This Is Your Skin On Perimenopause & Menopause

Picture this: You spent most of your 20s, 30s, and early 40s working really hard to get the skin of your dreams. You've invested in good skin care products, clocked plenty of hours at your dermatologist's office, and abided by the cardinal rules of maintaining a healthy complexion. Then, perimenopause and later menopause come along, changing your skin entirely.

The harsh reality is that hormone-related skin changes don't occur just during our formidable teenage years. Perimenopause (the transitional time that occurs eight to 10 years before your last period) and menopause (12 months since your last menstrual cycle) bring about numerous skin-related changes.

During perimenopause and menopause, the production of the female sex hormones estrogen and progesterone starts to slow, and a rollercoaster effect of changes takes hold — and fast. We've all heard about the dreaded side effects of this stage of life, such as hot flashes and night sweats, monster mood swings, brain fog, weight gain and other body changes, and sleeplessness. But the mounting transformations to the skin can be equally as devastating. “Everyone is different, but most women start to see initial skin and body changes in their mid-40s,” says board-certified dermatologist Dr. David Kim, M.D.

Skin concerns during menopause run the gamut from dryness and thinning skin to breakouts and beyond. Ahead, TZR unpacks all there is to know about what’s happening to the skin as perimenopause and menopausal-related changes creep up, including how to alleviate the discomfort and issues they can cause.

How Hormones Impact Aging Skin

The most essential skin hormone that the body produces is estrogen, which maintains moisture, thickness and normal collagen production (which gives the skin its cushion-y plumpness). It’s also responsible for making the skin look vibrant, plump and youthful, and modulating the functionality of hair follicles and sebaceous glands. Besides estrogen, progesterone, also known as the pregnancy hormone, is also influential because it stimulates sebum production to keep the skin hydrated.

Without sufficient amounts of female hormones, the skin takes a turn towards accelerated aging. Studies link dwindling estrogen to decreased skin thickness, moisture levels, elasticity, and collagen production. "A lack of estrogen also causes dull, dry skin with increased wrinkling and crepiness to the skin on the face, neck, and body," says board-certified dermatologist Dr. Jeanine Downie, M.D. Simply put, a decline of much-needed estrogen can make all the difference between good and great skin.

Perimenopause, which most women experience in their mid-40s, is like the appetizer to menopause, the main course. “With perimenopause, there may be some skin dryness and mild acne flares,” Dr. Kim says. Then, as the body transitions into menopause years later, estrogen levels start to decrease more rapidly, and estrogen-deficient skin changes become most noticeable. When a woman is about five years into menopause, Dr. Downie says she's already lost about 30% of the skin's natural collagen. "Then, about 2% of additional collagen is lost each year, further contributing to skin that's noticeably drier, thinner, duller, and more wrinkled.”

The Most Common Menopause-Related Skin Changes

Everything from dryness to breakouts to a significant drop in the quality and quantity of collagen can arise as hormone levels wax and wane. Even how fast the hair grows and its thickness can be affected. Plus, night sweats, hot flashes, and major mood swings come with estrogen and progesterone dips.

Dry, Rough Skin

Dry skin and perimenopause/menopause go hand in hand. That's because, as Dr. Downie explains, collagen loss, which is inescapable at this stage of life, lends itself to dryness. In addition, a decrease in naturally occurring hyaluronic acid and sebum production also exacerbates the issue. The skin on the body is equally susceptible. However, changes to the face tend to be more visible and often show signs of estrogen loss quicker, too.

Dr. Downie says that collagen loss also changes the skin's texture, resulting in roughness. Couple that with inadequate hydration, and the skin can feel uneven and bumpy, often a sign that the skin barrier is compromised. "As we age, the skin barrier weakens, which increases the chance of moisture loss and the potential for dryness," adds board-certified dermatologist Dr. Marisa Garshick, M.D. A compromised skin barrier is also more likely to become infected and open the pathway for irritants and allergens to enter. Furthermore, research shows post-menopausal skin lacks a strong skin barrier and displays even more signs of skin elasticity changes with further decreased hydration.

A Loss Of Collagen & Elastin

The skin experiences incremental changes to the quality and quantity of collagen at a rate of about 1% per year, starting around age 30. But that speeds up tremendously during perimenopause and menopause. "When we lose collagen due to estrogen depletion, the skin naturally experiences collagen loss. So truth be told, collagen loss is more related to declining estrogen levels than chronological age," Dr. Downie says.

