The menopause and perimenopause can play havoc with skin, causing sensitivity, acne and dryness. We reveal how you can help clients manage the symptoms by switching them to a regime designed to nourish oestrogen-depleted complexions.
Menopause has an astonishing effect on both mental and physical health of women worldwide, with a survey by Skin Health Alliance revealing that 43% of menopausal women believe they have become less attractive, 28% no longer like looking in the mirror and 22% feel stressed and/or depressed by the changes happening to their skin.
The data from the survey went on to reveal that more than half (65%) of menopausal women feel less confident in their skin and appearance since turning 40, and a staggering 96% shared how they had experience skin changes as a result of the menopause.
With more than half (60%) of UK women confessing to not knowing what early or premature menopause is, and half suffering with dry skin during the change, there has never been a more prudent time to talk about the menopause... Especially as the topic is becoming less taboo and starting to get the attention it needs and deserves.
"Menopause is a major change happening to the clients in front of you," says Dr Ginni Mansberg, GP, author and founder of ESK Skincare.
"Less than 10% will go through menopause and not have any symptoms so if you understand what is happening and empathise and validate what they're bringing to you, you can be their superhero, not just their facialist."
Why is menopause a hot topic?
“Discussion about the menopause has been an avoided topic with significant health and wellbeing consequences,” says Candice Gardner, education manager for skincare brand Dermalogica.
“For many women, this means they don’t know what to expect and may not be aware of the steps to take that can help them manage the symptoms.”
But this cycle of confusion needs to stop, and the salon and spa environment is the ideal place to educate women on what to expect.
The menopause is a natural part of ageing that usually occurs between 45 and 55 years of age, causing oestrogen levels to decline, marking the end of a woman’s menstrual cycle.
Vital hormones – oestrogen, progesterone and testosterone – start to fluctuate, leading to a number of physical and mental changes.
“This nosedive in hormones causes havoc with the body as it struggles to rebalance and it affects absolutely everything – wellbeing, mood, sleep, digestion, sex drive, energy, memory and, of course, the skin,” explains Tracy Tamaris, co-founder of the International Institute of Active Ageing (IIAA), which distributes vitamin A-rich skincare range Environ.
How does perimenopause affect the skin?
With there being a staggering “51 different symptoms of menopause, including one where it feels as if ants are crawling on your skin”, according to The Menopause Consortium’s clinical lead director Dr Joanne Hobson, the change will affect everyone differently, which means you need to be responsive in your approach to treating clients in salon.
The skin will have different requirements during perimenopause, known as the transition phase, and menopause, which the NHS say women reach when they haven’t had a period for 12 months, marking the end of their menstrual cycle.
“The perimenopause is known as the beginning of the change, which can start as early as 35 and last for as long as 10 years.
"Changes are starting to happen in the body and many clients won’t be aware it’s a perimenopausal state they are in,” says skin specialist Martine Jarman, founder and director of SkinGenius Clinic in Cheshire.
During this phase, there can be a surge of reproductive hormones, which fluctuate wildly – “it’s the body’s way of saying, ‘this is your last chance to get pregnant, time is running out’,” explains Gardener.
“The skin can become more sensitised and respond unpredictably to treatments and products, and the symptoms will vary depending on whether there are high or low oestrogen levels.
"For some, the vascular hyperactivity can cause issues like telangiectasia (thread-like red lines or patterns on the skin) and rosacea to develop.”
Tracy Munro, a mindful menopause coach, says, "There are changes in the skin which therapists carrying out facials will notice. There’s dryness and dehydration, and quite often there is redness and sensitivity.
"If this is the case, then therapists need to be looking at rebuilding the skin’s barrier. You also often see more pigmentation and if clients have a history of breakouts, then these can reappear as well."
"As estrogen declines, we see a loss of collagen... within five years of menopause we lose 30% of our collagen," says Dr Mansberg.
And continue to lose another 2.1% of your collagen every single year after menopause for at least 12 years after that. So obviously, if you are seeing people who are in the lead up to menopause, you want them to hit menopause with as much collagen in their skin as possible to make that journey smoother and slow down rapid acceleration of all of the signs of ageing."
25% of women will also get a perimenopausal acne breakout adds Mansberg.
"Studies show that this new onset of acne that happens in midlife women is very different to women who have had it throughout their 20s and 30s. Anyone who starts to get acne in their 30s or later or those who had 10 years off, we should be thinking about polycystic ovarian syndrome," she says. "Other studies have shown that up to 80% of women who get acne in midlife have an unmasking of polycystic ovarian syndrome that potentially wasn't picked up when they were younger."
How can it be treated?
The symptoms will also vary according to the client’s inherent skin type – for example, dry or prone to breakouts – so make sure to swot up on their skincare history, as well as analysing the state of their complexion every time they visit, before choosing your skincare protocol. Also, be aware that the changing hormones can lead to difficulties maintaining the water balance in the body, which can result in fluid retention, swollen eyes and puffiness.
Being mindful of the affect these fluctuating hormones will have on the skin is key to helping clients manage the symptoms effectively. “You should be advising the use of vitamin A to normalise and regulate the healthy functioning of the skin cells, as well as hyaluronic acid to hydrate and plump,” adds Tamaris.
