“It was like somebody put a furnace in my core, and turned it on high, and then everything started melting,” Michelle Obama, 56, recounts on a menopause-related hot flash during a recent episode of her new eponymous Spotify podcast.
By 2025, over a billion women globally will be post-menopausal, according to the North American Menopause Society. Yet despite its universality, Dr Sylvia Ramirez of Cutis Medical Laser Clinics believes the attitudes towards menopause have remained largely unchanged: that is to say, negative, with menopausal women still being dismissed as “irritable, emotional and erratic”. Little has been done to rebrand menopause after 19th-century physicians identified hysterical fits as one of 50 symptoms, perpetuating a culture of silence around one of the last taboos, says Ramirez. After all, which strong, empowered woman wants to be dismissed or stereotyped as being excessively moody and wildly hormonal?
For Dr Manuela Maria Vazquez, an ob-gyn of 12 years who created her own line, La Maria, to address menopausal skin: “There is so much beauty, joy and pride that can come with a life well lived, and the women of today are more confident and surer of who they are than they ever have been. They don’t want to turn back the clock to a younger version of themselves; they want to relish the moment they are living in now, and the trials and triumphs that got them there.”
Menopause 101
Dr Susan Logan, senior consultant, Department of Obstetrics & Gynaecology at National University Hospital tells Vogue Singapore, “Menopause comes from the Greek word ‘mensis’ or month and pausis, cessation.” Menopause, shares Dr Logan, is when a woman’s menses stops for 12 months due to “ovaries running out of eggs like a gasoline tank in a car.” Women are born with all the eggs they will ever have, somewhere between 700,000–1 million eggs. When these get to low numbers, the menopause occurs. The date is the date of a woman’s last menses.
A 2005 study in Singapore revealed the top common symptoms of menopause as being muscle and joint aches and pains, lethargy, headaches, insomnia, irritability, poor concentration, a dry or sore vagina, dizziness, urinary bladder symptoms, a loss of sex, depression and finally hot flashes. A similar research programme conducted by the Integrated Women’s Health Programme at the National University Hospital in 2017 found the proportion of women affected by each symptom to be even higher.
A study on menopause published in the Singapore Medical Journal in 2013, found that body aches, irritability and sleep disturbances were the top symptoms experienced by Asian women.
“Menopause is often viewed as a marker of ‘getting old’, something that’s uncomfortable with overwhelming bodily sensations such as mood swings and hot flushes,” says Emma Lewisham, founder of the eponymous clean skincare brand from New Zealand. “Menopause is often hidden away and is seldom discussed widely, but this shouldn’t be the case. It’s an exciting new phase in our lives, with new opportunities and change. Openness and talking about menopause is the first step to removing social stigmas around it.”
How the skin changes with menopause
“One of the most difficult aspects of the perimenopause and menopause years is just how unpredictable the symptoms can be, says Dr Vazquez.
“Women tend to start experiencing skin changes during perimenopause or the menopause transitional phase. It begins eight to 10 years before menopause, with the body gradually producing less oestrogen,” Ramirez explains. So vital is oestrogen in the skin, that its deficiency “leads to a dramatic change in our skin health”. Collagen and elastin in the skin peaks in our 20s and 30s, corresponding to the peak in our oestrogen production. Thus, a decline in oestrogen spells the sudden acceleration of ageing and change in our skin’s metabolism.
“As you get older, you develop inflammation from all the things you are exposed to—this is called the exposome,” shares Barbara Paldus, the Founder of Codex Beauty Labs. “The exposome consists of sun (UV) and pollution exposure from time outdoors, stress, household cleaners, hormonal changes (pregnancy/menopause), diet, and lack of sleep. Most of us accumulate the inflammation from these factors that is almost never addressed in the skin. This exposome creates reactive oxidative species in your body and skin that need to be neutralised. While many of us rely on vitamin C serums, the menopausal population needs something more powerful to restore balance and undo the effects of age, hormonal changes, and sun damage from UV exposure.
Menopause and dry skin
“Everything gets drier,” says Dr Logan. And not just drier, but potentially itchier, flakier and in areas that aren’t just limited to the face. “Dry hair, dry eyes, dry mouth, dry skin, dry nails, dry vagina!”
Declining oestrogen levels lead to a drop in your body’s oil production, adds Ramirez, with skin losing its ability to retain moisture.
