Skin changes in menopause: dryness, sensitivity and what helps

Hot flashes get most of the attention, but many women notice their skin changing around menopause too. It feels drier, itchier and tighter, stings with products that never bothered it before, and takes longer to recover. None of this means anything is wrong with you. It’s a predictable effect of falling hormones, and a few changes to your routine can make a real difference.

What estrogen does for your skin

Estrogen isn’t only a reproductive hormone. A 2022 review in Clinical and Experimental Dermatology notes that estrogen receptors, the docking sites that let skin cells respond to the hormone, are found throughout the skin, most densely on the face, the genital area and the legs. When estrogen levels drop, the skin responds.

Two changes stand out:

• Water loss. The skin barrier is the outer layer that keeps moisture in and irritants out. The review notes that estrogen applied to the skin has been shown to reduce transepidermal water loss (TEWL), the water that evaporates through the skin, and to improve barrier function. Lower estrogen is likely to mean a leakier barrier.
• Collagen loss. Collagen is the protein that gives skin its strength and springiness. The AAD says women lose about 30% of their skin’s collagen in the first five years of menopause, then about 2% a year for the next 20 years.

The result is skin that’s thinner, drier and less resilient. The AAD adds that skin can bruise more easily and heal more slowly.

Dryness and itch: the most common complaints

The NHS lists dry and itchy skin among the symptoms of menopause, which can last seven to nine years or longer. It also notes that itchy skin in general is particularly common during menopause.

The 2022 review goes further. It reports that eczema-type rashes, including allergic contact dermatitis and asteatotic eczema (a form of eczema caused by very dry, cracked skin), were the most commonly reported skin conditions in a large study of women in perimenopause and menopause. A weaker barrier lets more water out and more irritants in, which is exactly the set-up for dryness, itch and rash.

That fits the Canadian experience well. Cold, dry air outside and heated air inside draw moisture from the skin, and the AAD notes that menopausal dryness is more noticeable in dry air.

Why skin can become more sensitive

Many women find their skin starts reacting to things it used to tolerate: a favourite cleanser, a scented body lotion, a new serum. The AAD notes that the skin’s pH changes around age 50 and that skin can become more easily irritated.

Put that together with a thinner barrier and you get more stinging, burning and redness from everyday products. It doesn’t necessarily mean you’ve developed an allergy. Often the skin simply has less margin for error, so the same product that was fine at 40 is too much at 52.

Menopause can also bring other changes that look like sensitivity:

• Flushing. The 2022 review notes flushing affects around 75% of women in perimenopause and menopause.
• Acne. The AAD says some women get acne that looks like teenage acne as hormone levels fall.
• Rosacea. It can look like flushing or acne. The review notes that blackheads and whiteheads point to acne rather than rosacea.

A gentler routine that helps

The good news is that the fixes are simple, and they mostly mean doing less. Pulling together advice from the AAD, the NHS and the 2022 review:

• Swap soap for a mild cleanser. The AAD recommends mild cleansers instead of soap, and the review lists avoiding irritants, including soap, among measures for menopausal itch.
• Shorten your showers and baths. The review and the NHS both suggest less time bathing.
• Moisturize every day. The review suggests using a low-pH emollient, a moisturizer that softens and seals the skin, at least once daily. The AAD suggests looking for humectants such as glycerin or hyaluronic acid, which draw water into the skin. The NHS recommends fragrance-free moisturizers. You can browse moisturizers and filter for fragrance-free options.
• Use a humidifier in winter, as the review suggests.
• Wear sunscreen daily. The AAD recommends broad-spectrum SPF 30 or higher, since years of sun exposure start to show at this stage.
• Keep nails short and don’t scratch. The review includes short nails, and the NHS suggests patting or tapping the skin, or holding something cool against it, instead of scratching.
• Introduce new products one at a time, so you can tell what your skin does and doesn’t like.

If you want to try active ingredients like retinol for wrinkles, which the AAD mentions, start slowly and back off if your skin stings or peels. Thinner, drier skin tolerates less.

When to see your doctor

Most menopausal dryness and itch improves with a gentler routine. But itch isn’t always just dry skin. The NHS notes that itching can occasionally be linked to thyroid, liver or kidney problems, and that a doctor may order blood tests to find out.

See your doctor or pharmacist if:

• Itch is affecting your sleep or daily life
• It doesn’t get better with self-care after two weeks, or keeps coming back
• It’s severe or all over your body
• You have a rash that’s spreading, blistering or weeping
• You have genital dryness, soreness or itching, which the NHS lists among menopause symptoms

It’s also worth talking to your doctor about menopause symptoms in general. Hormone therapy may help some skin changes, according to the 2022 review, but it’s a decision with benefits and risks well beyond the skin.

To sum up: falling estrogen leaves skin drier, thinner and more reactive, and itch is a common result. A mild cleanser, shorter showers, a daily fragrance-free moisturizer, a winter humidifier and sunscreen go a long way. If itch disrupts your life or won’t settle, don’t just live with it: see your doctor.