Without healthy, abundant collagen bundles and elastin (which allows the skin to snap back into place), the skin becomes outfitted with deep lines, wrinkles, and folds and takes on a crepey, saggy appearance with a loss of definition. In addition, a lack of healthy collagen causes the skin to lose its natural plump, youthful look, especially on the lower face, neck, chest, lip, and eye areas. "As women begin to notice skin laxity from collagen degradation, they lose definition in the jawline, and the nasolabial folds become more prominent," Dr. Kim explains. "Then, during menopause, the skin, fat, muscle, and bone lose volume and density, which causes the face to lose support and the skin to become looser."

Fine Lines & Wrinkles

Dr. Garshick says that the effects of decreased collagen from menopause can lead to fine lines and wrinkles. “A lack of moisture also makes the skin appear drab while enhancing the appearance of fine lines and wrinkles, which no one wants.” Unfortunately, any part of the face or body is susceptible to age-induced lines and wrinkles. "They tend to impact the face, neck and hands, which may appear crepey,” she adds.

Dull Skin

Perimenopausal and menopausal skin may seem consistently dull no matter how much highlighter you layer on. This is because estrogen drops contribute to a not-so-lit-from-within complexion. Plus, when the body is in the throes of menopause, cell turnover doesn’t happen as frequently or efficiently as it once did, leaving the skin looking less radiant. To add insult to injury, Dr. Downie says if there are years of accumulated sun damage, that will also contribute to dullness.

When the skin is laden with dead skin cells, the light can't reflect nearly as well off of it, so exfoliation is critical. Plus, fine lines, wrinkles and enlarged pores become more pronounced with an abundance of dead skin cells. "A lack of hydration can also cause the skin to appear lackluster," Dr. Kim adds.

Thinning Hair

Dwindling estrogen doesn't just affect the skin; it can impact the hair, too. Women may experience hair loss and notice changes in texture, density, and thickness, and even the growth cycle once menopause hits. Just like how male hormones (androgens) dominate when estrogen and progesterone levels drop, the same phenomenon happens to the hair on the head, leading to hair loss. Some women notice the first signs of thinning hair via a widening part or patchiness. The hair can also become dry and frizzy since the scalp produces less sebum.

An Uptick In Facial Hair

It's also normal to find a few rogue hairs sprouting up on the chin, jawline or even above the lip (here, they may be darker than usual). That's because as estrogen levels fall, the body continues to produce male hormones (testosterone), which in turn causes more hair to grow on the face. "This imbalance of testosterone versus estrogen causes an increase in facial hair,” Dr. Kim says. “When testosterone has a larger impact, it can stimulate hair growth in certain areas of the face.”

Breakouts

Just like facial hairs that pop up unexpectedly, so can breakouts for the same reason: an unequal estrogen-to-testosterone ratio. As a result, perimenopausal and menopausal acne breakouts can be problematic for many women. Dr. Downie says these blemishes, which are more cyst-like or deep bumps, tend to occur on the jawline and around the mouth, but they can pop anywhere on the face, chest, shoulders, back, and even buttocks.

Age Spots

Menopause isn't responsible for sun damage, age spots, hyperpigmentation, and other forms of discoloration. But, as Dr. Garshick explains, the cumulative effects of sun exposure, including sunspots and other signs of photodamage, can be more noticeable and continue to the appearance of dark spots as we age. "Often, brown spots reflect prior sun damage." Research indicates that estrogen has a photo-protective effect on the skin to some degree (sunscreen is still necessary). Regardless, age spots and discoloration become more evident on the face, hands, neck, arms, or chest.

How To Take Care Of Menopausal Skin

Menopausal skin requires special TLC, and you may need to swap some of your tried-and-true skin care products for those that cater to your current concerns. If a product no longer provides noticeable results, switch it out for something more powerful or even specific to menopausal skin. However, that doesn't necessarily mean stronger or harsher products are the way to go — they're not, since menopausal skin can't typically handle them. For some, bio-identical hormone replacement therapy (BHRT) may be the holy grail for getting the skin back on track since it replenishes the body with the hormones it lacks. "It can help with the skin quality in terms of firmness and hydration," Dr. Kim adds.

Hydrate, Hydrate, Hydrate

There's no discounting the role of a good moisturizer as the skin loses its ability to hold water as it goes through perimenopause and menopause. "The only thing that can help alleviate dryness is moisturizing regularly," Dr. Downie says.

