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Healthy Skin in Menopause: Separating Science from Sales Pitches

Updated: May 25, 2023

In 2007, I embarked on my journey in aesthetic medicine, primarily focused in the treatment of acne scars, pigmentary disorders, and other skin aging-related issues such as wrinkles, fine lines, and skin laxity. To achieve optimal results and effectively manage treatment expectations, it is crucial to have a thorough understanding of how skin ages over time, taking into account biological sex, ethnicity and differences in skin types. Whether you opt for injectable products like botulinum toxins, dermal fillers, skin bio stimulators, or energy-based devices, what is often overlooked is the ongoing conditioning of your skin with appropriate cleansers, moisturizers, and sun protection to support changes that occur during menopause, age and in optimising skin treatment results. Unfortunately, women are left to navigate the $130 billion skincare industry on their own, bombarded with powerful marketing claims and exorbitant price tags. However, having healthy skin doesn't always require the most expensive skincare products.

The purpose of this article is to delve into the fundamental and critical aspects of skin aging during menopause, enabling you to comprehend which particular family of ingredients to seek in your skincare regimen without having to spend a fortune. Through my 15 years of experience in treating cosmetic issues, I have observed that patients who consistently incorporate suitable skincare into their routine often experience improved outcomes from their cosmetic treatments.

Sex differences can impact various aspects of our skin, such as the thickness of the skin barrier, hormonal influences, metabolic health, and medical conditions - all of which are intrinsic factors. Additionally, external environmental factors like UV exposure, temperature, wind, and humidity can also affect our skin. As we age, both men and women become more susceptible to extrinsic factors, especially UV radiation and pollution, which can lead to oxidative stress. This occurs due to the production of reactive oxygen species (ROS) and a lack of adequate antioxidants to counteract the resulting damage to our skin cells.

During mid-life, women may notice a hastening of skin dryness, more visible fine lines, and decreased elasticity. Hormonal changes can trigger melasma, a multifaceted pigmentation condition that's particularly concerning for Asian women. Due to the numerous myths and misunderstandings surrounding this topic, it merits a separate post.

During menopause, women undergo a decrease in estrogen levels, which can result in lower levels of hyaluronic acid (HA), collagen, and ceramides in the skin. This can leave the skin more vulnerable to dryness, dehydration, irritation, redness, fine lines, and wrinkles. In the first five years of menopause, around 30% of collagen is typically lost. Furthermore, the dermis and epidermis become thinner, wound healing slows down, and immune responses are delayed. Sweating and sebum production decrease, leading to challenges in retaining moisture, uneven skin tone, increased pore size, and a lackluster appearance.

Skin function and dysfunction

The outermost layer of the epidermis is called the stratum corneum, which represents the final stage of keratinocyte maturation and development. As cuboidal cells migrate from the lower half of the epidermis to the top layer, they produce a substantial amount of keratin, leading to the creation of flattened, keratin-filled keratinocytes, also known as corneocytes. These corneocytes overlap to form a nearly waterproof "brick and mortar" barrier, with intercellular lipids filling the gaps between them. If the normal function of the stratum corneum is disrupted, water can escape from the skin's outermost layer. As new cells from the epidermis replace the old ones in the stratum corneum, this renewal cycle occurs over a period of 26-42 days. However, if the SC water content drops below 20% for an extended period, it can compromise the barrier's ability to prevent water loss. Furthermore, when the water content falls below 10%, the SC loses its flexibility and becomes prone to mechanical stress.

The epidermal barrier performs the following functions:

  1. Limits transepidermal water loss (TEWL)

  2. Maintains a 20-30% water content in the epidermis

  3. Preserves water homeostasis in the epidermis

  4. Sustains optimal lipid synthesis

  5. Allows for the orderly desquamation of SC cells

Note: Although sebum-rich skin may appear moisturized, it can actually have a low water content. It's a misconception that dry skin is the complete opposite of oily skin, as sebum production and moisture regulation are two distinct and separate processes. Unfortunately, those who suffer from acne and also have dry skin often mistakenly avoid moisturizing their skin, which can exacerbate the issue.

Stratum corneum = SC

Hyaluronic acid = HA (purple ovals) sugar molecules that hold water

Collagen = amino acids bound to make a protein that gives structural support to soft tissues

Collagen is a crucial protein that gives structure to various body parts such as skin, bones, tendons, and ligaments. It helps to maintain a youthful and plump appearance of the skin. On the other hand, hyaluronic acid serves as a lubricant and shock absorber for our joints. Additionally, it plays a crucial role in keeping our skin supple and hydrated. Skin hyaluronic acid makes up about 50% of the body's total HA.

While dehydrated skin lacks water, dry skin lacks natural oils (also called sebum). Also, dry skin is a skin type, while dehydration is considered a condition.

