Looking After Your Skin in the Menopause
Menopause is a time of changing hormone levels. Skin is the largest organ in our body; it’s connected to our nervous system and is influenced by stress and hormones.
How do we best protect our skin without neglecting the needs of our bones during the menopausal years and how much sun exposure is healthy? The answer is not as straight forward as we may have thought.
In this article, Hormone Health Associate and BMS Menopause Specialist Dr Liz McCulloch, shares practical information and advice on what increases your risk of skin cancer and how to look after your skin in the menopause.
Dr McCulloch also answers the question whether using higher SPF sunscreen blocks vitamin D production, which is known for its role in the calcium metabolism and responsible for bone health. Calcium is a vital nutrient for women going through menopause.
Skin cancer is one of the most common types of cancer worldwide.
In women in the UK, melanoma skin cancer is the 5th most common cancer, and it is one of the most preventable.
The number of women diagnosed with skin cancer has increased by 25% in the last decade. As the UK summers are getting hotter, we travel to tropical destinations or spend more time outdoors for leisure, we are becoming increasingly aware of the dangers of excessive sun exposure and the importance of skin health. Understanding skin cancer has never been more critical.
What is the cause of skin cancer?
Cancer Research UK states that we are now seeing the highest number of cases of melanoma skin cancer ever. The organisation reports that Melanoma skin cancer rates have been increasing by 7% in people between 25-49 over the last ten years. Worryingly, over the past decade there has been a 57% increase in skin cancer in the over 80s.
It is evident that skin cancer is an important concern for women to be aware of.
The main cause of melanoma skin cancer is ultraviolet (UV) radiation from the sun or tanning beds, with several factors that can increase the risk of developing skin cancer including:
- Having lighter skin colour
- A history of sunburn
- Excessive sun exposure
- Family history of skin cancer
- Immune suppression
- Ageing
Lighter skin colour
Melanin, which is the pigment in our skin, plays an important role in protecting the skin from the harmful ultraviolet rays in the sun. These UV rays can damage the skin and lead to skin cancer. People with lighter skin colour have a lower UV tolerance.
History of Sunburns
You may have enjoyed a childhood playing outdoors in the sun, however if you were burned by the sun a lot as a child there is an increased risk of developing skin cancer later in life. Research shows that having five or more sunburns doubles your risk of getting melanoma skin cancer and even one blistering sunburn in childhood or adolescence more than doubles your chances of developing melanoma later in life.
Sunburn is a clear sign the skin has been harmed by ultraviolet radiation and the damage to the skin cells’ DNA can lead to mutations which over time can develop into cancer.
Excessive Sun Exposure
As an adult you may enjoy an active lifestyle outdoors, perhaps you spend a lot of time outside in your job or you’re an avid gardener.
Be aware that cumulative years of doing this, without protecting yourself with sunscreen or protective clothing, can increase the risk of skin cancer.
Family History of Skin Cancer
Another factor to be aware of is a history of skin cancer in your family. Families who have light skin, red or blonde hair are amongst those at highest risk of developing skin cancer.
Your genes determine your phenotype (your physical appearance) as well as your immune system and DNA repair mechanisms, which also play a crucial part in the process of developing skin cancer.
Immune Suppression
If you have a medical condition or take medication that weakens your immune system, you may be at increased risk of skin cancer. If this is your situation, it is particularly important to examine your skin on an even more frequent basis.
Ageing and menopause
As women age, their risk of developing skin cancer increases, but we also have seen an increase in younger women. In fact, melanoma is the most common cancer in women aged 20-24 years old.
Over a lifetime, repeated exposure to UV radiation from the sun causes progressive damage to the skin’s DNA. This is a cumulative effect, which increases the likelihood of mutations that can lead to skin cancer. Our UV tolerance is different in our teens to our 40s, 50s and 60s due to the mutation profile burden.
Dr McCulloch says “During the menopause the skin can become drier and thinner. Exposure to sunlight can not only cause skin cancer but also accelerate skin ageing, causing increased wrinkles and pigmentation.”
The relationship with the menopause and its fluctuation of hormones is a complex one. We know that the drop of oestrogen leads to a loss of collagen and elasticity and also a thinning of the skin.
