For women transitioning into menopause, the shift can bring more than hot flashes and joint pain. It may also prompt the onset or worsening of rosacea, a chronic inflammatory skin condition affecting the face, with symptoms like visible blood vessels, acne-like bumps, flushing, and persistent redness.
"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.
Declining estrogen can cause skin changes and symptoms that affect the blood vessels, like hot flashes, which can exacerbate rosacea symptoms. Here's a look at the physiological link between menopause and rosacea, along with some treatment options that may help.
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.
"As we age, we lose water and collagen in our skin, making it thinner, and the blood vessels beneath the top layer of skin cause flushing and redness," she says. For women, those skin health challenges can be exacerbated due to hormonal changes associated with the years leading up to menopause, known as perimenopause.
"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."
The main effects are:
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?
Research suggests that up to 80 percent of women experience hot flashes during menopause. Because a rosacea flare can also involve warmth and flushing of the skin, it can be easy to mistake one for the other. But there are some key differences, says Efe Kakpovbia, MD, a dermatologist at NYU Langone Health in New York City.
"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."
In contrast, a rosacea flush is generally confined to the face and is more likely to be associated with persistent skin changes, including redness, facial bumps, and visible blood vessels, she says.
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.
They include:
Topical skin-care medications such as metronidazole (Metrocream, Metrogel, Rosadan), azelaic acid (Finacea, Azelex), and ivermectin (Soolantra)
Systemic therapies like oral antibiotics
Laser or light treatments such as a pulsed-dye laser or intense pulsed light
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.
"However, it's important to keep in mind that data on the effects of hormone therapy on rosacea are mixed," she says. "Some studies suggest there may actually be an increased risk of rosacea for patients on these medications, but this research is limited."
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.
