Pause for thought |
Aesthetic Medicine
Aesthetic Medicine


Pause for thought

There’s no missing the impact of Davina McCall’s influence on our awareness of all things menopause. Finally, discussions are becoming more open, and women are making more informed decisions on the right pathway for them.

So significant is the need for these discussions that in early June, a group of healthcare specialists, professors and journalists used their influence to hold the first Menopasue

Mandate meeting to amplify the voices of women who suffer in silence and need more support. Commenting on the event, Alice Hart-Davis, founder of The Tweakments Guide, said, “It was a huge privilege to be at the Menopause Mandate event at the Houses of Parliament.

The option to get Hormone Replacement Therapy (HRT) should be accessible for all women who want it, and the Menopause Mandate aims to empower women to have that option.”

Oestrogen plays a fundamental role in the production of collagen and elastin, and as collagen levels and elastin levels drop, this creates a loss of volume and tone


Menopause is when a woman stops having periods and can no longer reproduce. The stage leading up to it is known as peri-menopause, which usually lasts around four to eight years. The average age of menopause is around 51.

During this time, women experience an array of symptoms, which can include hot flushes, night sweats, weight gain, lower libido, vaginal dryness, incontinence, mood swings, irregular periods, painful joints, anxiety, hair thinning, insomnia, loss of collagen and dry skin.


The link between skin and hormones is well acknowledged. Oestrogen plays a fundamental role in the production of collagen and elastin, and as collagen levels and elastin levels drop, this creates a loss of volume and tone. It’s estimated that women lose 30% of their collagen in the five years following menopause, dropping to about 2% every year for another 20 years after that. The epidermis also begins to thin as cellular turnover reduces and capillary blood flow slows down. This leads to reduced barrier function, with the skin often becoming dry.

Finally, melanocytes degenerate and produce less melanin, the natural protector against the sun. Melanin can be overproduced in certain areas that have previously been exposed to a lot of sun. As a result, the skin is more sun-sensitive, and you may see an increase in both hypo and hyperpigmentation. Consequently, many women feel overwhelmed by what’s happening to their bodies and appearance.

So how can we help? Supporting clients at this time is essential. Every woman should be enabled to make an informed decision if HRT is right for them. This helps minimise menopausal side effects and preserve body function. There are many benefits to HRT, both physical and cognitive. In terms of skin, there have been numerous studies that suggest HRT can help in the management of skin-related symptoms associated with menopause, with studies showing it can help increase epidermal hydration and skin elasticity and thickness1as well as boost dermal collagen levels. 2

In one observational study, more than 3,000 women found that compared to non-users, HRT use was associated with a statistically significant reduction in dry skin and wrinkling.3 However, it won’t improve the rate of skin turnover or reduce pigmentation, especially preexisting pigmentation attributed to the natural ageing process.

With this in mind, a discussion about a holistic approach is beneficial to try to reduce the skin cycle and keep the skin bright and healthy. It’s also important to highlight the impact of diet, exercise and sleep on overall health, too.

Ingredients that stimulate oestrogen receptors have become key in maintaining menopausal skin health. Aside from hydrating agents, antioxidants and retinoids both protect from further collagen loss and help boost skin turnover while building new collagen and controlling pigment.

Retinoids are derivatives of vitamin A, converted in the body to retinoic acid, the active form of vitamin A. They’re robustly proven to visibly change the surface of the skin and reduce lines and wrinkles, achieved through regulating cell turnover and promoting the growth of keratinocytes.

They also strengthen the epidermis’s protective function, reducing transepidermal water loss (boosting hydration) and slowing collagen loss.4As they’re fat-soluble molecules, they need support to be well absorbed.

Sensitivities to retinoids can limit their use, but proper discussions with clients as to how to introduce them safely and slowly can limit side effects.


Vitamin C is an essential part of our diet and prevents damaging oxidative reactions in our bodies. When applied topically, we can increase the availability 20 times and ensure concentrated and therapeutic levels in the skin.

The addition of zinc (in sunscreens) or tyrosine can further increase its bioavailability. Vitamin C is a potent antioxidant or free radical scavenger, a molecule that can prevent oxidative reactions by giving away a free radical but without becoming destabilised itself. This process prevents the loss of collagen that occurs as part of oxidative damage from free radicals.

Other studies have suggested that vitamin C plays a part in collagen and elastin production, both essential components in healthy, plumped skin. Further studies have shown it to be effective in inhibiting melanin synthesis through down-regulation of tyrosinase enzyme activity.

This, in turn, improves hyperpigmentation. Formulation is essential as vitamin C is inherently unstable and readily broken down with exposure to light and free radicals in the environment. Concentrations tested in studies range from 1-20%. PH3.5was suggested to be optimal. .5


Chronic sun exposure is known to cause photo-ageing to the skin, increasing rhytides, and pigmentation, reducing collagen (volume loss) and causing telangiectasia.

It’s estimated that 80% of skin damage is attributable to UV exposure. Not only have sunscreens been shown to prevent photoageing, but evidence also suggests that they may play a role in the reversal of extrinsic ageing.6


In general, a good diet and lifestyle negate the need for supplementation, with the exception of taking vitamin D in the Autumn/

Winter months, as recommended by the National Institute for. Health and Care Excellence. (NICE). At a time when depletion of collagen is so rapid and taken up by key joints first, it would seem sensible to load the diet as much as possible. Supplements of calcium may also be beneficial where diets are lacking.


All treatments that boost collagen can be helpful in supporting a healthy skin cycle. Dermal fillers can be particularly helpful for replacing lost volume, while skin treatments can be used to target pigment, increase the rate of skin turnover, or lift and tighten sagging skin. This might include radiofrequency microneedling, chemical peels, ultrasound treatments or laser

Menopause can be a difficult time and is only now being openly discussed. The role of the declining levels of oestrogen in skin health is well known, and side effects include rapid collagen loss, both dry and thinning skin and shifts in pigmentation.

Taking a holistic approach with your clients is essential, and great skincare, combined with supplements and skin treatments, may help restore their confidence and improve their skin health.


Sharron Gordon worked for more than 25 years in NHS practice in senior local, regional and national roles, specialising in thrombosis care, as well as running anticoagulant clinics across clinical settings. Her work has been shortlisted for two HSJ awards, and she has received an award from five patient charities for patient consultation support with anticoagulants. She currently runs her aesthetics clinic, ‘The Secret Garden Winchester’, specialising in holistic skincare journeys.


1. Sator PG, Schmidt JB, Sator MO, Huber JC, Hönigsmann H. The influence of hormone replacement therapy on skin ageing: a pilot study. Maturitas. 2001 Jul 25;39(1):43-55. doi: 10.1016/s0378-5122(00)00225-5. PMID: 11451620

2. Brincat MP et al. Climacteric 2005; 8: 110-123

3. Dunn LB et al. Arch Dermatol 1997; 133(3): 339-342

4. Retinoids: active molecules influencing skin structure formation in cosmetic and dermatological treatments -PMC ( accessed 15th June 2022

5. The effect of Vitamin C on melanin pigmentation – Asystematic review -PMC ( accessed 15th June 2022

6. Sunscreens and Photoageing: A Review of Current Literature -PMC ( accesses 15th June 2022


This article appears in the July-August 2022 Issue of Aesthetic Medicine

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This article appears in the July-August 2022 Issue of Aesthetic Medicine