Thinner Skin After Menopause: Collagen Loss and Whether HRT Helps

Skin after menopause can feel drier, look thinner and bruise more easily.¹ Here is what the research shows about why, and what changes it.

What happens to collagen

Collagen gives skin its firmness and thickness. US dermatologists cite studies showing skin loses about 30% of its collagen in the first five years of menopause, then about 2% a year for the next 20.¹

Studies from the 1980s pointed to hormones:

• Biopsies from 55 postmenopausal women found about 48% more collagen in those who’d had estrogen and testosterone implants for 2 to 10 years.²
• In women without hormones, collagen fell with years since menopause, not with age itself. Women given implants had thicker skin.³

Those studies compared treated and untreated women rather than assigning treatment at random, used implants that included testosterone, and measured tissue, not how a face looked.²

Does modern hormone therapy change wrinkles?

The best test is a randomized trial, the KEEPS skin study:⁴

KEEPS skin study
Who	Women aged 42 to 58, within 3 years of their last period4
Treatment	Low-dose estrogen pill, estrogen patch with progesterone, or placebo, for 4 years4
Measured	Wrinkles at 11 spots on the face and neck, and firmness of the forehead and cheek, every year4
Result	No difference in wrinkles or firmness between hormones and placebo4

The biggest predictor of skin aging in those four years was race and ethnicity, not hormones.⁴ Hormone therapy is used for symptoms like hot flashes, not for skin appearance; see is hormone therapy safe?

What helps

1. Sunscreen every day, SPF 30 or higher, on face, neck and hands. It can’t thicken skin but can prevent further thinning.¹
2. A mild cleanser instead of soap, which can be too drying for mature skin.¹
3. Moisturizer after bathing and whenever skin feels dry; hyaluronic acid or glycerin can help.¹
4. Ask about a retinoid cream or laser if thinning or lines bother you.¹ See prescription tretinoin.

Collagen supplements have weak independent evidence; see do collagen supplements work? For easy bruising and tears, see purple bruises on the forearms and skin tears and thin skin.

Try: “My skin has become thin and dry since menopause, and it bruises easily. What can I do for it, and is anything here a reason to look closer?”

My Body Changed. Now What? covers this in Chapter 9, “Desire, Skin and Hair,” in a section called “Skin After Estrogen.” Its Change Map separates itching, cracking, a new rash and a cosmetic worry, so you can tell a clinician which one you’re bringing. See the book.