Skin Aging and Menopause: Implications for Treatment
Authors: Raine-Fenning N.J.1; Brincat M.P.2; Muscat-Baron Y.2
Source: American Journal of Clinical Dermatology, Volume 4, Number 6, 2003 , pp. 371-378(8)
The skin is one of the largest organs of the body, which is significantly
affected by the aging process and menopause. The significant changes sustained by the skin during the menopause are due to
the effect sustained on the skin's individual components.
The estrogen receptor has been detected on the cellular components of the
skin. Accordingly, dermal cellular metabolism is influenced by the hypoestrogenoemic state of menopause leading to changes
in the collagen content, alterations in the concentration of glycoaminoglycans and most importantly the water content. Consequently
changes in these basic components leads to an alteration in function compatible with skin aging.
Changes in the skin collagen leads to diminished elasticity and skin strength.
Collagen content may be measured by various methods such as direct skin biopsy, skin blister assessment for collagen markers
and skin thickness measurement. All these variables indicate a reduction in collagen content following menopause. This may
be reversed with the administration of estrogen given both topically and systemically.
A reduction in hydrophilic glycoaminglycans leads to a direct reduction
in water content, which influences the skin turgor. These effects on glycoaminoglycans, due to the hypoestrogenia, have been
clearly shown in animal studies and appeared to be rapidly
reversed with the application of estrogens. The sum total of these basic effects on the skin leads to wrinkles,
the skin condition typifying skin aging.
Structures resident in the skin are likewise influenced by menopause. Changes
to the cutaneous vascular reactivity are noted following menopause. Capillary blood flow velocity decreases significantly
in postmenopausal women. Postmenopausal flushing is due to profound vasodilatation in the dermal papillae. Hair growth is also influenced by the hormonal milieu and consequently hair loss
has been associated with the beginning of menopause.
Treatments administered for menopause, in particular hormone
replacement therapy, appear to alter its effects on the basic components of the skin as well as the more complex structures
residing in the skin, consequently retarding the skin aging process.
Estrogen and Skin: An Overview
Authors: Shah M.G.1; Maibach H.I.1
Source: American Journal of Clinical Dermatology, Volume 2, Number 3, 1 March 2001 , pp. 143-150(8)
Abstract: As the population of postmenopausal women increases, interest in the effects of estrogen grows. The influence
of estrogen on several body systems has been well-documented; however, one area that has not been explored is the effects
of estrogen on skin. Estrogen appears to aid in the prevention of skin aging in several
ways. This reproductive hormone prevents a decrease in skin collagen in postmenopausal women; topical and systemic estrogen
therapy can increase the skin collagen content and therefore maintain skin thickness. In addition, estrogen maintains skin moisture by increasing acid mucopolysaccharides and hyaluronic acid in the skin and possibly maintaining
stratum corneum barrier function. Sebum levels are higher in postmenopausal women receiving hormone replacement therapy.
Skin wrinkling also may benefit from estrogen as a result of the effects of the hormone on the elastic fibers and collagen.
Outside of its influence on skin aging, it has been suggested that estrogen increases
cutaneous wound healing by regulating the levels of a cytokine. In fact, topical estrogen has been found to accelerate and
improve wound healing in elderly men and women. The role of estrogen in scarring is unclear but recent studies indicate
that the lack of estrogen or the addition of tamoxifen may improve the quality of scarring. Unlike skin aging, the role of
endogenous and exogenous estrogen in melanoma has not been well established.
Received 15 August 2000; received in revised form 23 November 2000; accepted
1 December 2000. Volume 39, Issue
1 , Pages 43-55,
25 July 2001
Maturitas, The European Menopause Journal
The influence of hormone replacement therapy on skin
A pilot study
Objectives: We studied the
effect of hormonal treatment on skin ageing in menopausal women. Methods: Twenty-four patients (45–68 years;
mean age, 54.9 years) without hormone treatment for at least 6 months were included. Patients were assigned to three therapy
groups: 1, oestrogen only (Estraderm TTS® 50) (n=6); 2, transdermal oestrogen and progesterone (Estraderm TTS® 50 and
0.4 mg progesterone vaginal suppository) (n=7); and 3, oral oestrogen and progesterone (2 mg Progynova® and 0.4 mg
progesterone vaginal suppository) (n=8). One group without therapy was included as a control group (n=3). Treatment
was continued for 6 months. Three patients, one from group 2 and two from group 3, discontinued therapy before the study endpoint.
The following skin parameters were measured at monthly intervals during treatment: skin surface lipids, epidermal skin hydration,
skin elasticity and skin thickness. Concomitant clinical evaluation included a subjective clinical evaluation form, a patient
questionnaire and laboratory tests for oestradiol, progesterone and follicle stimulating hormone. Results: Mean levels
of epidermal skin moisture, elasticity and skin thickness were improved at the end of treatment based on both subjective and
objective evaluation in patients with hormone replacement therapy (HRT). Skin surface lipids were increased during combined
HRT, which may reflect stimulatory effects of the progestagen component on sebaceous gland activity, while oestrogen alone
has a sebum-suppressive action. In the HRT groups, the questionnaire for climacteric complaints demonstrated significant improvements,
while laboratory tests showed increases in oestradiol and progesterone and decreases in FSH. Conclusions: HRT with the mentioned regimes significantly improved parameters of skin ageing.