How Menopause Affects Rosacea

"There are many factors that contribute to the way our skin changes over time, especially for women, and that can contribute to how rosacea presents itself," says Suzanne Sirota Rozenberg, DO, a specialist in family practice and dermatology, and the chief of dermatology at Episcopal Health Services in Rockaway Park, New York.

Menopause, Aging, and Skin Health

Apart from menopause itself, aging causes significant changes in the skin's integrity and functionality over time, according to Dr. Rozenberg. In part, this comes from a lifetime of sun exposure, but it's also a natural aspect of getting older.

"This is when your ovaries slowly decrease function over time, and hormone levels like estrogen decrease, while cortisol — [a] stress hormone — increases," she says. "This hormone imbalance is associated with flares of rosacea because we have estrogen receptors in our skin."

• Changes in the skin's structure and function due to less estrogen
• Lower oil production and a weakened skin barrier
• Heightened inflammation due to hormonal changes

Decreased estrogen is also connected to other skin changes, such as increased dryness and wrinkling, and can also make skin more reactive to irritants, says Kecia Gaither, MD, an obstetrician-gynecologist and an associate professor of clinical obstetrics and gynecology at Weill Cornell Medicine in New York City. All of this can predispose women to rosacea, and feeling stressed about the situation can often make symptoms worse, she says.

"Also, rosacea triggers such as temperature extremes, spicy foods, skin-care irritants, and alcohol can all hit harder due to estrogen loss," says Dr. Gaither. "This can lead to more redness and flushing due to a higher level of systemic inflammation."

Is It a Hot Flash or a Rosacea Flare?

"A hot flash is typically a sudden sensation of heat that affects not only the face but also the chest, neck, and back," she says. "These episodes are transient and often accompanied by additional symptoms such as sweating, chills, and palpitations."

Managing Your Rosacea Triggers During Menopause

How you manage rosacea during menopause will depend on the severity and frequency of skin issues, says Dr. Kakpovbia. But there are a number of commonly used treatments that may be considered.

Rosacea Treatment

There are a number of potential treatments to reduce the effects of rosacea, Kakpovbia says.

• Topical skin-care medications such as metronidazole (Metrocream, Metrogel, Rosadan), azelaic acid (Finacea, Azelex), and ivermectin (Soolantra)

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• Systemic therapies like oral antibiotics
• Laser or light treatments such as a pulsed-dye laser or intense pulsed light

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In some cases, surgical procedures may be used for rosacea if other treatments aren't effective, says Rozenberg.

Hormone Therapy

Although hormone therapy (aka hormone replacement therapy) is not a primary treatment for rosacea — even if the condition develops as you approach menopause — it may be considered as a way to minimize menopause symptoms, says Kakpovbia. It may reduce hot flashes and decrease rosacea flushes as a result, and hormone therapy could improve skin hydration and thickness as well by increasing estrogen.

Because of that, she suggests speaking with your doctor if you have concerns that hormone therapy may negatively affect your rosacea, and monitoring your skin health if you're already taking hormone therapy.

Lifestyle Changes

Beyond therapies prescribed by your doctor, there are lifestyle habits that can potentially alleviate some symptoms of menopause as well as rosacea, says Rozenberg.

"People should maintain a healthy diet, partake in regular physical exercise, reduce stress where possible, and quit smoking," she says.

Gentle skin-care routines that are geared toward aging skin can also be helpful, says Gaither. That means using nonirritating cleansers and moisturizers without alcohol or fragrance, and avoiding exfoliation products that can be harsh on the skin.

"Daily sunscreen that's at least SPF 30 and mineral-based is another way to help prevent rosacea from worsening," she says.

Discuss Menopause and Rosacea With Your Healthcare Team

It's important to check in with your healthcare team about the intersection between hormonal health and rosacea, which may include both your dermatologist and gynecologist.

"It's important to have an individualized discussion about the potential impact of rosacea as you're going through perimenopause and menopause," says Kakpovbia. "Monitoring for symptom changes and adjusting treatment as needed is a practical approach."

The Takeaway

• Declining estrogen levels during menopause may worsen rosacea symptoms, including flushing.
• Although facial warmth and redness can occur with rosacea, menopause-related hot flashes are different, since they usually involve more of the body and last for a shorter time.
• Managing rosacea during menopause will require an individualized treatment plan, but the good news is that there are options for handling both skin health and menopause symptoms.