Menopausal skin can also be easily irritated, which is why Paldus suggests “using fewer products that are clinical proven for efficacy.” Instead of excessive layering of products, Paldus says that it’s about focusing on protecting your skin’s microbiome and skin barrier. “Moisturising your skin daily and drinking plenty of fluids is essential to supporting and protecting the skin barrier, especially after washing. Avoid excessive use of strong acids or abrasive scrubs on your face: excessive washing and/or exfoliating can damage the skin’s acid mantle and consequently, the skin barrier, thereby increasing the likelihood for inflammation, allergies, and breakouts.”
Thinning of the skin
Menopause also means reduced blood flow, leading to less oxygen and nutrients delivered to the epidermal layers, causing epidermal thinning and an increased loss of trans-epidermal water. Thinning skin can also make a complexion more prone to sun damage.
Age spots
Here’s where your diligence in sun protection pays off. If you’ve spent lots of time in the sun without protection, you are likely to see more visible age spots and discolouration on areas frequently exposed to the sun, such as the face, neck, chest and arms. Hormonal melasma can also appear, showing up as patchy spots of pigmentation. Dark spots also often appear in the skin during menopause due to a combination of hormonal changes and sun exposure,” says Lewisham. “If you live in a hotter climate, pigmentation may be more pronounced.
Beyond religious use of sunscreen to protect your skin from ultraviolet radiation from the sun, Paldus says an SPF 30 or higher helps shield the skin from “HEV radiation emitted by computers and other electronic devices, will help to prevent photo-aging, collagen break down and in a worst-case scenario, skin cancer.”
Wrinkles, sagging skin and possibly even acne
The decline in collagen and elastin production usually translates to skin that’s less firm and elastic, with the appearance of jowls, lines and wrinkles, says Ramirez. “Sagging skin is common around the cheeks, neck and jawline.” During this time, we may lose structure or volume in the fat pads around our under-eye area, cheekbones, nasolabials and jawline.
Some women may also expect redness, bumps, and other signs of irritation due to these shifts in oestrogen levels before and after menopause, says Paldus. “We recommend products that hydrate (deliver water into the skin), moisturise (prevent the water from evaporating), reduce irritation and improve elasticity. Products that help strengthen the skin barrier while allowing the epidermis to re-densify are ideal for women in menopause. Finally, some women can even experience menopausal acne, triggered by a rise in testosterone levels: the skin’s sebaceous glands go into overdrive, producing excess sebum, an oily substance that can block pores.”
Changes to hair growth
The rise in testosterone or male hormones may lead to unwanted facial hair. It’s also common to experience hair loss, thinning or receding hairlines during this period, adds Ramirez.
A better transition into menopause
The basic tenets of skincare don’t disappear with age. If you’ve spent years slathering on the SPF, using antioxidants such as vitamin C by day and topical vitamin A to reverse the signs of skin ageing by night, it’s time to keep it up and zero in on targeted ingredients.
“As hormone therapy may not be appropriate for many menopausal women, we can consider phytoestrogens, in particular isoflavones which are commonly derived from soy. Consider supplements and skincare that contain these, as there is at least one study that suggests improvement in wrinkles, fibroblasts and collagen production with its topical use (Rzepecki, 2019),” says Ramirez. She also recommends resveratrol for the skin, with numerous studies linking this powerful antioxidant with increased collagen production.
Embracing the change
Before you resign yourself to the overwhelming list of skin-and-body symptoms, Logan recommends finding workouts that you enjoy and are sustainable for you. And importantly, to seek help if you are struggling.
“The 50s can be a hectic time for women who are juggling children, caring for elderly parents, [and dealing with] marital, health, wider family, finance and career issues,” she says. “Prioritise self-care. Make sure everyone else’s needs do not overtake yours. Make time to do things that benefit your emotional and physical well-being.”
“The reality is that we are all going to age, and it is much easier and healthier for the soul to embrace that reality than to work against it because either way, nature wins in the end,” says Vazquez. “Self-acceptance is an act of self-love, and self-care means recognising that peace of mind is inseparable from peace of body and peace of spirit.
“Most importantly, women need to educate themselves well in advance of entering menopause on what they might expect-talk to your doctor, your girlfriends, read articles etc.
“At the end of the day, there isn’t any way to slow down nature. The healthiest thing that you can do for mind, body and spirit is to embrace the changes that you are experiencing and support yourself with whatever self-care that will get you through the hard parts.”
She reflects on the major transitions in a woman’s life, from first periods to pregnancies, saying there are positives and negatives to every experience. “Approach perimenopause and menopause with the same mentality: relish the positive, listen to your body, and be proactive with supporting yourself out of one stage of life and into another.”
