Eczema and Hormones: How Menopause Impacts Your Skin

Hormonal changes during menopause can affect nearly every organ in the body, including the skin. While menopause doesn’t directly cause eczema, the hormonal fluctuations that happen during this transition can alter the skin’s structure and function, increasing the risk of flare-ups.

Estrogen plays a vital role in maintaining skin health. Its decline can weaken the skin’s protective barrier, reduce its ability to retain moisture, and disrupt the balance of lipids that keep the skin hydrated and resilient. These changes can make the skin more susceptible to irritation, dryness, and inflammation, potentially triggering eczema, especially in individuals with a history of the condition.⁽¹⁾

Understanding this connection is crucial for managing eczema effectively during the menopausal transition. This article explains the role of menopause in eczema and different treatment methods to help manage it.

What is eczema?

Eczema is a general term for a group of conditions that cause the skin to become inflamed, itchy, and red. Atopic dermatitis, the most common form of eczema, is a chronic condition characterized by persistent itchy rashes. It’s associated with a weakened skin barrier, making the skin more susceptible to moisture loss, irritation, and infection.

The skin is a multi-layered organ that protects the body from external threats while maintaining internal hydration and temperature balance. It consists of three primary layers:⁽²⁾

• Epidermis (outer layer): This layer is made up of tightly packed cells and serves as the body’s first line of defense. It contains dead skin cells and natural oils that form a waterproof shield.

• Dermis (middle layer): This thicker layer provides strength, elasticity, and support to the skin.

• Subcutis (inner layer): This layer of the skin is composed of fat and connective tissue that provide insulation and cushioning for the body.

Stratum corneum, the outermost layer of the epidermis, maintains a balanced moisture content and protects against environmental stressors. It contains lipids like ceramides, cholesterol, and fatty acids that keep the skin supple and hydrated. 

However, this lipid layer is often compromised in eczema-prone skin. Reduced levels of ceramides and other essential lipids disrupt the skin’s barrier, leading to increased water loss and heightened sensitivity to irritants.

The Connection Between Menopause and Eczema

The skin is a dynamic, hormone-responsive organ with receptors for various hormones, including estrogen and progesterone. These receptors influence various skin functions, from collagen production to moisture retention. Estrogen, in particular, plays a critical role in maintaining the structure and function of the skin barrier.

It promotes the production of collagen, a protein that provides structural support and elasticity to the skin. It also increases the synthesis of hyaluronic acid, which helps with moisture retention. Estrogen also supports the production of ceramides, a key component of the skin’s lipid barrier that protects against transepidermal water loss and environmental irritants.⁽³⁾

While estrogen has generally positive effects on the skin, its decline during menopause can disrupt this balance. The skin’s ability to produce ceramides and maintain its barrier function gets compromised as estrogen levels drop, which results in skin dryness and sensitivity. This makes the skin more vulnerable to external irritants, allergens, and infections, creating conditions that can predispose it to eczema.⁽¹⁾⁽³⁾

Hormonal fluctuations can also affect the skin’s immune response. Estrogen generally supports a more robust skin barrier and helps regulate inflammation, while other hormones, like progesterone, may have a more complex and, sometimes, counteracting effect. This hormonal interplay can impact the skin’s ability to recover from barrier disruptions, potentially contributing to the onset or worsening of eczema.⁽³⁾

While hormones do not directly cause eczema, the impact of hormonal fluctuations on the skin’s structure, hydration, and immune response can create a more permissive environment for the condition to develop.

Symptoms to Watch for

Eczema can present in various ways, with symptoms often influenced by hormonal changes, skin type, and environmental factors. While the severity and location can vary, common signs include the following:⁽⁴⁾

• Thin, dry, tight, fragile, or flaky skin

• Persistent redness, itching, and irritation

• Crease-like lines below the eyes (Dennie-Morgan lines)

• Hyperpigmentation or hypopigmentation in affected areas

• Thickened, rough skin with exaggerated lines (lichenification) in chronic cases

• Increased skin sensitivity to irritants and allergens

• Flare-ups on the flexural areas (e.g., elbows, knees, wrists)

• Small, fluid-filled blisters that may break and weep in severe cases

• Cracked, rough patches on the hands, feet, or other pressure points

Causes and Triggers of Hormonal Atopic Dermatitis

Eczema is a complex condition influenced by genetic, hormonal, immunological, and environmental factors. Understanding these triggers is essential for effective management and prevention.⁽⁴⁾

• Genetic Factors: The filaggrin gene plays a crucial role in the skin’s protective barrier function. Mutations in this gene are strongly associated with eczema, as individuals with these genetic variations often have a compromised barrier, leading to increased water loss and greater sensitivity to irritants. In addition, mutations in other genes involved in lipid synthesis and skin barrier formation, like ceramide synthase and ABCA12, can also contribute to barrier dysfunction.

• Immune Disorders: Eczema is linked to an overactive immune response. Hormonal changes can influence the balance of pro-inflammatory and anti-inflammatory chemicals, affecting the skin’s ability to heal and resist allergens.