Menopause doesn’t always start with the obvious hot flushes and night sweats (known as vasomotor symptoms). Sometimes women are troubled by sleeping difficulties before vasomotor symptoms start. When your sleep is affected, you can see it in your skin and your eyes. Studies have shown that the mechanisms of our DNA repair are reduced when sleep deprived. Whether this reduced repair has an influence on the risk of developing skin cancer still needs further research due to the many variables involved.
What are the types of skin cancer?
Besides some rarer types, there are three main types of skin cancer, the most common is Basal Cell Carcinoma, the second most common is Squamous Cell Carcinoma, and less common is Melanoma, the most dangerous type. For every 1 Melanoma there are 10 Non-melanoma skin cancers.
1. Basal Cell Carcinoma (BCC)
This is the most common type of skin cancer. BCCs usually appear as small, shiny bumps or nodules on the skin, especially in areas frequently exposed to the sun, such as the face and neck. They grow slowly and rarely spread to other parts of the body, but if left untreated, they can cause significant erosion in the location of the nodule/ bump.
2. Squamous Cell Carcinoma (SCC)
SCCs are the second most common type of skin cancer. These can develop in sun-exposed areas, but are more likely to spread to deeper layers of the skin and other parts of the body, if not treated promptly.
3. Melanoma
86% of melanoma skin cancer is preventable. Though less common than BCC and SCC, melanoma is the most dangerous form of skin cancer. It can develop in existing moles or appear as new dark spots on the skin. Melanomas are prone to spreading to other parts of the body, making early detection and treatment crucial.
Tips and reminders for reducing the risk of developing skin cancer
Not all skin cancers are sun driven, some can develop in areas completely protected from the sun like the genitals or the mouth due to a virus known as HPV (Human Papilloma Virus), which can lead to cancerous changes. However preventing skin cancer still involves minimising exposure to ultraviolet light from tanning beds and sunlight. On the other hand complete sun avoidance can have a negative impact on our overall health. So how much is healthy and what are the different sunscreens available?
Follow these tips and reminders, and you’ll be taking action to protect yourself from the risk.
Use sunscreen
Apply a sunscreen known as a ‘broad-spectrum’ which protects you from both UVA and UVB rays. Make sure it is at least SPF 30, but personally I prefer SPF 50, and applying a generous amount is essential for protecting you from excess UV exposure.
Don’t let a cloudy day fool you, or even if you’re sitting indoors near a window. Using sunscreen on those days too, will protect your skin.
Dr McCulloch says “Sun can break down the skin’s collagen and lead to early wrinkling in a similar way as smoking does. If you use only one skincare product, I would invest into a broadspectrum sunscreen. Make sure it protects you from UVA and UVB.”
You may have some make-up and moisturisers containing SPF, however they usually don’t offer you the same level of protection as a good quality broad-spectrum sunscreen.
Mineral based also known as physical sunscreens contain inorganic substances like zinc or titanium. They don’t undergo a chemical reaction when exposed to UV Light.
Chemical sunscreen also known as organic sunscreens react with a chemical change. Some contain phenolic compounds, which are hydrophobic and lipophilic, meaning they can cross membranes very easily.
When you choose your sunscreen, look for a brand that you will use and offers broad spectrum UVA and UVB protection.
Wear Protective Clothing
Sunscreen reduces your risk of Melanoma and SCC, but I would recommend to wear protective clothing as well as topical sun screen to also reduce your risk of developing Basal Cell Carcinoma.
One of the most effective ways to protect your skin from the sun, in addition to applying a broad-spectrum sunscreen, is to wear a long-sleeved top, a wide-brimmed hat to protect your face, and sunglasses to protect your eyes.
Protecting yourself this way will reduce the risk of sunburn, skin ageing and damage and skin cancer, and protects sensitive areas such as the eyes and the delicate skin around the eyes.
Did you know: Prolonged UV exposure can lead to eye conditions like cataracts and macular degeneration.
Seek Shade
The harmful ultraviolet rays from sunlight are the strongest at midday, so avoid exposure during that time whenever possible. By doing this, you’ll lower your exposure to the ultraviolet rays and reduce any cumulative risk over time.
Sunburn is also most likely to occur at this time of day, so if you’re prone to burn, do your best to stay out of the sun in these hours. The UV-Index for your current location on many phones is a useful tool to see when the sun is at its strongest.
