We’ve come a long way since the menopause was shrouded in shame and secrecy, often referred to as going through – *whisper it* – ‘The Change’.
Both experts and celebrities alike have helped to open up the conversation and now, thank goodness, there is a lot more support and information out there for women navigating this often quite challenging time. In the clinic, we’ve found our clients are much more open and forthright in talking about it, which is so great to see.
At Kate Kerr London, we see it as a privilege to grow old, which is why we’re all about achieving optimal skin health and supporting the skin to age beautifully, rather than being “anti-ageing”. The menopause is a time that should be celebrated – after all, historically, women didn’t live long enough to ever reach it! Now we’re living longer, and our value is based on so much more than our fertility.
Whilst you might be familiar with some of the health and wellbeing symptoms (from hot flushes to brain fog), there is still very little information available when it comes to how these huge hormonal shifts affect the skin, and what can be done to combat that.
This guide is designed to give you all the information you need in order to keep your skin healthy, as well as improving your overall wellbeing, too. First things first, let’s start with the basics…
What is the menopause?
Natural menopause is defined as the permanent end of menstruation, which is confirmed when a period hasn’t occurred in 12 consecutive months. It’s a process that occurs due to a decline in the female reproductive hormones: oestrogen, progesterone and testosterone. Oestrogen and progesterone both decline quickly, whereas testosterone declines more slowly – this causes an imbalance, which triggers all kinds of unwelcome symptoms.
The menopause can also be caused by taking certain medications, medical conditions and surgeries, such as having a hysterectomy – this usually causes a much quicker and more intense onset, in comparison to natural menopause.
What is perimenopause?
There is a transition period leading up to the menopause, called perimenopause, where similar symptoms to that of the menopause can occur before periods actually stop and this can continue for up to 10 years. Many will enter perimenopause naturally as early as their late 30s and early 40s.
What general symptoms might you be experiencing?
You might be surprised to know that an overwhelming 34 symptoms can occur during perimenopause and the menopause. These include everything from the more well-known hot flushes, night sweats and mood changes to the more obscure – think burning mouth and electric shock sensations.
If you are experiencing these symptoms, it’s important to speak with a medical professional who can advise you on the best course of treatment for you. At Kate Kerr London, we can refer to relevant medical professionals, as well as holistic experts such as nutritionists and hypnotherapists.
When it comes to how these huge hormonal shifts impact the skin, there is very little information available – and we hope to help fill that gap. Before we dive into how to combat your skin-related symptoms, first, let’s understand, in a bit more detail, the role your hormones have to play and how they change at this time.
The role your hormones play
There are five key hormones that come into play when it comes to womens’ menstrual cycles, perimenopause and the menopause:
- Follicle stimulating hormone
- Luteinising hormone
Find out more about their key roles and how things shift as we enter perimenopause and the menopause below. Note that this is an exhaustive list of all the symptoms you might experience; but you may only experience a few or none at all, so don’t worry that you’re about to fall apart at the seams!
This is the primary female hormone – it’s what causes soft skin, breast growth and a higher voice in women. Oestrogen increases steadily after a period, thickening the uterus, until it peaks mid-cycle before steadily declining.
When this hormone is at its highest levels, we are likely to experience plump, luminous skin as it increases our natural hyaluronic acid production, and therefore our hydration levels. It also makes the skin and hair more radiant.
The menopause shift: During perimenopause and the menopause, oestrogen declines quickly, and as a result, our skin becomes more dry and less radiant. Oestrogen controls the genes associated with collagen and elastin production, so less oestrogen means a drastic reduction in the production of collagen and elastin, resulting in a decrease in elasticity and firmness and an increase in fine lines and wrinkles. This is experienced, not just on the face, but all over the body.
The lack of oestrogen also causes the skin’s cell turnover to slow down and reduces ceramides (these are lipids that make up 50% of the skin’s protective barrier) and GAGs (that’s glycosaminoglycans – the body’s natural moisturisers), which leads to further dryness and an impaired barrier function. Dry skin can, of course, be very itchy and scratching can cause a rash to develop. At this time, wound healing also slows down.
