Patricia Yarberry Allen, M.D. is a Gynecologist, Director of the New York Menopause Center, Clinical Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medical College, and Assistant Attending Obstetrician and Gynecologist at New York-Presbyterian Hospital. She is a board certified fellow of the American College of Obstetrics and Gynecology. Dr. Allen is also a member of the Faculty Advisory Board and the Women’s Health Director of The Weill Cornell Community Clinic (WCCC). Dr. Allen was the recipient of the 2014 American Medical Women’s Association Presidential Award.

Dear Dr. Pat:

I am a 53-year-old woman who is three years into menopause.  I am writing about my skin.  I am of Irish-American ancestry and have always had delicate skin. But since menopause—and in the winter, primarily—my skin has become a nightmare. I saw a dermatologist before I entered menopause to begin some anti-wrinkle treatments.  I use a retin-A product and try to avoid the sun. I wash my face with a cleanser and then put an expensive moisturizer on, day and night.  Most of the year I am okay, but when the weather changes to cold—and, worse, when there are freezing winds—my skin turns bright red, and it burns. My skin is SO dry. I feel as if I could sleep in a bottle of moisturizer and the skin on my face would still be dry and very red everywhere. Actually, it’s so dry that it feels as if it is forming little cracks. Is this the result of menopause?  What should I do?  I did see a famous dermatologist and bought all his products, but nothing is helping.  Other than this problem, I am healthy and have nothing to worry about.  But when my face hurts and looks bad, it worries me a lot. My complexion did improve a bit this spring and summer but I need help before winter begins.

Eileen

Dr. Pat Responds:

Dear Eileen:

Your question could have been written by me six years ago. I used Neutrogena SOAP and water on my postmenopausal complexion, then used  various anti-aging potions, changing them when each failed to produce the promised results.  My skin became red, dry, and cracked, and then I attacked it with an exfoliating brush!  I had  lovely skin for half a day, then it became discolored, with red, dry patches once again.  My friend Margret Avery is a makeup artist. One day she told me that I had to stop destroying my complexion. I agreed to never expose my face to water again; to use a simple cleansing routine with Ponds Cold cream twice a day; and to use a delicate eye makeup remover from Neutrogena.  She suggested that I find a thick moisturizer without fragrance or any chemicals for day and at night after cleaning my face.  It took weeks for my skin to recover from years of abuse, but these simple tricks worked well for me.

There are likely a few contributing factors that are making your skin extra-sensitive at this time of year. First, there is genetic predisposition. Certain ethnic groups, including people of Irish descent, may have a propensity for sensitive, dry skin that can become easily irritated and red. Second, as you probably know, our skin changes as we age, becoming less supple and less able to retain moisture. Third, you mentioned menopause. It is clear that estrogens play a role in maintaining skin elasticity. Not only do we start to lose this elasticity once these estrogens decrease, but the skin also thins as well. This decrease of estrogens may also be responsible for increasingly dry skin, thanks to less sebaceous oil production.

Together, your genetic makeup and the change in hormones after menopause are a setup for easily irritated skin. Add a retinoid and cold, dry weather and you have a perfect storm of factors leading to the condition you describe. I’m afraid that not all of those underlying causes can be corrected, but don’t give up; there are certainly ways to improve this condition.