Signs of dry skin type include:

  • scaly skin

  • white flakes

  • redness

  • irritation

Dry skin can be linked to skin conditions such as psoriasis, eczema, and post-acne breakouts. However, it's essential to note that these are medical conditions and are not the same as having dry skin type or skin dehydration.

Dehydration refers to a situation where the body loses more water than it takes in. This can happen due to various reasons, including insufficient water intake, frequent urination caused by caffeine or diuretics, or excessive sweating during exercise.

Dehydration can cause the following symptoms:

  • itchiness

  • dullness

  • darker under-eye circles

  • sunken eyes

  • “shadows” around the face (especially under the eyes and around your nose)

  • increased incidence or appearance of fine lines and surface wrinkles

Choosing Skincare:

Choosing skincare products is a personalized process that should take into account an individual's skin type, skin condition, and the type of external exposure they face. It's important to note that changes in climate, humidity, and temperature can impact skin condition. Therefore, women should be aware of seasonal, wind, and geographical changes and adjust their skincare routine accordingly.


Selecting the appropriate cleanser is essential for maintaining skin health and preserving the skin's acid mantle, which acts as a barrier function and regulates bacterial flora. A good cleanser should cleanse the skin thoroughly while minimizing harm to the skin's barrier. Since many environmental impurities and cosmetic products are not water-soluble, washing the skin with plain water may not be enough to remove them. Cleansers contain surfactants that help to lift dirt and make oily impurities more water-soluble, making them easier to wash away. However, the pH of a cleanser can also affect the skin's barrier function. The skin's natural pH ranges from 4.0-6.5, and alkaline or soap-based cleansers can disturb the skin's lipid layer. Although the sensation of tightness may indicate clean skin, it can eventually lead to increased skin irritation, sensitivity, and dryness. Normal soaps usually have a pH range of 9-11. It's recommended to choose a cleanser that is pH neutral or slightly acidic to maintain the skin's natural pH balance.


The objective of facial moisturizing is to replenish the elasticity and flexibility of the stratum corneum (SC) while restoring its barrier function. Proper hydration of the SC facilitates the activity of desquamation enzymes involved in the skin renewal process, resulting in a soft, supple, glowing, and healthy-looking skin.

Skincare product labels typically list the active components, along with any additives and preservatives used. It's crucial to learn how to read these labels to understand why and how a particular product works on the skin. Some products may contain multiple active ingredients, with those listed first being the most abundant. In the following discussion, we'll explore some common ingredients found in skincare products that can help mitigate the loss of skin moisture and elasticity, while also offering protection against external factors.


Humectants are moisturizing agents that attract water to the skin, and they play a crucial role in maintaining skin hydration and suppleness. These ingredients act like sponges, drawing in moisture and retaining it. Hyaluronic acid (HA), which is naturally present in the dermis, is an excellent example of a humectant. Topical application of humectants can draw water from both the epidermis and dermis of the skin, as well as from the external environment when ambient humidity is over 80%. HA, in particular, is an incredibly potent humectant, capable of retaining up to 1000 times its weight in water. Another vital humectant is glycerin/glycerol, which helps to maintain the skin barrier and hydration by utilizing various pathways critical to the cell renewal process. It's regarded as the gold standard of skin moisturization.

Look for ingredients that contain glycerin/glycerol, hyaluronic acid or caprylyl glycol in the top ingredients on the label in humid climates.


Emollients are moisturizers that generally contain oils or lipids, which help to soften, smooth, and repair the skin barrier. They function by repelling water from the external environment and are synthesized in the stratum corneum (SC). Ceramides are the most abundant lipids, making up approximately 40% of the SC lipid content. Cholesterol accounts for 25%, while free fatty acids make up 10-15%, with smaller amounts of triglycerides, stearyl esters, and cholesterol sulfate. Emollients assist in smoothing the skin and preventing transepidermal water loss (TEWL). Any product that achieves this is considered an emollient. Ceramides, fatty acids, and oils are the most prevalent emollients found in skincare products, with some also serving as humectants or occlusives.

Emollients can be beneficial if you've been using unsuitable cleansers, exposed to excessive UV radiation or sun, subjected to extreme cold and windy climates, experiencing chronic stress, inadequate sleep, or if you are a smoker.

Look for ingredients that contain ceramides, dimethicone, trixilosane, glycerine, hyaluronic acid, capryly methicone, hydrogenated palm glycerides


Occlusives are products that complement humectants and help prevent transepidermal water loss (TEWL) by creating a water-repellent barrier on the skin. They are particularly useful in cases of itching and flaking of the skin caused by mechanical damage or loss of skin pH. Examples of occlusives include petrolatum, mineral oil, beeswax, lanolin, and silicon. While petrolatum is an excellent occlusive, it can feel quite thick on the skin. Lanolin has a distinct odor and may cause allergies, making it unsuitable for use on the face. Silicon is a newer type of occlusive that is lightweight and feels comfortable on the skin. Appropriately selected moisturizers can aid in supplementing the function of endogenous epidermal lipids and restoring the epidermal barrier function.

