Did you know that low oestrogen levels can cause itchy skin? According to the Skin Cancer Foundation spokesperson, ‘itchiness increases with age’ due to our nerve endings being more prone to irritation. According to MedlinePlus (Health Information Library), there are multiple medical causes of itching, including metabolic disorders, for instance, diabetes, breast cancer, thyroid problems, and other skin conditions, such as eczema. Another possible cause of itching is low oestrogen levels.1 Oestrogen is concerned with collagen production required for skin building, as well as oil production for skin moisturisation. Therefore, the absence of oestrogen can result in thin and flaky skin.
Menopause and ageing are associated with the depletion of oestrogen levels in the body, leading to more sensitive and dehydrated skiing, and increased itchiness. Incessant itchy skin can be a source of irritation and impede daily living. This article will list the ways one can combat low oestrogen levels to avoid itchy and dry skin.
The Causes of Low Oestrogen
Oestrogen is a predominant hormone in people assigned female at birth (AFAB). However, those assigned male at birth (AMAB) can also produce it in small amounts. Oestrogen levels below normal can cause a number of health issues.
Low oestrogen levels can be a result of eating disorders, such as anorexia. Alternatively, oestrogen levels drop when the ovaries that produce oestrogen are damaged, when people AFAB enter perimenopause or approach menopause as they age.
Levels may decline in the following conditions:2
- Premature ovarian failure
- Turner syndrome
- Thyroid and other hormonal problems
- Being thin or underweight
- Low functioning glands in the brain (pituitary gland)
Symptoms of Low Oestrogen
Oestrogen is essential for many functions in people AFAB, such that its absence or abnormal levels can cause health problems.2 Below are some of the manifestations and symptoms of low oestrogen levels: 8
- Missed and/or irregular periods
- Inability to conceive or infertility
- Below normal bone health
- Hot flashes and hot flashes
- Mental health issues (e.g. depression)
- Vaginal dryness and low libido
- Bacterial infections of the vagina and UTIs
- Weight gain during perimenopause and in menopausal women
- During menopause results in ageing skin and vaginal atrophy
Oestrogen has numerous roles in the body. For instance, it contributes to immunity, wound healing, skin physiology and angiogenesis (new blood vessel formation). Furthermore, it plays an additional role in keratinocytes (form epidermis and are important for skin repair), sebaceous glands (prevent skin water loss and protect the skin from infection), hair follicles (regulate hair growth), and melanocytes (distribute melanin). Oestrogen decline has been associated with a significant decrease in skin collagen, resulting in thinness, loss of skin elasticity, wrinkling, and skin dryness. It has also been connected to hair loss and pigmentary changes.3
Prevent Itchy Skin
According to the National Eczema Association (NEA), frequent itching can make people depressed and anxious and lead to developing sleeping problems. Therefore, it is essential to consult a dermatologist about the excessive itchiness, who will then try to find the underlying cause of distress. For example, if it is suspected that itchiness might be caused by depletion of oestrogen levels, a dermatologist might recommend a patient to undergo blood tests, X-rays, and tests to assess liver and kidney function.4 Once the cause is known, a dermatologist can prescribe suitable medication (if necessary) and introduce the following solutions on how to reduce and/or prevent the itchiness:
Changing your shower habits
According to the American Academy of Dermatology Association, limiting bath time to a maximum of 10 minutes would help with itching. It is inadvisable to take a bath or shower with extremely hot water - lukewarm water is recommended for best results with itching. It is also advisable to use unscented soaps and fragrance-free soaps as additional harsh chemicals may further irritate the skin.
Protect your skin from the sun
Extreme heat is not good for the skin, and one must wear loose-fitting cotton clothes for protection from the sun. Applying a wet, cold cloth or ice pack to the skin soothes the sore and itchy skin. One can also put cooling creams by chilling them in the refrigerator before applying them to itchy skin.
Apply calamine and menthol-based moisturisers or regular ones like Cetaphil. One should also opt for fragrance-free, additives-free, perfume-free creams as these are less likely to irritate your skin. Moisturise all areas of the skin, including medicated areas, by using dermatologist-recommended creams only, at least once a day. Short-term corticosteroid creams are good for alleviating red and inflamed skin pruritus.1
Apply medicated corticosteroid creams to the red and inflamed areas. A cool, damp cotton material can be put over the area as moisture can better help absorb the cream. Other creams include capsaicin, camphor based, and a topical anaesthetic called pramoxine. Calcineurin inhibitors like tacrolimus (Protopic) and pimecrolimus (Eidel) can also be used for relieving skin conditions like itching and dryness.
