorates due to sun exposure coupled with hormonal deficiency [4]. Menopause results in oestrogen deficiency and the effects on the skin include:

  • Atrophy
  • Decreased collagen and water content
  • Decreased sebaceous secretions
  • Loss of elasticity
  • Manifestations of hyperandrogenism
  • Poor wound healing

 

An integral role for estrogen in skin integrity was substantiated with the discovery of estrogen receptors in dermal fibroblasts and epidermal keratinocytes [16]. Further, a study aimed at identifying specific estrogen-sensitive structures examined human skin for the ability to bind an antibody against a protein, p29, typically found in estrogen-responsive cells [17]. Strong and specific binding to the p29 antibody was seen in discrete structures within skin [16].

There are lipid variations in the epidermis of Menopausal women, most commonly a reduction in the ceramide content of the SC. Sterols and free fatty acids were also found to reduced in menopausal skins. The reduction in stratum corneum lipids explains the epidermal barrier decline and the dryness that is associated with menopausal skin. Stratum corneum lipids reduce by 1/3 compared to a younger skin.

Menopausal skins have a decline in Ceramide, Cholesterol and Free Fatty Acid synthesis. The most profound abnormality is cholesterol with a marked reduction in the synthesis of this component of the skin. Not only is the synthesis of lipids reduced, they also do not up-regulate properly after barrier disruption. Normally after barrier disruption the skin cytokines are released to increase the production of lamellar bodies and ceramides resulting in barrier homeostasis. This signalling process does not work effectively in a menopausal skin.

 

Three Generations of Women

 

Collagen

In normal human dermis, collagen is a relatively stable molecule, synthesized from procollagen molecules by the action of specific enzymes and degraded by collagenases.  Collagen levels and metabolism do not change immediately after the menopause. It is a gradual decline in functioning of the skin. Estrogens have been shown to inhibit collagen degradation.  In menopausal skin the collagen atrophies and contains thickened, clumped basophilic collagenous material, indicating partial degradation of collagen. There is also a significant decline in the dermal quantity of collagen with ageing.  The enzymes involved in processing of collagen are also decreased, together with a decline in the amounts of hydroxyproline in Type I collagen.  There is a reduction in the number of fibroblasts that synthesize collagen and vessels that supply the skin. This contributes to an increase in laxity, making wrinkles more evident [5].  There is a strong correlation between skin collagen loss and oestrogen deficiency secondary to the menopause [6,7]. As much as 30% of skin collagen is lost in the initial five years after the menopause. Total collagen content declines with an average of 2.1% per postmenopausal year over a period of 15 years [8].

Elastin

Young women with a premature menopause were shown to have accelerated degenerative changes in dermal elastic fibres [4]. Histological studies demonstrate that topical oestrogen can increase the number and thickness of skin elastic fibres [12].

Water

One of the most common dermatologic conditions in older women is dry skin. Healthy skin requires substantial water content which is determined by both the cutaneous evaporation rate and epidermal hydration. It has been shown that the transepidermal water flux, or evaporation, varies during the menstrual cycle [18] and decreases with age [19]. A sensitive measure of functional changes in water-holding capacity of the skin is the plastic occlusion stress test (POST). One small clinical study on 15 healthy menopausal women used the POST method to show that transdermal estrogen therapy can lead to a significant increase in the water-holding capacity of the stratum corneum.

The amount of glycosaminglycan’s produced in the dermis decreases significantly with menopause. Over 36% of menopausal women have dry skin. The use of Oestrogen significantly decreased the likelihood of dry skin [13]. These positive effects may be related to oestrogen-stimulated increases in mucopolysaccharides and hyaluronic acid levels in skin which correlate to an increased dermal water content [10], which may also lead to an increase in skin thickness.

Sebaceous glands

The activity of cutaneous sebaceous glands is regulated by levels of circulating hormones; estrogen can reduce the size and number of sebaceous glands, as well as the production of sebum, while androgens oppose this action, there-by stimulating secretory activity [19]. Indeed, clinical studies have shown that sebaceous secretions decrease with age and estrogen replacement alone has a sebum-suppressive action [20], but the addition of a progestin results in significant increases in skin surface lipids.  HRT has been shown to increase sebum production in post menopausal women. Herbs that have been shown to increase sebum production include Gynostemma Pentaphylum (Jiaogulan). Gynostemma Pentaphylum contains Gynosaponins which stimulate lipid synthesis and increase barrier function. Jiagoulan is also known as Twisting Vine Orchid and the Plant of Immortality.

Skin thickness

There is an increase in skin thickness up to the age of 35 to 49 years, followed by an age-related thinning [17]. For the initial 15 to 18 postmenopausal years, the decrease in skin thickness accelerates with as much as 1.13% annual decline [5,7]. The thinning effect is due to decreases in collagen, water and glycosaminoglycans [17]. Most clinical trials have shown that postmenopausal women who take HRT have greater skin thickness when compared to non-users.

 

Elasticity

Skin ageing, especially in the face, is associated with a progressive increase in extensibility and a reduction in skin elasticity. In postmenopausal women, skin elasticity declines 0.55% per year after the menopause. The HRT for 12 months increases elasticity by 5.2%. The HRT delays the deterioration in the extensibility of the skin, slowing the progress of cutaneous slackening that follows the menopause.

Wound healing

Oestrogen has been shown to induce TGF-β secretion by dermal fibroblasts, and this can enhance the rate and quality of wound healing [13]. As women age their skin becomes more fragile and has been shown to bruise and tear easily. Menopause decreases the levels of transforming growth factor (TGF)-β (12).

