Hormones, skin aging & treatments

Menopause is a time of hormonal changes, and chronological aging that impacts our body in a variety of ways. Skin health and appearance is a top concern for many patients, and what we can do about it. Learn more about what contributes to skin aging and what treatments have evidence and research behind them.

What causes skin aging?

Skin aging can be due to a combination of our genetic make up, with environmental and lifestyle choices.

Extrinsic aging refers to the factors outside of our bodies that contribute to skin aging (pollution, smoking, sleep deprivation, poor diet or anything else that increases free radical production). This may account for 80-90% of skin aging - and you can read more about what we can do in our previous blog.

Intrinsic or internal factors include cellular, genetic, and hormonal causes that alter skin as it ages.

For women, the reduction in estrogen released from the ovaries in perimenopause and menopause is the most important factor influencing skin changes. Progesterone plays less of a role. Typically facial aging is where most individuals notice these changes, and it impacts multiple tissue layers, including muscle, fat and bone. 

How does estrogen influence skin?

Collagen is the structural infrastructure for other chemicals like hyaluronic acid, and elastin to create the cell matrix of our skin. We have estrogen receptors here that are influenced by the reduction in estrogen in menopause, which causes less activity in these cells, and therefore less collagen production, as well as increased collagen breakdown. 

The skin thins due to this collagen loss, which also makes it have a harder time retaining moisture and elasticity, leading to the formation of wrinkles, and skin laxity (think a stretched out rubber band, it has a hard time recoiling). With the loss of hyaluronic acid and glycosaminoglycans (which bind water) the skin looks less hydrated and moist than in our youth. Blood flow to the skin layers is reduced by the decline in estrogen, as is our natural repair and growth, and pigmentation increases - leading to blotchiness of the skin when exposed to sun. 

Estrogen also exerts influences on the way in which our fat is structured in our face - which changes as we age and changes the shape of our face. 

In our youth, our fat distribution of the face typically has full cheekbones and the pointy apex of the “triangle” is our chin, creating an upside down triangle shape to the face, which is termed “the triangle of youth”. As we age, the fullness of this triangle typically shifts to the bottom of the face, with the cheeks hollowing out creating a heavier base or right-side up triangle. We also experience facial volume loss - the forehead and cheek area lose fat, and the mouth and jaw gains it. 

The triangle of youth refers to the shape in which our younger faces carry our fat distribution, with the majority being high in the cheekbones, and the pointy apex being the chin. With age related changes, the fat is redistributed to the lower jaw and cheek, causing a shift in the triangle.

Even our facial bone structure is impacted by these changes! With decreased estrogen, we experience more bone resorption which can create changes in our facial bone - that can exacerbate the appearance of jowls, nasolabial folds (marionette lines) and increase the distance between nasal tip and upper lip.

What can we do?

You may be thinking, well-great we have all these changes that will occur due to hormones or chronological aging, and some of them we have little to no control over. However, fortunately there are many topical products and treatments that can help promote dermal repair, collagen production, and encourage skin hydration at different levels of the skin.

Sunscreen & UV protection

The number one thing we can do to support our skin health is to properly protect ourselves from the sun and avoid harmful UV rays. You can read more about the importance of this, why and proper sunscreen use is integral to preventing skin aging here. Our favourite sunscreen is EltaMD, available to purchase online or in clinic.

Topical agents

Moisturizers

Moisturizers that minimize water loss in the skin can help it look more hydrated. Typically a cream based moisturizer (that doesn’t easily pour out of a jar) will have components that mimic a youthful skin composition (things like; glycerin, shea butter, ceramides). You can also add hyaluronic acid that will help the skin attract water and stay hydrated.

You should be using a daily moisturizer after cleansing your face and applying any serums, but before you apply your sunscreen.

For an easy and affordable hyaluronic acid, we love this one from the Ordinary.

Retinols & Retinoids

Topical retinoids have been extensively looked at for supporting skin aging changes. They can impact multiple layers of the skin, including decreasing the proteins that are responsible for the degradation of collagen. Retinoids can cause side effects like redness, irritation or dry skin.

There are weaker retinols that are available as cosmetic products, retinoids that are available with a prescription from a medical doctor. Allowing your skin to adjust to the dose of commercially available products, and then working your way up to a prescription strength potency is one strategy to avoid side effects. Talk to your naturopathic doctor or dermatologist on how best to approach this.

Alpha-Hydroxy-acid (AHA) & Beta-Hydroxy-Acid (BHA)

If patients are having a hard time with using retinoids due to side effects, they may opt to use a alpha-hydroxy-acid (AHA), or beta-hydroxy-acid (BHA) which are commercially available. They appear to be less effective than retinoids, and don’t have the ability to penetrate to deeper layers of the skin, but have a better tolerability and less side effects.

Treatments

There are many cosmetic treatments that may be safe for addressing concerns in menopause. These may range from treatments offered by clinics or aestheticians.  The below treatments have good evidence for supporting collagen production and supporting skin health.

Cosmetic Acupuncture

Cosmetic acupuncture or facial acupuncture involves providing targeted treatments areas of the face to assist with collagen production. Typically these treatments may also involve gua sha, and acupuncture points that support your personal health needs and goals. You can book with one of our acupuncturists and use your acupuncture extended insurance for these treatments.

Chemical Peels

Chemical peels of a varying strengths and concentrations can improve skin texture and discolouration. There are side effects that may include burning, stinging, uneven penetration, and prolonged redness. 

Lasers
Fractional lasers were developed in the early 2000s and create thousands of microscopic columns of heat damage without overlapping. This stimulates the cells to create collagen in this deeper level. Laser may be deeper, or targeted at vascular concerns. Intense pulsed-light treatments are non laser options that can target vascular or pigmented concerns.

Botox

Botox, or botulinum toxin purified protein extract ,can smooth lines created from increasingly active facial muscles. It works by blocking acetylcholine release within the muscle temporarily, and typically last for 3-4 months. With on-going use, many patients find the results tend to last longer, which is likely due to the fact that patients “re-train” themselves to use other muscles of the face for facial expression, only needing treatment 2-3 times a year.

Fillers

Dermal filler agents are composed of hyaluronic acid gels or synthetic gels and temporarily fill a line, fold, wrinkle or augment lip volume for approximately 6-18 months. For filling agents, the repetitive trauma to the skin from needle insertion will cause collagen production at the area, making the lines less visible even when the filling agent has dissolved away.

Radiofrequency

Radio-frequency delivers both heat and energy to the deeper layers of the skin. This causes remodelling in the deeper dermal layers increasing collagen production - and may take from 6 to 9 months to show the full effects.

Microneedling

Microneedling (medically known as collagen induction therapy or ICT) is a minimally invasive treatment done using a Health Canada approved microneedling pen. It creates tiny punctures in the skin using thin needles that causes a "micro-injury" and starts the process of collagen production. It also helps us deliver topical products to the skin during the treatment, like hyaluronic acid. Microneedling has been found to be helpful for fine lines, acne scarring, stretch marks, wrinkles, enlarged pores and other scars. It has minimal downtime and side effects, and most patients notice results  immediately, however the amount of treatments and results depends on the concerns and individual (certain scars may take many more treatments if it's more severe). We offer microneedling at Crafted Balance, and you may be able to use your extended acupuncture benefits to cover the treatment.

Want to learn more about what you can do to support your skin and your health during the perimenopausal transition? Book a complimentary meet and greet to learn more about how Dr. Madeleine Clark, ND can support you during this time.