Oestrogen regulates the melanocytes within the skin – these are the skin cells that produce melanin, which is what gives our skin its colour and helps to protect the skin from UV damage. Less oestrogen causes the melanocytes to become erratic, which can lead to increased melanin production and irregular placement, leading to sun spots and irregular discolouration.
A thinner skin (due to the breakdown of collagen and the declined production of new collagen), combined with irregular melanin production, means the skin is more sensitive to damage from the sun. This makes the skin more prone to sun spots, sunburn and prickly heat. The skin will also take longer to heal from sunburn and there is a higher risk of developing skin cancers at this time. Plus, years of sun damage and exposure can now become visible.
The decline of oestrogen also contributes to disrupted sleep (often as a result of other symptoms caused, such as night sweats and anxiety. As a result, we experience dark under-eye circles and sluggish skin, which is compounded by the fact that our skin repairs itself when we sleep, and less sleep means less repair.
Lastly, oestrogen protects bone loss, so less oestrogen can lead to a loss in facial structure and skin sagging.
Progesterone is also known as the ‘PMS hormone’ – it shows up mid-cycle and peaks about three days before a period, when PMS usually rears its ugly head. Progesterone’s primary use is to support the growth of a baby during pregnancy, and so it’s most prominent during our reproductive years. It stabilises the thickening of the uterus, making it the perfect home for an egg to burrow and grow – if there is no egg, the progesterone allows the lining to shed by way of a period.
The upside is that progesterone increases the production of collagen and elastin (giving us youthful skin) and has a calming, sedative effect, helping to soothe any anxious feelings we may have. The downside is that it also increases oil, especially when it peaks mid-cycle, which can cause oily skin, breakouts and the exacerbation of rosacea.
The menopause shift: Low progesterone levels are thought to increase insulin, , which leads to androgen excess. This amplifies testosterone production in the skin, which for some can cause acne, dry and brittle skin, unwanted facial hair growth and hair loss following the shape of male pattern baldness. Low levels of progesterone have also been linked to mood changes – particularly anxiety or depression – hot flashes, night sweats, vaginal dryness and headaches or migraines. The decline of progesterone may also contribute to sleep disturbance as when levels are higher it can have a sleep-inducing effect.
Testosterone is the primary male hormone, but it’s also vital for women. It’s essential for contributing to a woman’s sexual wellbeing by boosting libido and supporting reproductive health. It’s also necessary for the development of new blood cells – without enough testosterone, we can experience fatigue, muscle weakness and mood changes.
Being the primary male sex hormone, testosterone is what also causes thicker, rougher skin and a deeper voice. In women, it’s produced by the ovaries and the adrenal glands and remains relatively stable all month, but during a period, oestrogen and progesterone levels decrease – this causes a counter-spike in testosterone, which activates the oil glands, contributing to breakouts.
Testosterone can also cause women to grow hair in male pattern areas, or to lose hair in the male balding pattern. This is commonly a result of stress causing adrenal fatigue, which prompts the adrenal gland to produce excess testosterone. Those with polycystic ovary syndrome experience an increase in testosterone throughout their entire cycle, which is why it is common to experience acne breakouts and male pattern hair growth.
The menopause shift: During perimenopause and the menopause, oestrogen and progesterone decline quickly, whilst testosterone declines more slowly. This leads to an imbalance of testosterone, which prompts the androgen receptors on our oil glands to become more sensitive to testosterone, increasing breakouts, exacerbating rosacea (made worse by all the hot flushes) and causing male pattern hair growth.
Follicle stimulating & luteinising hormone
The follicle stimulating hormone (or FSH) stimulates the growth of ovarian follicles in the ovary before the release of an egg from one follicle at ovulation. The luteinising hormone (LH) is what causes the release of that egg from the follicle. Both hormones tell the ovaries to make more oestrogen.
The menopause shift: During the menopause, both FSH and LH stimulate the ovaries to make oestrogen – but the ovaries ignore these requests, which causes an increase in FSH and LH. This contributes to a further hormonal imbalance, leading to a wide range of symptoms.