“Peptides will also help to stimulate healthy production of collagen and elastin, and vitamin C will strengthen capillaries. All treatments should use enhanced penetration techniques to ensure these active ingredients reach the deeper layers of the skin.”
Dr Maryam Zamani echoes the benefits of vitamin C for menopausal clients, adding that, “Vitamin C, which supports with fighting against free radical damage that causes oxidative stress and skin ageing while brightening skin.
Adding a retinoid is essential to brighten the complexion while helping increase cell turnover and promoting the proliferation of collagen and elastin.”
"Acne breakouts require ingredients that balance the microbiome and reduce inflammation while promoting the healing process, such as niacinamide,” explains Gardener.
How does menopause affect the skin?
The menopause brings with it many changes, the most common being hot flushes, vaginal dryness, decreased sex drive, memory fog and increased fat in the stomach area, to name a few. However, the skin is heavily impacted too, which is why clients need to seek help from a trusted specialist to keep it calm and happy.
“The skin gets drier and more sensitive because of the reducing oestrogen levels, and in the first five years of the menopause, clients lose around 30% of their collagen.
It’s one of the biggest issues, with skin looking thinner and showing more pronounced lines and wrinkles,” explains consultant dermatologist Dr Emma Wedgeworth. This is the time to offer clients more advanced treatments like radiofrequency and microneedling, which are good for skin tightening.
Cell renewal also drops during this time and the sebaceous glands slow down the production of oil, leading to dull, rough skin, meaning that even the most robust complexions can become more vulnerable to irritation.
Therefore, it’s not uncommon for clients to experience sensitivity to products they’ve been using for years.
“The skin barrier, which controls skin sensitivity, becomes more fragile during this time, so you need to increase hydration for clients by choosing products that are a little richer,” adds Wedgeworth.
However, avoid pore-blocking oils and steer clear of abrasive treatments and deep scrubs because they can break down the skin barrier too.
How can it be treated?
Wedgeworth advises salons look into stocking more advanced skincare options such as Emepelle, a serum and moisturiser range designed specifically for menopausal skin, which “uses intelligent technology to try and reverse hormonal changes by restoring an oestrogen-like effect on the skin”, she adds.
For clients suffering with relentless hot flushes or sensitive skin conditions such as rosacea, reach for cooling gel formulas or those formulated with oats to help calm the irritation in treatment.
All the experts agree that you should be recommending sulphate-free cleansers packed with antioxidants to help stimulate collagen production and protect against ageing caused by environmental aggressors, as well as steering clear of fragranced products, which can irritate sensitised skin.
Jarman explains that clients bone density also starts to change during this time - the underlying facial skeleton starts to deteriorate and the deep fascia ligaments become lax, “causing sagging of the skin around the jaw area and sunken, hollow eyes.” Jarman advises using HIFU (high intensity focused ultrasound) with radiofrequency to tighten the deeper fascia ligaments.
If your clients are struggling with all aspects of the change then encourage them to book an appointment with their GP to talk about the options available, including hormone replacement therapy (HRT), a synthetic drug that comes in two forms – oestrogen-only and a combination of oestrogen and progestogen; and bioidentical hormone replacement therapy (BHRT), a hormone preparation made from plant sources that are promoted as being similar to human hormones.
For large spa operations, you could introduce menopausal-specific day packages to your menu too, to help clients manage the skin symptoms caused by the change. These packages contain nutritional meals, wellness therapies and facials tailored to that client's specific skin needs.
How can therapists help on an emotional level?
The act of taking time out of their day to visit a salon or spa can also be a crucial part of a client's menopause treatment, and it's important that therapists support them emotionally as well as through their beauty or spa treatment.
"Ask clients how they are and really listen to what they tell you," says Munro.
"Give them permission to take some time out for them. "Current publicity around the menopause is helping, but a lot of people won’t necessarily want to talk about the menopause. Clients might have tried to talk about it at home and not gotten anywhere, they may have spoken to their GP and been told they’re too young and their symptoms are something else.
"Therapists need to support them in that space and try to give them help and make sure they feel supported."
"People going through menopause might be pretty angry," says Dr Mansberg. "They're not sleeping properly and exhausted and can be extremely emotional. This is a time when they are most likely to experience anxiety and depression.
"Its a peak time for divorce and bust-ups with friends because women are more sensitive and paranoid at this time. This is all completely normal at this time of life, and you validating that makes them feel seen."
3 ways to reduce menopausal symptoms:
• Regular exercise – Yoga and tai chi are said to reduce stress levels. You could partner with a personal trainer to offer a combined treatment and fitness programme for clients.
• Healthy diet – clients should be opting for a diet rich in vegetables, fruits and healthy fats, while cutting down on caffeine and spicy food, which the NHS says can trigger hot flushes.
• Self-talk – “Women can feel less worthy during this time so you have to help build up their confidence,” says Dr Howard Murad, founder of the eponymous skincare range. He recommends giving clients daily affirmations to say to help boost their self-esteem.
