Why Do Scars Flare Up During Menopause? The Hormonal Science Behind Midlife Scar Changes

Quick Summary Old scars can become itchy, tight, or more sensitive during perimenopause and menopause - and there is a biological reason this happens. Declining estrogen levels affect skin collagen, hydration, barrier function, and nerve signalling in ways that can reactivate dormant scar tissue. This is common; it is not a sign that something is newly wrong, and there are evidence-based ways to manage it. The key is understanding what is actually happening beneath the skin.

What Changed? The Midlife Scar Question Many Women Ask

You had a C-section 15 years ago. The scar settled, faded to a pale line, and you barely thought about it for years. Then, somewhere in your late 40s or early 50s, it started feeling different - occasionally itchy, a little tighter than it used to be, or more noticeable when the weather changes or you feel warm.

You are not imagining it.

This is one of the more common - and least discussed - experiences during the menopausal transition. Women who have had surgery, significant injuries, or previous skin procedures often notice their scars behaving differently after decades of quiet. Understanding why requires a closer look at what estrogen actually does for skin, and what happens when its levels fall.

How Estrogen Shapes Skin Biology in Midlife Women

Estrogen is not simply a reproductive hormone. It plays an active regulatory role in skin structure, and the skin contains estrogen receptors in keratinocytes, fibroblasts, and melanocytes - all cells involved in maintaining healthy skin.

Research published in Cosmetics (2024) confirmed that declining estrogen levels negatively affect the extracellular matrix, the structural scaffolding that gives skin its strength and resilience. The specific changes include several interconnected processes.

Collagen loss accelerates significantly. Research suggests significant collagen loss occurs in the early years following menopause, with some studies indicating losses of up to 30% in the first five years, and collagen content continues to decline at approximately 2.1% per postmenopausal year. Importantly, this rate correlates with time since menopause rather than chronological age, suggesting that estrogen deficiency is the driver, not simply aging.

Skin thins measurably. Skin thickness decreases by approximately 1.1% per year following menopause, as reduced fibroblast activity limits the production of structural proteins.

Glycosaminoglycans decline. These molecules are responsible for retaining moisture in the dermis. As their levels fall, skin becomes drier, less plump, and more prone to surface friction and microtrauma.

Barrier function weakens. Reduced sebum production and thinner epidermis mean the skin's protective outer layer becomes less effective at regulating water loss and resisting environmental stressors.

Vascular response changes. Estrogen supports blood vessel integrity and wound healing. Its reduction leads to impaired microcirculation and a slower, less efficient cellular response to injury or irritation.

Cellular turnover slows. The rate at which the skin renews itself slows, so damaged or compromised cells are replaced more slowly.

These changes do not occur in isolation - they interact. And scar tissue sits within this shifting biological environment, subject to all of it.

Why Scar Tissue Is Particularly Vulnerable to Hormonal Change

Scar tissue is structurally different from the skin that surrounds it. When the body heals a wound - whether from surgery, injury, or a deep burn - it lays down collagen in a disorganised, cross-hatched pattern rather than the basket-weave arrangement found in normal skin. This creates a more rigid, less flexible tissue.

Several features of scar tissue make it more reactive to the menopausal environment:

Scar collagen is already irregular. In normal skin, collagen fibres run in different directions, giving it flexibility. Scar collagen is largely parallel and disorganised, reducing stretch tolerance and increasing the likelihood of mechanical tightness as the surrounding skin thins.

Scar tissue lacks glands. Hair follicles and sweat glands are not rebuilt during healing. This means scar tissue cannot produce its own moisture or sebum, making it wholly dependent on hydration from adjacent skin, which is itself becoming drier during menopause.

Scar nerves are often hypersensitive. During healing, nerve fibres regenerate in altered patterns. Research on hypertrophic scars has found elevated levels of neuropeptides, including substance P (SP) and calcitonin gene-related peptide (CGRP) - both associated with pain and itch perception. These nerves can remain sensitised for years.

Drying and thinning of the surrounding skin increases tension. As the dermis becomes thinner and less elastic with estrogen loss, the skin around a scar transmits greater mechanical force through the scar tissue itself, potentially triggering tightness or itch.

The scar is not being newly damaged. It is responding to a changed environment - one that is drier, thinner, less flexible, and less well-regulated than it was a decade ago.

Hormones, Nerve Sensitivity, and Why Scars Can Itch During Menopause

The relationship between estrogen and sensation is less well known than its effects on skin structure, but the research is meaningful.

A study published in PNAS (2021) demonstrated that estradiol influences itch sensitivity via spinal cord neurons - specifically those expressing gastrin-releasing peptide receptor (GRPR), which mediates itch processing. The researchers noted that female-specific pruritus (itch) occurs during pregnancy and menopause - two periods of significant hormonal fluctuation - and proposed that estrogen's regulatory effects on these neural pathways may explain why.