To alleviate skin itching and flaking or after experiencing chronic skin irritation/allergies and exposure to cold and windy climates, seek out ingredients such as beeswax, silicon, squalene, and paraffin. If you are using a hyaluronic acid (HA) moisturizer in arid climates, it's also essential to use an occlusive. However, if you have acne-prone skin, be cautious.


Exposure to chronic UV radiation can result in photoaging due to the production of proteases called matrix metalloproteinases (MMP), which are involved in various biological processes. MMP can lead to excessive desquamation and transepidermal water loss (TEWL). The use of sunscreen can minimize this effect and prevent the production of reactive oxygen species (ROS), which is often increased in aging skin. Randomized controlled studies have shown that sunscreen combined with antioxidants (such as grape seed extract, vitamin E, ubiquinone, and vitamin C) can reduce the formation of MMP. Sun exposure is responsible for over 80% of visible signs of aging, and individuals who use sunscreen daily are 24% less likely to exhibit increased aging compared to those who use it at their discretion. Smoking also increases MMP, and research indicates that it leads to premature skin aging.

All layers of the skin, epidermis, dermis and hypodermis are affected photoaging from UV radiation, visible light and infra-red (IR).

Sunscreen should be applied 20 minutes prior to going outdoors. A broad spectrum (UVA and UVB) water-resistant is the best choice. Based on an SPF 50 level, 1 teaspoon should be applied to the face, head, neck; 1 teaspoon to each arm and forearm; 2 teaspoons to front and back of trunk; and 1 teaspoon to each thigh and leg. Reapplication should occur after swimming, sweating or towelling off.

For those who work outdoors and cannot reapply every 2 hours, using a higher SPF and longer lasting (water resistant, nanoparticle) may make-up for this shortcoming.

Wearing hats, sunglasses, long-sleeves and seeking shade as much as possible are also important adjuvants to sunscreen.

Copyright: A Research ReviewTM Educational Series: Photoaging and Sunscreen.

Lifesystyle and Skin Aging

In my previous post, I used age-progression software that can illustrate how different lifestyle choices, stress levels, and sunscreen use can impact skin aging. The software can also generate an estimate of the visual improvement that can be achieved in each area of lifestyle factors, such as nutrition, alcohol consumption, smoking habits, physical activity, stress management, sleep quality, sunscreen use, and exposure to environmental pollutants.

Image credit to: ChangeMyFace via

The above image shows a woman in good health on the left. The middle photo shows skin changes at 5 years without sunscreen use, there is an increase in skin pigmentation and overall dull appearance of the skin. The image far right shows the impact of stress and sleep on skin aging with an increase in wrinkles, eye bags and a greyish skin tone.

I've discovered that this software can be a valuable resource for enhancing motivation and adherence to sunscreen use and sun protection. Moreover, it can serve as a motivating factor for individuals to adopt healthier lifestyle choices. Nonetheless, motivation alone is not always enough, and we often require assistance in transforming our behaviors and forming new habits. You can learn more about developing sustainable healthy habits here.

To summarize, menopause can accelerate signs of aging in women due to the loss of estrogen, combined with the natural aging process and increased vulnerability to free radicals. However, a healthy lifestyle, skincare, sun protection, and smoking cessation can help reduce the impact of these changes. Choosing appropriate skincare products and being aware of their ingredients doesn't have to be costly.

If you are uncertain about the suitability of your current skincare products or treatments, it is advisable to consult a cosmetic physician for guidance.

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1. Baran, R., & Maibach, H. (Eds.). (2011). Textbook of Cosmetic Dermatology (4th ed.). CRC Press.

2. Issa, Mariam and Bhertha Miyuki Tamura. “Daily Routine in Cosmetic Dermatology.” Clinical Approaches and Procedures in Cosmetic Dermatology (2017).

3. Papakonstantinou E, Roth M, Karakiulakis G. Hyaluronic acid: A key molecule in skin aging. Dermatoendocrinol. 2012 Jul 1;4(3):253-8. doi: 10.4161/derm.21923. PMID: 23467280; PMCID: PMC3583886.

5. Grether-Beck S, et al. Effective photoprotection of human skin against infrared A radiation by topically applied antioxidants: results from a vehicle-controlled, double-blind, randomized study. Photochem Photobiol. 2015;91(1):248-50.

6. Morita A. Tobacco smoke causes premature skin aging. J Dermatol Sci. 2007 Dec;48(3):169-75. doi: 10.1016/j.jdermsci.2007.06.015. Epub 2007 Oct 24. PMID: 17951030.


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