• Environmental Triggers: Common irritants include harsh soaps, detergents, fragrances, and environmental allergens like dust mites, pet dander, pollen, and mold. Extreme temperatures, low humidity, and excessive sweating can also exacerbate symptoms.

• Psychological Stress: Chronic stress can disrupt the skin barrier, increase inflammation, and trigger eczema flare-ups. It can also weaken the body’s immune response, making the skin more susceptible to irritation.

• Microbiome Changes: Hormonal shifts can alter the skin’s microbiome, reducing its natural defense against harmful bacteria like Staphylococcus aureus, which is commonly found on eczema-prone skin.

How to Treat Eczema During Menopause

Managing eczema involves a combination of lifestyle changes, non-hormonal treatments, and hormone replacement therapy (HRT), depending on its severity and the underlying causes. Choosing the right approach can help reduce flare-ups, improve skin health, and enhance overall quality of life.

Lifestyle Adjustments

Lifestyle choices play a critical role in managing eczema, as daily habits can directly impact skin health and barrier function.^(2)(4)(5)

• Including Moisturizers in Skin Routine: Regularly applying fragrance-free, lipid-rich moisturizers can help repair the skin barrier and reduce water loss. It’s best to apply these immediately after a shower or bath, when the skin is still damp, to lock in moisture.

• Avoiding Irritants: Harsh soaps, detergents, and synthetic fabrics can strip the skin’s natural oils. Choosing gentle, pH-balanced cleansers and using soft, breathable fabrics like cotton can help minimize irritation. Using humidifiers in dry climates and avoiding extreme temperatures can also help reduce flare-ups.

• Managing Stress: Stress can trigger or worsen eczema by increasing inflammation and disrupting the skin barrier. Techniques like deep breathing, yoga, or mindfulness can help reduce stress levels and minimize the risk of flare-ups.

• Making Dietary Changes: A diet rich in anti-inflammatory foods, like fatty fish, nuts, seeds, and leafy greens, can support skin health. Avoiding known allergens that may aggravate symptoms can also be beneficial.

• Drinking Enough Water: Adequate water intake helps maintain overall skin hydration and supports the skin’s natural barrier function.

• Maintaining Sleep Hygiene: Prioritizing quality sleep can help reduce inflammation and support overall skin health.

Non-HRT Treatments

Non-hormonal therapies are the first line of defense against eczema for many individuals. These treatments can help reduce inflammation, restore the skin barrier, and manage flare-ups.^(2)(4)(5)

• Topical Steroids: These anti-inflammatory creams or ointments are often the first choice for managing eczema flare-ups. They work by reducing redness, swelling, and itching. However, they require medical supervision as long-term use can result in skin thinning.

• Calcineurin Inhibitors: These non-steroidal creams, like tacrolimus (Protopic) and pimecrolimus (Elidel), reduce inflammation without the risk of skin thinning. They’re particularly useful for sensitive areas like the face and neck.

• Barrier Repair Creams: Products containing ceramides, cholesterol, and fatty acids help restore the skin’s natural barrier and reduce moisture loss.

• Phototherapy: This treatment uses controlled ultraviolet (UV) light to reduce inflammation and itching. It’s typically reserved for more severe cases that do not respond to topical treatments.

• Biologics: These are advanced medications, like dupilumab (Dupixent), that target specific parts of the immune system involved in eczema. They’re usually prescribed when other treatments are ineffective.

• Antihistamines: These medications block the effects of histamine, a chemical released during allergic reactions. While they may not directly treat eczema, they can help reduce itching and improve sleep.

• Probiotics and Prebiotics: Research suggests that maintaining a healthy gut microbiome can positively influence skin health and reduce inflammation.

• Natural Remedies: Some individuals find relief with natural options like oatmeal baths, aloe vera, or coconut oil, though the effectiveness can vary.

Hormone Replacement Therapy (HRT)

HRT is primarily used to alleviate menopause symptoms by replenishing declining hormone levels, particularly estrogen, which plays a vital role in maintaining skin health. Estrogen helps improve skin hydration, elasticity, and thickness, supporting the barrier function and reducing the likelihood of dryness and irritation. Progesterone is included in HRT to reduce the risk of endometrial hyperplasia and cancer for women with an intact uterus, as unopposed estrogen can stimulate the lining of the uterus.

HRT is available in various forms, including oral tablets, transdermal patches, topical creams, gels, and vaginal rings, allowing for flexible dosing and personalized treatment. However, it’s important to note that HRT is not specifically used for managing eczema. HRT is recommended only if other menopausal symptoms like hot flashes or vaginal dryness are present along with it. A physician can help decide the effectiveness of HRT in individual cases. 

Managing Eczema During Menopause

Living with eczema can be challenging, as constant itching and skin discomfort can significantly impact quality of life. However, most people can effectively manage symptoms with the right combination of lifestyle adjustments, medical treatments, and supportive care. A healthcare professional can help determine the best treatment options based on individual needs and medical history.