Effects of Hormone Replacement Therapy (HRT) on Aging Skin

Menopause is a turning point in women's lives. In addition to the intrinsic effects of aging, exposure to sunlight and other environmental and endogenous stimuli, the climacteric appears to exert some dramatic consequences on skin biology. The epidermis becomes dry, the dermis thins out with decreased elasticity, disorganized collagen bundles and microcirculation is impaired.

SKIN AND MENOPAUSE

HRT seems to have a beneficial effect on the skin. In Westernized societies, a woman's appearance is largely judged by the quality of her skin, which reflects general health. Menopause appears as a unique event in life, often perceived as a turning point announcing decline in skin qualities which seem to be worst in the decade following menopause due to the lack of HRT.

Postmenopausal women generally complain of dry, easily bruised and wrinkled skin. Aging skin can cause psychological distress to women. Several studies have shown that both skin thickness and dermal collagen decreases after menopause due to hypoestrogenism. Since the skin contains receptors to estrogens and androgens, these hormones exert a profound influence on both skin biology and composition.

Thus it is believed that adequate hormone levels are required to control its structural integrity and functional capacity. Indeed the one area that has fulfilled the hope of research on HRT has been the changes that occur in the skin and the bone.

In particular, the skin's connective tissue tends to become thinner during menopausal transition and in the following years. The decline super venting immediately after menopause apparently occurs at a much more rapid rate than in the later years.

The skin contains receptors to estrogens and androgens. It is believed that adequate hormone levels are required to control its structural integrity and functional capacity. Indeed the one area that has fulfilled the hope of research on HRT has been the changes in that occur in the skin and bone.

Skin collagen content and skin thickness have been reported to increase in women with on HRT compared to aged matched controls. Estrogens also increase the water content of the dermis, probably through the enhanced synthesis of Hyaluronic acid.

HRT and WRINKLES

The climacteric appears to be the most affected periods in life affected by wrinkles especially on the forearm and face. The reduction in the compactness and quality of the collagen bundles leads to skin loosening and loss of elasticity. Fine wrinkling, atrophy and a progressive deepening of facial creases ensue. These skin alterations have been noted to be partially reversed in postmenopausal women treated with estrogens or combined HRT.

HRT AND THE EPIDERMIS

Xerosis or dry skin is an alteration of the stratum corneum resulting from decreased hydration as well as a weakening of the barrier function of the skin. The skin water-holding capacity of the stratum corneum,appears to increase following HRT.

CONCLUSIONS

Skin after menopause suffers from some decline in its aspect and physical properties. HRT has been shown to protect in part the skin from some of the negative changes. The effects can be mediated by a direct hormonal effect when the cells have the adequate receptors.

All the foregoing findings indicate that chronologic aging, menopause, estrogen and HRT all have profound effects on various perts of the skin.

HRT has been shown in many studies to reverse either partially or completely some of the changes. At least the skin represents the one target organ where the HRT benefits are immediately obvious to the woman and her relatives.