 

Skin Sensitivity and Menopause

The decrease in secretion of sebum, ceramides and cholesterol, in turn, results in a reduction in the number of extracellular lamellar bilayers in the SC.   As a result, the extracellular matrix may be more porous in aged than in young epidermis.  There are larger gaps between the corneocytes. This can result in an increase in skin sensitivity. A porous skin allows more chemicals to enter the skin.

 

Treatment of Menopausal Skins

The decline in skin collagen and elastin content can be prevented with topical application of oestrogen [9]. Sebum production can be increased by HRT therapy and also Gynostemma Pentaphylum. The decline in glycosminoglycans can be augmented by topical application of Hyaluronic Acid and Tamarind Extract.   Barrier repair can be hastened by topical application of cholesterol. Cholesterol alone showed faster results for barrier homeostasis then a mixture of cholesterol, ceramides and Free Fatty Acids.

Creams that build collagen. Anything that builds collagen in your skin will help to maintain that youthful thickness, glow, and reflectivity.  Peptides are a good choice for menopausal skins, especially peptides that reinforce the dermal/epidermal junction.  Examples are Teprenone and Matrixyl.

Microdermabrasion should be avoided as the layers of the skin are less compact and are removed easily.  The barrier does not recover like that of a young skin and is prone to skin tears and abrasions.

Any treatment undertaken on menopausal skin should take into consideration the prolonged time required for healing.  Ablative treatments need to be spaced further apart to allow the skin sufficient time to heal.

 

References:

  1. Ghadially R, Brown BE, Hanley K, et al: Decreased epidermal lipid synthesis ac- counts for altered barrier function in chronologically aged murine epidermis. J Invest Dermatol 106:1064–1069, 1996
  2. Ghadially R, Brown BE, Sequeira-Martin SM, et al: The aged epidermal permeability barrier. Structural, functional, and lipid biochemical abnormalities in humans and a senescent murine model. J Clin Invest 95:2281–2290, 1995
  3. Brincat M, Moniz CJ, Studd JW, Darby A, Magos A, Emburey G, Versi E. Long-term effects of the menopause and sex hormones on skin thickness. Br J Obstet Gynaecol 1985;92:256–259.
  4. Brincat M, Versi E, Moniz CF, Magos A, de Trafford J, Studd JW. Skin collagen changes in postmenopausal women receiving different regimens of estrogen therapy. Obstet Gynecol 1987;70:123–127.
  5. Castelo-Branco C. Skin collagen changes related to age, menopause and hormone replacement therapy. In: Brincat MP, editor. Hormone Replacement Therapy and the Skin. UK: Parthenon Publishing; 2001.
  6. Castelo-Branco C, Duran M, González-Merlo J. Skin collagen changes related to age and hormone replacement therapy. Maturitas 1992;15:113–119.
  7. Shah MG, Maibach HI. Estrogen and skin. An overview. Am J Clin Dermatol 2001;2:143–150.
  8. Brincat M, Moniz CF, Studd JW, Darby AJ, Magos A, Cooper D. Sex hormones and skin collagen content in postmenopausal women. Br Med J (Clin Res Ed) 1983;287:1337–1338.
  9. Brincat M, Kabalan S, Studd JW, Moniz CF, de Trafford J, Montgomery J. A study of the decrease of skin collagen content, skin thickness, and bone mass in the postmenopausal woman. Obstet Gynecol 1987;70:840–845.
  10. Bunnonen R, Vaajalahti P, Teisala K. Local oestriol treatment improves the structure of elastic fibers in the skin of postmenopausal women. Ann Chir Gynaecol Suppl 1987;202:39–41.
  11. Bolognia JL, Braverman IM, Rousseau ME, Sarrel PM. Skin changes in menopause. Maturitas 1989;11:295–304.
  12. Calvin M. Oestrogens and wound healing. Maturitas 2000;34:195–210
  13. Sauerbronn AV, Fonseca AM, Bagnoli VR, Saldiva PH, Pinotti JA. The effects of systemic hormonal replacement therapy on the skin of postmenopausal women. Int J Gynaecol Obstet 2000;68:35–41.
  14. Brincat MP, Baron YM, Galea R. Estrogens and the skin. Climacteric 2005;8:110–123.
  15. MacLean AB, Nicol LA, Hodgins MB. Immunohistochemical localization of estrogen receptors in the vulva and vagina. J Reprod Med 1990;35:1015–16.
  16. Jemec GBE, Wojnarowska F. The distribution of p29 protein in normal human skin. Br J Dermatol 1987;117:217–24.
  17. Harvell J, Hussona-Saeed I, Maibach HI. Changes in transepidermal water loss and cutaneous blood flow during the menstrual cycle. Contact Dermatitis 1992;27:294–301.
  18. Wilhelm KP, Cua AB, Maibach HI. Skin aging: effect on transepidermal water loss, stratum corneum hydration, skin surface pH, and casual sebum content. Arch Dermatol 1991;127:1806–9.
  19. Bolognia JL, Braverman IM, Rousseau ME, Sarrel PM. Skin changes in menopause. Maturitas 1989;11:295–304.
  20. Sator PG, Schmidt JB, Sator MO, Huber JC, Honigsmann H. The influence of hormone replacement therapy on skin ageing: a pilot study. Maturitas 2001;39:43–55

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