How the menopause affects women of colour
It’s important to note that women of colour experience perimenopause and the menopause very differently. For example, studies have found that black and Latina women are more likely to experience symptoms such as hot flashes, dizziness, poor coordination and/or clumsiness, urine leakage, and vaginal dryness. These symptoms, particularly hot flashes, have also been shown to increase with age in black women, while white women often report a decrease in menopausal symptoms with age.
Much of what we know about how we experience menopause comes from the largest ongoing study of women and menopause, the Study of Women’s Health Across the Nation (SWAN), which began in 1996. Women from a variety of socioeconomic and ethnic backgrounds participated, giving researchers a glimpse into possible differences in how we all experience the transition.
This research shows that black women reach menopause two years earlier than the national median age, and this is the same for Latina women. It also appears from the data that black women spend more time in the menopause transition – or perimenopause – than white women do.
More research needs to be carried out to understand why these discrepancies occur, but many experts believe that stress – and in particular from the ongoing stressors that black women disproportionately face compared with white women – plays a role. Stress can fuel chronic inflammation in the body and this can lead to many health ramifications, including a more challenging menopause.
For Indian women, a separate study found that the prevalence of menopausal symptoms was lower in comparison to Caucasians. Similarly, Japanese and Chinese women reported less severity across all symptoms, except for forgetfulness. More research needs to be carried out to determine why there are these cultural differences, but one theory is that Asian women tend to have healthier diets rich in vegetable-based proteins, which may contribute to fewer and less impactful symptoms.
When it comes to the skin, there are a few ways that women of colour might see the menopause play out differently:
- Black skin is generally oilier, so an exacerbation of oil can be experienced, which causes breakouts and inflammation
- These breakouts can increase the risk of post-inflammatory hyperpigmentation, which women of colour are more prone to
- Rosacea symptoms can be exacerbated, but this is often overlooked as redness isn’t an obvious symptom – an increase in pore size, oil flow and sensitivity across the cheeks are generally the signs
- Women of colour tend to experience less photo ageing (think lines and wrinkles) as the higher amount of melanin within the skin provides an increased natural protection from the sun
- A slower cell turnover and desquamation (peeling skin) can make darker skin types appear more dull
- Abnormal melanocyte activity at this time can also increase pigmentation and lead to an uneven skin tone
How to treat the skin
The changes to your skin during perimenopause and the menopause, alongside the many other symptoms you might be experiencing, can be really overwhelming.
At Kate Kerr London, we tailor our approach to you as an individual, taking into consideration your medical history, skin health, skin type and skin tone, being mindful of the varied ways that perimenopause and the menopause can be experienced across different races. Below are just a few of the ways that you can do to keep your skin healthy…
Use medical-grade skincare
Whilst cosmetic-grade skincare only works on the surface layer of skin, medical-grade products contain higher doses of active ingredients that work deep within the skin and are proven to have a therapeutic effect on targeted cells, helping to correct any damage and leading to noticeable changes in the the skin – from long-lasting skin health and overall radiance to visibly plumped lines and wrinkles.
At Kate Kerr London, we provide our clients with a comprehensive skincare regime using medical-grade ZO Health skincare. The regime is entirely individual and all products contain therapeutic doses of active ingredients that are designed to perform very specific tasks within the skin. This allows us to be micro-focused when prescribing a regime to target all individual concerns.
Have regular facials
We recommend a regular Clinical Perimenopause & Menopause facials, which will address the symptoms that are already presenting on the skin, whilst also helping to minimise the impact of these hormonal changes going forward by stimulating the skin and waking up and reactivating processes that slow down or become dormant.
Our Clinical Perimenopause & Menopause facial is entirely bespoke and tailored to address individual concerns, however benefits can include:
- Activating collagen and elastin to improve the skin’s thickness, elasticity and texture
- Softening fine lines, minimising pore size and tightening the skin
- Lightening existing and preventing further hyperpigmentation, as well as evening discolouration
- Increasing the skin’s natural hydration by increasing the production of glycosaminoglycans and natural moisturising factors
- Regulating oil production and treating breakouts
- Helping to eliminate any inflammation and improving inflammatory skin conditions, such as rosacea
- Minimising itching due to dryness
- Ensures the skin is protected from environment stressors such as UV rays, pollution, extreme weather and air conditioning
- Repairing DNA damage and regulating cell replication to help prevent skin cancers
- Repairing and strengthening the skin’s barrier for calm, hydrated and resilient skin
- Reducing sensitivity and irritation
- Increasing cell turnover for a brighter complexion
- Minimising dark under-eye circles and plumping fine lines around the eye area
The treatment can be carried out on the face, as well as the neck, decolletage and the hands.
