As we age and go through life’s various stages our hormone levels change. An obvious and visible indicator of hormonal changes is the appearance of our skin. In this article, we will review the six key hormonal life stages and their corresponding effect on skin tissue. We will also discuss the correlation between hormones and skin.
The Six Hormonal Stages of Life for Women:
Puberty: Between the ages of 10-14 a female’s body experiences a surge in reproductive hormones - including estrogen, progesterone, and testosterone. This surge in hormones triggers the beginning of the menstrual cycle and other physical changes we see in puberty. The increase of testosterone causes sebaceous gland stimulation and increases sebum production leading to oily skin and clogged follicles. Excessive sebum is one of the causal elements of acne during puberty.
Acne flares are common at the beginning of the menstrual cycle due to the change in the ratio of estrogen to progesterone and testosterone. The decrease in estrogen levels (and a subsequent higher ratio of testosterone) leads to an increase in oil production. These two hormones work together to balance oil production on the skin. An imbalance in these hormones can lead to excess oil and breakouts. Acne is one of the most common skin conditions in teenagers, however, the severity of acne can vary widely depending on hormone imbalances, genetics, and environmental factors.
Pregnancy: During pregnancy, increased levels of estrogen and progesterone stimulate pigment cells in the body due to an increase in melanin stimulating hormone (MSH) from the anterior pituitary gland. This increase in MSH leads to darker moles, darker nipples, and vulva and can also result in a condition called melasma. Melasma is a hyperpigmentation of the skin due to the overproduction of melanin by pigment cells called melanocytes. This discoloration commonly occurs on the forehead, upper lip, and cheeks. Melasma is directly stimulated and worsened by UV exposure. It is paramount to avoid sun exposure and use a physical sunscreen if you have melasma. Pregnancy-induced melasma is benign and can resolve postpartum. However, if severe, prescription creams and procedures may be necessary to completely eliminate the hyperpigmentation.
Pregnant women are more susceptible to varicose veins. The spider veins and deeper engorged veins occur because of increased venous pressure in the lower legs during pregnancy and leaky valves affected by increased estrogen. These weakened valves allow blood to flow in the wrong direction and pool in superficial circulation. The good news is that for most healthy women veins tend to disappear or reduce in size in the months following delivery.
Hormones during pregnancy can also cause acne, even in patients who have not experienced acne in the past. Treating acne during pregnancy is limited due to the potential toxicities posed to the fetus. Hormonal therapy, oral antibiotics (like tetracyclines), and both oral and topical retinoids should be avoided during pregnancy. There are some safe topical therapies for pregnancy-induced acne, like topical erythromycin and sulfur-based products. Always consult with a board-certified dermatologist for approved topical therapies during pregnancy.
Postpartum: While there is an increase in estrogen during pregnancy, the opposite occurs post-partum. Estrogen levels decrease significantly after delivery and your skin “feels” this change. Some individuals can experience a dysregulation of oil production resulting in increased acne. Others experience a lack of luminosity, and severe dehydration manifesting in dry skin or cracked heels. While breastfeeding, topical medication should be cleared by consulting with your dermatologist. Decreased estrogen and hormonal imbalance return to a steady-state once breastfeeding ceases and normal menstrual cycles return.
Perimenopause: Perimenopause refers to the period of time before menopause when a female’s ovaries gradually begin producing less estrogen. Perimenopausal skin conditions include an increase in rosacea from flushing and overall aging of the skin (lack of elasticity, dullness, and volume shifts). Fluctuating estrogen levels during this time period also has an effect on lymphatic circulation and tissue health. A decrease in lymphatic drainage results in stagnant lymph fluid pooling in skeletal tissue may contribute to the appearance of cellulite.
Menopause: Menopause causes a natural decline in reproductive hormones including a drop in estrogen levels and an increase in the ratio of testosterone and progesterone. Estrogen increases collagen and thickness of the skin, therefore the decrease in estrogen during menopause causes significant dehydration due to an increase in trans-epidermal water loss. As a result, women feel drier and appear more wrinkled. Furthermore, the collagen depletion leads to a loss of skin elasticity and firmness.
As we age, the skin has a reduced ability to handle oxidative damage like sun exposure. During this time period, we see an increase in pigmentation issues like age spots, or solar lentigos. In addition, your risk of skin cancer rises, and annual skin exams are necessary as part of general health screening. Be sure to book an appointment for a full-body skin exam and see a board-certified dermatologist for screening. The earlier skin cancer is detected, the more treatable it is.
Post Menopause: During the post-menopausal period, skin continues to become drier and less elastic. This leads to thinner, more wrinkled tissue, and also volume depletion from significant collagen loss. The dermis, the deeper portion of the skin which provides the skin its turgor and tautness, becomes thinner resulting in a droopier appearance. These undesirable aging effects are exacerbated by declining estrogen levels in postmenopausal women. Systemic hormone replacement therapy (HRT) has been shown to improve some of these aspects of skin. Introducing more estrogen into your body can help restore skin thickness by increasing collagen synthesis and limit excessive collagen degradation. However, systemic hormone or estrogen replacement must be followed closely by your doctor because of the association of breast cancer in those with positive risk factors. Overall skin health, including wrinkling, elasticity, and hydration can be improved following estrogen treatment.
Hormones play a major role in the appearance of our skin. The various stages of our physiologic lives are largely defined by the hormone shifts that we experience. The severity of skin changes can vary widely from individual to individual, however, we all experience similar symptoms and changes as we grow throughout life. If you are experiencing any of the skin conditions mentioned in this article, make an appointment with a board-certified dermatologist for an evaluation.
Pregnancy and Melasma: http://www.scielo.br/scielo.php?pid=S0365-05962014000500771&script=sci_arttext
Acne and pregnancy: https://link.springer.com/article/10.1007/s40265-013-0060-0
Estrogen and Skin Post Menopause: https://link.springer.com/article/10.2165/00128071-200102030-00003