This article was first published in the June 2020 edition of National Eczema Society’s membership magazine, Exchange.
Q: I am 48 years old and going through the menopause. I have had atopic eczema all my life and until recently have been able to keep symptoms under control. But now the menopause seems to have returned my eczema to the severity I suffered as a child. Hot flushes and night sweats are making the irritation worse. My skin is very dry (especially on my lower legs), so I’m itching more and my eczema is flaring.
Can you advise on coping with eczema and the menopause? Might hormone replacement therapy help me?
Julie Van Onselen [NES dermatology nurse adviser] says: As you are going through the menopause, you are getting symptoms that many women will experience. Hormonal changes do seem to affect eczema, and hot flushes and night sweats will worsen your eczema, as perspiration is an irritant to eczematous skin. Menopause also causes changes to the collagen in the skin, changing the structure of your skin and making skin drier and thinner and reducing elasticity. All this can worsen eczema symptoms, and may explain why your eczema has returned to your childhood levels of severity.
Trying to take back control of your eczema and coping with menopausal symptoms is not easy, coupled with the reality that hormonal changes can make you feel more irritated and anxious. As your skin will become drier during and after the menopause, it may be worth changing your regular emollients. Humectant creams contain natural moisturising factors. This gives them enhanced hydration properties, so they last longer than simple creams or lotions. However, you may also need to moisturise more regularly. Ointments are good for hydrating dry skin, and are often recommended for overnight, however they are likely to irritate during night sweats.
Do talk to your GP about controlling your eczema flares. You may need to escalate treatment for a couple of weeks to gain better control. Improving your use of emollients and treating eczema flares is key to controlling itch. If you are considering hormone replacement therapy (HRT), you need to discuss this with your GP. They will discuss the risks and benefits, taking into account your age, medical history, risk factors and personal preferences. For the majority of women the use of HRT for the short-term treatment of menopausal symptoms is considered to outweigh the risks.
If HRT is suitable for you, it is likely to help your eczema as it will stop the hot flushes and night sweats, as well as improving skin hydration, thus removing some of the menopausal triggers for your eczema worsening.
Women on HRT should be reassessed by their doctor at least annually. For you, this will be important so they can assess your eczema too. Some women with eczema use HRT long term, for continued symptom relief and quality of life.