Consider advanced aesthetic treatments
Advanced treatments might be necessary to improve skin damage and prevent premature ageing, whilst supporting the skin through the natural ageing process, as well as treating hyperpigmentation, rosacea and acne scarring.
Microneedling can help to even out skin texture, reduce pore size and eliminate acne scarring. We use a microneedling device to create controlled micro-injuries, which essentially tricks the skin into rejuvenating and repairing itself.
Our Venus Radio Frequency treatment, which utilises both multi-polar radio frequency and pulsed electro-magnetic fields to deliver energy deep within the skin, is great for lifting and tightening the skin. It’s a great one to have as an add-on to the menopausal facial.
We also recommend our Venus Viva Nano Fractional Radio Frequency treatment, which uses targeted, controlled heat to cause fractional ablation, i.e. gently remove layers of damaged skin. This helps to tackle rosacea symptoms and acne scarring, as well as reducing pore size, minimising lines and wrinkles and helping to break down pigment in order to improve hyperpigmentation.
Our Intense Pulsed Light (IPL) treatment can also be great for improving discolouration and hyperpigmentation, or alternatively, our Tribella Skin Rejuvenation treatment combines IPL, Venus Viva Nano Fractional Radio Frequency and Venus Radiofrequency in one supercharged treatment.
Have regular mole checks
Thanks to a decrease in both progesterone and oestrogen, which thins our skin and upsets melanocyte function, there is a higher risk of developing skin cancers at this time, so it’s important to carry out regular mole checks on yourself.
When checking your moles and looking out for the signs of early melanoma, think ABCDE – that’s Asymmetry (the mole is not symmetrical), Border (the outer edges are uneven), Colour (the mole is dark black or has multiple colours), Diameter (it’s greater than 6mm) and Evolving (note any changes in size, colour or shape).
If you have a lot of moles, or you notice any that look suspicious, reach out to a medical professional to have mole mapping carried out for further investigation.
Holistic ways to soothe wider symptoms
As mentioned, it’s important to speak with a medical professional who can advise you on the best course of treatment for you when it comes to any symptoms beyond the skin.
At Kate Kerr London, we can refer to relevant medical professionals, as well as holistic experts such as nutritionists and hypnotherapists. That being said, there are a couple of key lifestyle changes that can be made to not only increase skin health, but ease other health and wellbeing symptoms, too.
Switch up your diet
At Kate Kerr London, we can refer to nutritionists and nutritional therapists to advise you on this further. Here, we’ve collaborated with nutritional therapist at The Natural Balance, Gail Da Silva Madalena to share some top tips for the dietary changes that can make a big difference to your overall health and wellbeing, as well as your skin.
- Increase protein consumption
Declining levels of oestrogen has been linked to a decrease in muscle mass and bone strength. Including protein-rich foods at every meal will help to maintain the strength and structure of your bones. Aim for 20-25 grams of high quality protein per meal, opting for leaner choices such as chicken, turkey, fish, eggs, beans, pulses and legumes. Protein also helps satisfy hunger, improves blood sugar levels and reduces cravings, which can be helpful in maintaining a healthy weight.
- Eat a wide variety of plant foods
A wide variety of fruits, vegetables, whole grains, pulses, lentils, herbs and spices will provide beneficial fibre for your gut microbes. A diet rich in colour will also increase your intake of essential vitamins and minerals, as well as antioxidants and compounds called phytoestrogens. These plant-based oestrogens have a mild oestrogenic effect in the body and can be useful in relieving menopausal symptoms, particularly hot flushes and mood swings. Foods that naturally contain phytoestrogens include soybeans, tofu, chickpeas, peanuts, flax seeds, berries, green and black tea.