The question of how much sun is healthy for us is very controversial. Personally, albeit wearing a SPF50 sunscreen every day even in winter and being cautious with my sun exposure, I don’t believe that complete sun avoidance is good for us either, if we look at the issue holistically. I think that a small amount of sun can be beneficial for our circadian rhythm, mental health and well-being. People, who go out for a walk, have lower stress responses and we can measure a decrease in cortisol levels. We often feel happier, if we have been for a walk on a sunny day and we can see an improvement of skin appearance and texture. If we have no sun, we are at risk of developing Seasonal Affective Disorder.
It’s a fine line between preventing skin cancer as well as premature ageing and your skin’s UV tolerance, which will be genetically preprogramed.
Avoid Tanning Beds
If you love sunbeds, think twice about booking your next session. Why?
Tanning beds emit mostly UVAs and just like ultraviolet rays from the sun, they penetrate deep into the skin and contribute to skin ageing, formation of wrinkles and fine lines and increase your risk for developing skin cancer.
Regular Skin Checks
If you’re concerned about your skin, it’s important to examine your body each month, topped up by seeing a dermatologist once a year.
Doing your own skin checks helps you to become familiar with your own skin and any changes such as new moles or lesions. Make sure to check your back in the mirror or ask someone for help with areas, which are harder to see. Be mindful that if you have lots of tattoos, it might be harder to spot skin cancer.
A professional skin health check with a dermatologist can assess your individual risk factors, such as skin type and family history, and provide a tailored plan for skin care and monitoring of your skin even in areas which are hard to see, giving you peace of mind. Some consultants offer body photography and mole mapping. Detection of skin cancer is essential at an early stage. If you have a lot of moles or are considered at high risk due to your family history or weakened immune system, screening may be recommended more frequently.
Can SPF sunscreen block Vitamin D absorbed from the sun?
Yes, sunscreen can block UVB absorption in the skin, which is needed to produce Vitamin D. During the winter months very little UVB penetrates the earth depending on your location.
It is important to consider whether your body can produce adequate amounts of vitamin D when following the above sun protection advice, or if you need to supplement it.
The synthesis of this vitamin is essential for bone health, overall well-being and a reduction of cardiovascular risk. Only very few people apply enough sun lotion to completely block all UVB. How much Vitamin D your body can produce will depend on your age, your skin colour, where you live and even on your weight. Recommendations on how much sun exposure is needed to produce sufficient Vitamin D vary. Some studies suggest that you only need about 15 min on your forearms, but you need to consider the time of the day, your location and the season. Contrary to this, a UK recommendation states that between October and early March we do not make enough Vitamin D from sunlight and many take vitamin D supplements over the winter.
The relationship between sunscreen use and Vitamin D synthesis is particularly relevant for menopausal women, as fluctuations in hormone levels can impact overall health. A persistent low level of oestrogen is associated with a higher risk of developing osteopenia or even osteoporosis in future years. Vitamin D plays an essential role in the bone metabolism.
Sunscreen is essential for protecting the skin against harmful UV rays, slowing down skin ageing and reducing the risk of skin cancer. Although it’s possible that sunscreen can impact Vitamin D synthesis, it’s important to take a holistic approach whilst continuing to practice sun safety. Women can naturally enhance their Vitamin D levels through a diet rich in Vitamin D sources, such as fatty fish (like salmon and mackerel), egg yolks and red meat.
A healthy and balanced diet, exercise and other lifestyle choices play an important part in protecting your bones in this transitional phase. I have seen many women in the UK, who have deficient levels of Vitamin D. Our clinic can provide a blood test to monitor your Calcium and Vitamin D levels and give you guidance whether you will need Vitamin D supplementation. We can also arrange a Bone Density Measurement (DEXA Scan) and a blood test called Crosslap markers to determine the current bone turnover.
Summary
Skin cancer is a serious health concern for women, but there is plenty you can do to reduce the chances of developing skin cancer.
By understanding the risk factors, practicing sun safety, and monitoring your skin regularly, you can reduce your risk and catch any potential issues early. A holistic approach is needed and some women may benefit from Vitamin D supplementation to support bone health alongside skin awareness.
If you notice any suspicious changes in your skin, see your GP as soon as possible. Early detection and treatment are key to effectively managing skin cancer.
Meet Dr Liz McCulloch
Dr McCulloch is a recognised BMS Menopause Specialist and is a member of the British Menopause Society and British College of Aesthetic Medicine. She trained in Obstetrics and Gynaecology in one of the most reputable Clinics (Ignaz-Semmelweis) in Vienna and has worked as a GP since 2008.
Dr Liz McCulloch