Menopause and eczema

This is an Ask the Expert Q&A with Helen Dennis, Dermatology Nurse Adviser to NES, which was published in Exchange 183, March 2022.

Q.: I had eczema as a child and then seemed to grow out of it. But since I’ve hit my fifties, it’s back! Could this be due to the menopause? And if so, would hormone replacement therapy (HRT) help?

Helen Dennis says: Women often wonder whether changes in their eczema are due to hormonal changes, such as during or after pregnancy or with the menopause – which hits a year after your periods stop – or the stage before that (the perimenopause).

The two hormones affected by the menopause are progesterone and oestrogen and there are receptors for both of these within the skin. We don’t know how lowered progesterone affects the skin. But we do know that when oestrogen levels drop, this has two important effects on the skin:

  • The sebaceous glands produce less oil, leading to increased water loss and drier skin.
  • The skin’s microbiome changes, with an increase in microorganisms such as bacteria.

Both these processes can worsen the skin’s barrier function. If you have a history of eczema, this barrier may already be impaired, making it more vulnerable to damage.

HRT literally replaces the missing hormones, to address some of these changes, and the benefits are numerous. 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.

At present, only one in ten women tries HRT – mainly due to fears about associated risks. Women who take HRT are slightly more likely to develop some types of cancer, but the increase is small and, as we’ve seen, they are at lower risk of other disease, including other cancers.

HRT can be taken in several different ways, including implants, tablets, patches and gels. You don’t need testing and you can stay on it for as long as you want. HRT prescriptions are free in Scotland and Wales. In England, the cost will soon be reduced to one prescription charge each year.

This is an under-researched area, and the benefits of HRT specifically for eczema are not well evaluated, so it is not usually prescribed for skin problems alone. But if eczema flares arise around the time of menopause, some doctors will suggest trying HRT to see if it helps. It is certainly worth speaking to your GP to see if it could work for you.

If you do want to try HRT, the recommendation is generally to use it for at least three months to see an improvement.