Separately, research on scar tissue has shown that hypertrophic scars contain higher levels of substance P, which contributes to pain and itch signalling via sensory nerve fibres in the dermis. When estrogen's moderating effect on the nervous system declines, scar nerves that have remained sensitised since the original injury may become more reactive.

Vasomotor changes during menopause - including hot flushes and increased skin temperature fluctuations - may also contribute. Heat and sweating can temporarily increase blood flow to scar tissue, amplifying sensation in an area that already has altered nerve architecture.

None of this is evidence of ongoing damage. It is, rather, the nervous system responding to a less regulated environment. The signals may feel significant, but they typically reflect sensitivity rather than injury.

Is a Scar Flare During Menopause Something to Worry About?

For most women, changes in scar sensation during the menopausal transition are a normal response to hormonal shifts - not a sign of a new problem.

Common and generally benign experiences include occasional itching, particularly after heat or sweating, a feeling of tightness that may be more noticeable in certain positions, slight changes in texture or colour that fluctuate with the menstrual cycle in perimenopause, and increased awareness of the scar after years of not noticing it.

There are situations where a GP or dermatologist should be consulted. These include growth of the scar beyond its original borders (which may indicate keloid development), progressive hardening or raised texture that was not previously present, persistent pain rather than occasional itch, and any colour change that appears to be spreading. These warrant professional assessment to rule out conditions such as keloid formation or, very rarely, malignant change.

If you are uncertain, a conversation with your doctor is always worthwhile. For most women, the answer will be reassuring.

What May Help: Evidence-Based Care for Menopausal Scar Changes

Managing scar sensitivity during menopause is primarily about addressing the underlying environment - dryness, thinning, and barrier vulnerability - while supporting the scar tissue itself.

Consistent hydration is the first priority. Menopausal skin loses moisture significantly faster than younger skin, and scar tissue, lacking glands of its own, is entirely dependent on topical hydration. Using a fragrance-free moisturiser twice daily over and around the scar may help reduce tightness and mechanical irritation.

Barrier repair products can also be beneficial. Look for ingredients such as ceramides, niacinamide, or hyaluronic acid, which support the skin's outer layer and help reduce transepidermal water loss.

Silicone therapy has one of the strongest evidence bases for scar management and may be particularly relevant during the menopausal transition. Medical-grade silicone is thought to work through two primary mechanisms: creating an occlusive barrier that maintains optimal hydration in the scar microenvironment, and potentially modulating fibroblast activity and collagen signalling within the scar tissue. As the surrounding skin becomes drier and less hormonally regulated, silicone's ability to create a stable local environment may help moderate some of the reactivity. Genova Silicone Scar Gel is a worth considering option; it is designed to support ongoing scar management and is formulated for consistent daily use. More information is available at genovaskincare.com.au/products/genova-silicone-scar-gel.

A gentle massage may help maintain mobility in scar tissue that is feeling tight. A few minutes of circular pressure around and over the scar, using a plain moisturiser, can support collagen remodelling and reduce the sensation of restriction. Avoid massage if the skin is broken or inflamed.

Sun protection is especially important for menopausal skin, as thinner skin burns more easily and UV exposure can cause scar discolouration or worsen sensitivity. Use SPF 30 or higher on scarred areas exposed to sunlight.

Minimising friction from clothing or waistbands over scar sites can reduce daily irritation. Soft, breathable fabrics reduce the mechanical load on skin that has less cushioning than it once did.

For related reading, if you're noticing scar itch without a clear hormonal connection, see Genova's article "Why Does My Scar Itch Years Later?" explores the broader biological mechanisms behind long-term scar sensitivity - the hormonal and non-hormonal causes often overlap, and understanding both builds a clearer picture.

Is It Too Late to Help an Old Scar?

This is a question many women in their 50s and 60s ask, and the answer is more encouraging than they expect.

Scar tissue remains metabolically active throughout life. The collagen within it continues to remodel - slowly but genuinely. The scar you have at 55 is not the same structure it was at 35, even if it looks similar. This means it can still respond to consistent, appropriate care.

The realistic expectation is not a dramatic change but a meaningful improvement in comfort, texture, and hydration over several months. Results vary between individuals, and older or more established scars may respond more slowly. Consistency matters considerably - sporadic application of any product is unlikely to produce the same outcome as daily use over 12 weeks or more.

What does not help: expecting quick results, stopping treatment at the first sign of improvement, or assuming that nothing can be done because the scar is old. Scar tissue is living tissue. It responds to care.

Myth vs Reality: What Most Women Get Wrong About Menopausal Scars

Myth: Menopause doesn't affect scars. Reality: The structural and hormonal changes of menopause directly affect the skin environment in which scar tissue exists. Reduced collagen, dryness, thinned dermis, and altered nerve regulation all have implications for scar behaviour.

Myth: If a scar changes over the years, something must be wrong. Reality: Scars can become more noticeable or sensitive during hormonal transitions without any new damage occurring. It is the environment, not the scar itself, that has changed.

