CHAPTER 20 – Menopause and the Skin

Numerous changes occur in the skin of menopausal women. These include dryness, increased sweating, wrinkling, general sagging of the skin (including breast ptosis), altered barrier function, thinning of the skin, and decreased wound healing. Skin appendages are also influenced and excess facial hair and thinning scalp hair are signs of the relative hyperandrogenism that accompanies menopause. Hormone replacement therapy has been demonstrated to enhance skin thickness and this is likely to be secondary to its effects on the structural proteins, collagen, and elastin. Hormone replacement therapy has also been correlated with improved wound healing and tissue resilience. These positive changes support the concept that in the absence of contraindicating factors, hormone replacement therapy should be strongly considered to help maintain skin integrity in menopausal women. Although local reactions to topical administration have occurred, these have generally been mild; topical hormone replacement therapy appears to be a convenient and useful way to provide hormone therapy to menopausal women in a safe and effective manner.