Though antihistamines like OTC allergy medicines called diphenhydramine make one drowsy, they are extremely effective. Thus, it is advised for those suffering from itchiness that disrupts sleeping habits to take a good dose before bedtime. Doxepin can be used for atopic dermatitis and also has a psychotherapeutic antipruritic effect that is helpful for itching.2
According to Better Health Channel, hormone replacement therapy (HRT) or menopausal hormone therapy (MHT) are treatment options for clinical symptoms of perimenopause, menopause and postmenopause. In addition, they are suitable for women who suffer from itchiness that disrupts activities of daily living.
Some examples of the most commonly prescribed hormone therapies by doctors and dermatologists for treatment during the menopausal transition in women are:5-7
- Combination therapy of levonorgestrel-releasing intrauterine system (LNG-IUS) along with a low dose of oral contraceptive
- Percutaneous oestrogen
- Low doses of combined oral contraceptives (COC's)
- Oestrogen and progesterone therapy (EPT).
There are many side effects of using MHT, including an increased risk of breast cancer, especially with increased progesterone. There are additional problems like frequent bleeding and a tendency for symptoms to occur again once therapy is discontinued.6
Stress is rampant in everyone's life. Stress can make day-to-day functioning challenging, and long-term stress can affect physical and mental health. The fight-or-flight mechanism is when the body decides to respond to stress by exerting different levels of hormones like cortisol, catecholamines, thyroid, and corticotropin-releasing hormones. Long-term exposure to stress negatively affects the body by depleting or increasing hormone concentrations that change the clinical condition or status of many diseases. It can also result in endocrine disorders, like Graves disease, Diabetes Mellitus, and obesity.6 Oestrogen enhances female-specific itching and scratching by histamine-mediation in cells. This process becomes more frequent during menopause and pregnancy when these hormone levels fluctuate. When the itchiness is combined with high levels of stress, this can ultimately result in itch diseases in females. However, if stress and oestrogen levels are under control, the chance of developing itch disease can be minimised.7
Oestrogen levels decrease in perimenopause, menopause, and postmenopause and can wreak havoc on the body with clinical symptoms like itchy, dry skin, among others. It is important to consult a dermatologist if the itchiness prevents one from performing activities of daily living. Despite some conditions requiring medication, itchiness can be reduced and/or prevented by actively moisturising the skin, protecting the skin from the sun, and changing shower habits, among others.
- Jay K. Menopause Itching: Causes, Treatment, Prevention, and More [Internet]. Healthline. 2017 [cited 2022 Jun 29]. Available from: https://www.healthline.com/health/menopause/menopause-itching
- Collins BC, Laakkonen EK, Lowe DA. Aging of the musculoskeletal system: How the loss of estrogen impacts muscle strength. Bone [Internet]. 2019 Jun;123:137–44. Available from: https://www.sciencedirect.com/science/article/pii/S8756328219301206
- Thornton MJ. Estrogens and aging skin. Dermato-endocrinology [Internet]. 2013 Apr 1;5(2):264–70. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3772914/
- Estrogen Levels Test: MedlinePlus Lab Test Information [Internet]. medlineplus.gov. Available from: https://medlineplus.gov/lab-tests/estrogen-levels-test/
- Sayed GH, Zakherah MS, El-Nashar SA, Shaaban MM. A randomized clinical trial of a levonorgestrel-releasing intrauterine system and a low-dose combined oral contraceptive for fibroid-related menorrhagia. International Journal of Gynecology & Obstetrics. 2010 Nov 19;112(2):126–30
- Lee S, Cho M, Cho Y, Chun S, Hong S, Hwang K et al. The 2020 Menopausal Hormone Therapy Guidelines. Journal of Menopausal Medicine. 2020;26(2):69.
- Ranabir S, Reetu K. Stress and hormones. Indian J Endocrinol Metab. 2011;15(1):18-22. doi:10.4103/2230-8210.77573
- Takanami K, Uta D, Matsuda K, Kawata M, Carstens E, Sakamoto T et al. Estrogens influence female itch sensitivity via the spinal gastrin-releasing peptide receptor neurons. Proceedings of the National Academy of Sciences. 2021;118(31):e2103536118.
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