BH27 Characterizing nail changes in menopause: symptom patterns and perceived impact

Abstract

Menopause is characterized by significant hormonal changes that can affect skin appendages, including nails. Menopause-associated nail changes are less well characterized in the literature, but may relate to downstream effects on nail matrix keratin production, collagen synthesis and decreased nail plate lipids [Brosche T, Dressler A, Platt D. Age-associated changes in integral cholesterol and cholesterol sulfate concentrations in human scalp hair and fingernail clippings. Aging Clin Exp Res 2001; 13: 131–8; Chessa MA, Iorizzo M, Richert B et al. Pathogenesis, clinical signs and treatment recommendations in brittle nails: a review. Dermatol Ther (Heidelb) 2019; 10: 15–27]. Patient-reported evidence on prevalence, symptom patterns and impact remains limited. We describe the prevalence and spectrum of nail symptoms reported in menopause and evaluate the impact of symptom burden. A mixed-methods quantitative–qualitative study was carried out comprising an online survey open to people experiencing peri­menopause or menopause in England. Semistructured interviews with 17 participants explored lived experiences of symptom burden. Among 1457 survey respondents, 578 of 1457 (40%) reported brittle nails, 350 of 1457 (24%) reported thin nails and 71 of 1457 (5%) reported thicker nails. In semistructured interviews, participants described nail changes as negatively impacting confidence, self-image and identity. Some reported coping strategies, including use of nail cosmetics, such as gel nails, to provide structural support for markedly thinned nails. Menopause-associated nail symptoms were frequently reported, with brittleness and thinning being the most common. Qualitative findings suggest these symptoms can carry meaningful psychosocial impact and prompt adaptive coping behaviours. Clinicians should proactively assess nail concerns in menopause. Improved recognition and evidence-based signposting are needed to address unmet support needs.