Myth: Only new scars respond to treatment. Reality: Scar tissue continues to remodel throughout life. Older scars can show improved texture and reduced sensitivity with consistent, appropriate care — though expectations should be realistic and timelines longer.

Myth: If my scar is itchy, it must be healing again. Reality: Itch in an old scar usually reflects nerve sensitivity or dryness rather than any active healing process. It may indicate the scar needs more consistent hydration and protection.

Myth: Nothing works after 50. Reality: This is simply not supported by evidence. The biology of scar response does not switch off at menopause. Slower response is possible; no response is not.

Frequently Asked Questions

Can menopause make old scars itch? Yes, this is a recognised experience. Declining estrogen affects both skin hydration and nerve regulation, and scar tissue, which has altered nerve architecture and no ability to self-moisturise, is particularly vulnerable to these changes. Itch in an old scar during menopause is usually a sign of sensitivity, not damage.

Why does my C-section scar hurt or feel tight during menopause? C-section scars are deep and often involve multiple tissue layers. As the dermis thins and loses flexibility with estrogen loss, mechanical tension through the scar can increase. This may manifest as tightness, pressure, or an ache rather than a classic itch. Consistent hydration and gentle massage may help. If pain is persistent or worsening, consult your GP.

Do hormones affect scar tissue? Estrogen receptors are present in skin fibroblasts and keratinocytes, both of which play roles in scar formation and remodelling. Changes in estrogen levels during the menstrual cycle, pregnancy, and menopause can all influence how scars feel and behave over time.

Can HRT improve scar sensitivity during menopause? HRT addresses systemic estrogen deficiency and has been shown to improve skin collagen, hydration, and thickness in menopausal women. Whether this directly translates to scar improvement is not well studied in isolation, but improved overall skin health would logically reduce some of the environmental factors driving scar reactivity. This is a conversation worth having with your treating doctor if you are considering HRT for other reasons.

Why do scars feel tighter after 50? Thinning of the surrounding dermis reduces the skin's natural cushioning and flexibility. The scar, which is already less flexible than normal skin, experiences greater relative tension as the surrounding tissue loses elasticity. This is a structural response to hormonal change, not evidence of scarring worsening.

Is a scar flare-up during menopause dangerous? In most cases, no. Increased sensitivity, itch, or tightness in an existing scar during the menopausal transition is typically a benign response to hormonal change. Growth beyond the original scar border, progressive hardening, persistent pain, or spreading colour change are signs that warrant assessment by a dermatologist.

Does silicone gel help menopausal scars? Silicone therapy is one of the more evidence-supported options for ongoing scar management. It may help by maintaining hydration in the scar microenvironment and modulating collagen activity. While specific research on menopausal scars and silicone is limited, the mechanisms by which silicone works are relevant regardless of hormonal status. Consistent daily use over at least eight to twelve weeks is generally recommended to assess any benefit.

What should I look for in a scar product if I am menopausal? Prioritise hydration, barrier support, and clinically grounded ingredients. Products containing medical-grade silicone, ceramides, or hyaluronic acid address the core issues driving menopausal scar reactivity. Avoid heavily fragranced products, which can further irritate sensitive scar tissue.

Looking After Your Skin Through Change

Menopause is a biological transition, not a deterioration. The skin changes that accompany it are real and often frustrating - but they are also understandable when you know what is driving them.

Your scar is not failing. It is responding to a changed internal environment - one with less collagen support, less moisture, thinner structure, and different nerve regulation than it had a decade ago. These are all manageable factors.

Thoughtful, consistent care - daily hydration, barrier support, sun protection, and appropriate use of scar-specific products - can make a meaningful difference to how scar tissue feels and behaves during and after the menopausal transition. It is not about reversing time. It is about working with the skin you have now, understanding what it needs, and giving it the support that evidence suggests may help.

Individual results vary, and what works well for one person may be less effective for another. If you have concerns about significant changes in a scar, a conversation with a GP or dermatologist will always give you the most personalised guidance.

Related Reading:

• Why Does My Scar Itch Years Later?
  
• Can Silicone Gel Help an Old Scar?

Disclaimer: Results vary between individuals. This article is for educational purposes and does not constitute medical advice. If you have concerns about changes in a scar, please consult a qualified healthcare professional.

Sources:

1. Viscomi, F. et al. (2025). Managing Menopausal Skin Changes: A Narrative Review of Skin Quality Changes, Their Aesthetic Impact, and the Actual Role of Hormone Replacement Therapy in Improvement. Journal of Cosmetic Dermatology. https://pmc.ncbi.nlm.nih.gov/articles/PMC12374573/

2. Imamoto, S. et al. (2021). Estrogens influence female itch sensitivity via the spinal gastrin-releasing peptide receptor neurons. Proceedings of the National Academy of Sciences (PNAS). https://pmc.ncbi.nlm.nih.gov/articles/PMC8346901/