Eczema is one of those conditions that waxes and wanes throughout life. For many women, changes in hormones can trigger eczema flare-ups. The teenage years can often see a recurrence of childhood eczema. The same is true during pregnancy. In my case the first sign that I was pregnant was a flare up of eczema that had been dormant for years. That said, some lucky women find that their eczema improves during pregnancy.
It’s no surprise that the hormone changes associated with perimenopause and menopause can also trigger eczema flare-ups. We look at the underlying causes for these flare-ups and how they can be treated.
What is the perimenopause
Perimenopause means "around menopause" and refers to the time during which your body makes the transition to menopause when your periods stop.
During the perimenopause, levels of the hormones progesterone and oestrogen gradually fall. You may notice signs, like menstrual irregularity, in your 40s. But some women notice changes as early as their mid-30s. This transition period can last 2-10 years.
The symptoms of perimenopause vary hugely between women and can include lengthening or shortening of the menstrual cycle, mood changes, reduced libido, weight gain, acne, hot flushes and night sweats, brain fog and flare-ups of previously dormant eczema symptoms. Menopause is the period after you’ve had 12 consecutive months without a menstrual period.
How does perimenopause affect eczema?
The two main skin affecting hormones affected by the menopause are progesterone and oestrogen and there are receptors for both of these within the skin. As oestrogen levels drop, the sebaceous glands produce less oil, leading to increased water loss and drier, itchier skin. At the same time, the skin’s microbiome changes, with an increase in microorganisms such as bacteria. Both these processes can weaken the skin’s barrier function making it more sensitive to previously well tolerated irritants.
While the hormone changes associated with perimenopause and menopause don’t cause eczema, they do alter the skin to make it more vulnerable to irritation. If you are already prone to eczema, it’s not uncommon for it to flare up during the perimenopause. One study found that around 8% of women reported issues with eczema during their perimenopause or menopause1.
Eczema and the menopause
Eczema in the menopause is very similar to that of the perimenopause. However, as oestrogen levels stop fluctuating and bottom out, your eczema should stabilise and become a little more predictable.
As the perimenopause progresses, collagen levels in your skin also start to fall. This results in a reduction in your skin’s resilience and elasticity. This decline continues throughout the menopause with the skin losing around 30% of its collagen during the first 5 years of menopause. After that, the skin loses 2% of its collagen every year for the next 20 years2. This lack of elasticity makes your skin more vulnerable to damage, making eczema scratching more problematic than when you were younger. As your skin now takes longer to heal, it’s important to keep any scratching under control.
Treating peri/menopausal eczema
Treatments for perimenopausal eczema are the same as those for eczema at any other time of life, with the added option of HRT and cosmeceuticals that mimic oestrogen.
Hormone replacement therapy (HRT)
HRT literally replaces the missing hormones. It can alleviate the direct symptoms of menopause, such as flushing, insomnia, anxiety, changes in sex drive and skin dryness. It also helps preserve bone density. Some studies in women taking HRT have found a reduced risk of cardiovascular disease, bowel cancer, delayed onset of dementia and osteoarthritis.
The relationship between HRT and eczema is poorly understood with little research available for the impact of modern HRT doses. As a result it is not usually prescribed for skin problems alone. However if eczema flares up around the time of menopause, some doctors will be open trying HRT to see if it helps. It is certainly worth speaking to your GP to see if it could work for you.
Cosmeceuticals
Cosmeceuticals are cosmetics with bioactive ingredients which claim to have medical benefits. There are no legal requirements to prove that these products live up to their claims. The name is a portmanteau of "cosmetics" and "pharmaceuticals". Some cosmeceuticals have been specifically designed to replenish oestrogen. These products are typically based on oestrogen mimicking chemicals found within certain plants. While some of these chemicals do have scientific backing, it is typically funded by the cosmetics company behind the brand. These studies tend to be small and without the controls of placebos and randomisation, so should be treated with caution. However, they may be worth investigating as there is some evidence that they can increase skin hydration3.
Standard eczema treatments
Other things you can do to control perimenopausal (or menopausal) eczema
- Use emollients regularly, especially after bathing. Typically you will need to use them at least 2 a day and reapply as necessary.
- If eczema flare-ups can’t be controlled with emollients, ask your GP for steroid creams. Be sure to follow their instructions for usage.
- Try to identify and avoid things that trigger eczema flare-ups. If you had eczema as a child, the same triggers that aggravated your eczema then are likely to affect it now.
- Avoid soaps altogether (use emollients for washing instead) or stick to fragrance-free skin care products.
- Take shorter, cooler showers or baths.
- Review your wardrobe. Loose fitting cotton fabrics allow the skin to breathe and may be less irritating than other fabrics. The Tepso range of baselayers can also help here.
- Switch to a fragrance free laundry detergent without optical brighteners
- Aiming to avoid extreme hot or cold temperatures where possible, as this can cause an eczema flare-up.
- Review your diet. We are what we eat. Aim for a Mediterranean style diet with plenty of protein and added berries.
- As we age, skin takes longer to heal, minimise scratching damage by keeping your nails short and, if necessary, wearing gloves when you are more likely to scratch.
- Be sure to drink plenty of water to keep the skin hydrated.