- Eat calcium-rich foods
The decline in oestrogen levels can increase women’s risk of bone fractures. Dairy products, such as milk, yoghurt and cheese contain phosphorus, potassium, magnesium and vitamins D and K – all of which are essential for bone health. Calcium is also found in fortified milk alternatives; fish with edible small bones such as sardines or anchovies; soybeans and soy products; green vegetables such as broccoli, kale and cabbage and nuts and sesame seeds.
- Increase sources of omega-3 fatty acids
Omega-3 fatty acids are potent anti-inflammatories that are important for keeping the heart healthy, which can be affected during and after the menopause. They can also help alleviate night sweats. A balance of fats is important and opting for unsaturated oils like olive oil and avocado oil are great choices. The best dietary source of beneficial omega-3 fatty acids is oily fish, which includes salmon, mackerel, anchovies, sardines and herring. You can also find omega-3 in nuts and seeds such as flax seeds, chia seeds and hemp seeds.
- Avoid trigger foods
Cut back on foods and drinks that are likely to trigger or worsen menopausal symptoms; particularly hot flushes and night sweats. Spicy food often contains the heat-producing compound capsaicin, which makes hot flushes worse, while both caffeine and alcohol can increase blood-flow to the skin and make you feel flushed. Consider swapping your morning coffee for a healthy herbal tea. Avoid refined sugars in the form of cakes, biscuits, chocolate and sweets, which will raise your blood sugar, followed by a sharp dip, leaving you feeling low on energy and tired. Sugary foods will also contribute to weight gain around the stomach, which some menopausal women are more prone to.
Eating plenty of healthy fats, as well as calcium-rich foods and lots of iron will also give your skin antioxidant protection, which helps to protect the skin’s surface from oxidative damage caused by free radicals and environmental aggressors like UV and pollution.
Foods containing beta-carotene, such as yellow, red and green leafy vegetables (think spinach, carrots, sweet potatoes and red peppers) or yellow fruit such as mango papaya and apricots, will help to protect the skin against the sun alongside your daily SPF. These foods also help to encourage hydration and increased vibrancy within the skin.
A mix of cardio, weights and yoga can be effective at helping to maintain a healthy weight, as well as helping to burn off stress hormones and improve your overall mental health. Yoga has been proven to decrease anxiety and the symptoms of insomnia that are associated with the menopause. Combining yoga with more intense exercise, such as cardio or weight training, helps to improve sleep even further.
Lifting weights, in particular, can help prevent bone loss as a result of a decline in oestrogen, which helps to prevent a loss of elasticity and skin sagging.
Exercise, in general, has also been shown to increase collagen production for a plumper complexion, and can also improve sleep, which encourages the skin to self-repair.
Take care of your mental health
We’ve asked Angela McKrill – a fantastic clinical and cognitive behavioural therapist who we regularly refer our clients to – to share some of her top tips for taking care of your mental health during perimenopause and the menopause. Here’s what you need to know…
As women transition through perimenopause and into menopause, many feel the shift not only physically (bones, heart, muscles, skin etc), but emotionally too. One of the primary reasons for this is the incremental rise in stress hormones like cortisol and adrenaline.
As we ramp up the activity of the sympathetic nervous system (known for its fight or flight properties) the ‘rational’ mind becomes frequently hijacked by the ‘monkey’ mind – with moods, logic, sleep, memory, learning and reasoning often impacted. It’s also not uncommon to be left feeling low, overwhelmed, anxious, angry and depleted.
When our sense of balance is derailed in this way, the brain can scramble to add ‘meaning’ to our experience in order to make cognitive sense of it. We inadvertently create stories about ourselves to mirror our state (think ‘I’m useless/unattractive/an emotional wreck’) and this can increase our emotional distress, compounding general stress and impacting our self-esteem.
When stress chemistry is high, we tend to respond to situations in a more intense way. But if we can master self-awareness, we can move towards responding – rather than reacting – to an experience. We can also dampen down how long the response lasts and how often it gets triggered. A few of these techniques include:
- Meditation practices, which can help to improve sleep, increase serotonin levels, balance the brain and tame our mood and reactivity.
- Cognitive behavioural therapy, which can help us to recognise and dismantle the unhealthy stories that we attribute to ourselves during turbulent times. We can learn to witness and question before we unwittingly worsen a situation.
