Skin changes

Changes in how your skin looks and behaves in the years around menopause. NHS inform lists changes in skin conditions among the common symptoms of menopause: dryness, more oiliness, and acne that starts in adulthood. The NHS website lists skin changes, including dry and itchy skin, among the symptoms too.

Later on, the Pakistan Menopause Society lists skin dryness and thinning, wrinkling, and loss of collagen and elasticity among the longer-term changes after menopause (Table 1).

This page is the overview. Dry and itchy skin has its own page, as do new facial hair and hair thinning, which often arrive alongside.

Spots along the jaw and chin. A T-zone that turns shiny by lunch. Then, sometimes in the same month, skin on your arms and shins that feels tight and rough. Skin that looks thinner on the backs of your hands. Foundation that sits differently.

The NHS acne page adds that acne can affect how you feel about yourself, and your mood. At an age when you expected to stop worrying about your skin, that can hit harder than the spots themselves.

The NHS website lists changes in hormone levels, including during the menopause, among the causes of acne. Acne happens, it explains, when hair follicles become blocked with oil and dead skin.

For the later changes, the Pakistan Menopause Society lists thinning skin and loss of collagen and elasticity among the long-term effects of menopause (Table 1), and also reminds doctors that age, lifestyle and other conditions shape the changes of midlife, not falling estrogen alone.

If you are on HRT, the NHS website lists acne among the possible side effects of progestogen.

For spots, the NHS website suggests:

• washing your skin twice a day with a gentle cleanser, and removing make-up at night
• skincare and make-up labelled non-comedogenic, which means it will not clog pores
• acne treatments you put on your skin, such as salicylic acid or benzoyl peroxide, with a pharmacist's advice
• not picking, squeezing or scrubbing, which can scar or irritate

For dryness, see dry and itchy skin.

The NHS website says a GP can offer prescription treatments for acne, as creams or gels or as tablets, or refer you to a skin specialist. Which one suits you depends on your skin, your health and any other medicines you take, including HRT, so it is a conversation for your doctor.

If your skin changed after starting HRT, the NHS website says side effects usually go away after a few weeks, and that a GP may suggest changing the dose, type or route if they do not.

On HRT and skin itself, The Menopause Society, the North American menopause body, says in its 2022 statement that estrogen appears to help skin thickness, elasticity and collagen when it is given around the menopause. It rates that evidence as limited. If you are weighing HRT for other symptoms, ask your doctor what, if anything, to expect for your skin.

The NHS website says to see a GP about acne if treating it yourself is not working, if spots are deep, painful or scarring, if the skin looks infected, or if it is affecting your mental health.

It also says to see a GP if irregular periods come with dry or oily skin, hair growth on your face, weight gain or tiredness. The same page names polyendocrine metabolic ovarian syndrome (formerly PCOS) and thyroid problems among the causes of irregular periods, and they are worth ruling out before putting everything down to perimenopause.

Skin is public in a way most symptoms are not. Relatives notice, and remedies arrive: haldi, besan, something an aunt swears by. Kindly meant. If your skin is reacting or getting worse, it is fine to thank her and ask a pharmacist or doctor instead.