- Breathwork, which allows us to ‘hack’ the nervous system and create profound changes in both our physical and mental states.
- Talk therapy, which provides a buffer for feelings and emotions and helps us to take stock and make necessary changes.
- Hypnotherapy, which encourages our relaxation response and can really help us to make positive lifestyle changes – such as stopping smoking or making better dietary choices.
Speak to your GP
The symptoms of menopause and perimenopause can be treated by your doctor, so be sure to keep knocking on their door until you get the support that you need. Aside from hugely helping to alleviate many symptoms associated with health and wellbeing, taking hormone replacement therapy (HRT) can also improve skin hydration by replacing oestrogen levels in the body.
Many women who take HRT often notice that their skin becomes brighter with an improved skin texture and tone. It can also slow down the onset of ageing – the skin often looks firmer and plumper as the oestrogen works to strengthen the collagen and elastin fibres.
Your menopause survival kit
These products will be your skin saviours…
- La Roche Posay mineral water spray to keep beside your bed to tackle night sweats. Keep it in the fridge for hot flushes in the day, too.
- Medik8 Skin Recovery mask to cool, hydrate and calm irritated skin.
- AQ Advanced Hair Complex to prevent hair loss, rejuvenate damaged hair follicles and restore healthy hair growth cycles
- La Roche Posay Lipikar AP is a fantastic moisturiser for the body to help with dry skin and itching.
- AQ Vaginal Rejuvenation System to help relieve dryness and itching, as well as improving elasticity and the strength of the vaginal wall, which has become inflamed and thinner due to the decline in oestrogen.
The menopause directory
Knowledge is power! Below you’ll find all kinds of resources to help guide you through perimenopause and the menopause. Remember, you don’t have to navigate this on your own…
Books to read…
Confessions of a Menopausal Woman, by Andrea McClean
Preparing for the Perimenopause and Menopause, by Louise Newson
The Dr. Louise Newson Podcast
The Midpoint with Gabby Logan
Menopause Whilst Black with Karen Arthur
The Black Girl’s Guide to Surviving Menopause
People to follow on Instagram…
@TheMenoCharity – The Menopause Charity shares fact-based information and advice
@Adele.Johnson – aka the menopause coach, she helps women reclaim their identity, vibrancy and confidence
@MeeraBhogal – menopause expert and founder of Made from Scratch, Meera offers bespoke fitness and meal plans
@Menopause_Doctor – GP and menopause specialist, Dr Louise Newson, shares her top tips and advice for navigating perimenopause and the menopause
@DrNighatArif – NHS GP and a specialist in women’s health who is also a familiar face on BBC Breakfast and This Morning, Dr Nighat Arif, shares tips and advice, as well as helping to raise menopause awareness
@melaniefloodnutrition – a nutritionist, health coach and female hormone expert who shares tips and advice to help women struggling with hormones and perimenopause to achieve balance
…and on Facebook
Join The Mid.Pointers Facebook group to access a community who share openly and candidly about their midlife challenges
You can also catch Meera’s Made From Scratch on Facebook for more dietary and exercise advice
Join the Black Women in Menopause Facebook group, founded by Nina Kuypers to discover advice tailored to women of colour and to find out about monthly events around the menopause
Menopausematters.co.uk – for up-to-date, accurate information about the menopause, menopausal symptoms and treatment options
themenopausecharity.org – supporting women with fact-based menopause research and ensuring access to the safest hormone replacement therapy
Deborahthemenopauseconsultant.com – sign up to menopause consultant Deborah Forsythe’s menopause magazine for informative information and advice
menopausecare.co.uk – Dr Naomi Potter and her associates offer a bespoke service with the best in British Menopause Society Gold Standard care using Body Indentical hormone therapy
The Black Girls’ Guide to Surviving Menopause – founded by Omisade Burney-Scott, this is an excellent resource for women of colour, or who identify as gender non-conforming or non-binary, who are looking for more inclusive stories and advice
GEN M – an online platform offering support and advice for menopausal women of all ethnicities and backgrounds in the UKmegsmenopause.com – Meg Matthews turned 50 and began to experience her first symptoms of the menopause. Shocked at the lack of information out there, she made it her mission to break the stigma