To curb dryness, consider day and night moisturizers with thicker textures rather than lightweight ones. Dr. Kim recommends formulas (both for the face and body) that are chock-full of lipids and ceramides, which support the skin barrier and are "effective at keeping the skin hydrated and protected." Dr. Garshick likes them as well, as humectants such as hyaluronic acid, glycerin, and anti-inflammatory niacinamide soothe the skin while creating barrier support. For additional moisture, apply a deep skin hydrating mask as needed. Or, apply moisturizer and then layer on a few drops of face oil to lock in moisture.

Inadequately moisturizing the skin can be problematic, too. "A lack of moisture to skin experiencing menopause can be detrimental because it causes the skin to become uncomfortable and crack or tear," Dr. Downie says. To treat cracked skin, apply a thicker cream or even an ointment that contains petrolatum. “It will provide an occlusive barrier to lock moisture in and protect the skin from external irritants,” adds Dr. Garshick.

Build Up Lost Collagen

Even when the body has less estrogen, it can still create collagen. To do that means relying heavily on collagen-stimulating ingredients such as topical retinoids and retinol, peptides, growth factors, and vitamin C. While retinoids can be helpful, Dr. Garshick advises against using too many active ingredients, which can dry out the skin. There's also proof that applying topical non-hormonal plant-based phytoestrogens (naturally occurring antioxidants in plants) can improve skin texture, suppleness, elasticity, and hydration.

Skin care companies are getting in on the action and formulating topical products that help restore lost collagen. For example, Biopelle's Emepelle collection, which consists of a serum, night cream, and eye cream, uses the hormone-free estrogen receptor stimulator methyl estradiolpropanoate (MEP) technology to address skin changes from estrogen deficiencies to restore lost collagen. Dr. Downie adds that Emepelle products improve skin firmness, hydration, the glow factor, and overall luminosity.

Fillers also have a home in dermatologists' toolboxes for treating perimenopausal and menopausal skin. One of the many effects of reduced collagen loss is less volume in the skin, which causes facial features to appear flat. Several different fillers can be injected to restore volume and counteract the effects of collagen loss. One popular filler, for example, is Sculptra (a biostimulatory collagen-producing filler), which Dr. Kim says effectively stimulates the skin cells to produce more collagen.

In-office treatments like lasers and radiofrequency microneedling also have super collagen-stimulating powers. "Even Ultherapy, an ultrasound-based lifting device, can help keep the skin cells engaged in producing more collagen," Dr. Kim adds.

Get Your Glow Back

When the skin needs a little push in ridding itself of dulling dead skin, gentle exfoliation, both at home and in-office, with light, non-drying chemical peels or exfoliating products, are the way to go. Tried-and-true ingredients like alpha hydroxy acids, enzymatic exfoliators and lactic, mandelic, and glycolic acids are best for mature skin. "But still, it's important to avoid over-exfoliation," Dr. Garshick adds.

Smooth Out Lines & Wrinkles

Fine lines and wrinkles can call the face, neck, and chest home well before perimenopause and menopause — repeat movements, sun damage, and the initial signs of collagen loss are to blame. But once estrogen levels dip, they can become more apparent. Skin rejuvenating ingredients to consider include collagen stimulators such as retinol, peptides, and growth factors, which help erase lines and wrinkles. Dr. Garshick adds that hyaluronic acid can be helpful, too.

While topical products can minimize these visible signs of aging, there's a time and place for professional aesthetic intervention, and nothing does the job quite like neuromodulators such as Botox. By delivering a dose of wrinkle-paralyzing neurotoxins to a specific area, like the forehead lines or between the eyebrows, the crinkling of the skin is relaxed. Plus, the smoother the skin is, the more hydrated it looks.

It's also important to consider what you eat. For example, Dr. Downie says consuming too much sugar causes glycation, which leads to more wrinkling.

Banish Breakouts

To treat acne-prone skin during perimenopause and menopause, a bevy of different ingredients and even medications can improve the skin. However, the key is to avoid using anything drying since the skin is already experiencing lower-than-normal levels of natural moisture, which Dr. Garshick says can cause it to be more sensitive to some acne-fighting ingredients. So, hands off your teenager's pimple products, which can contain skin-stripping ingredients.

Instead, opt for gentle formulas that still incorporate actives like retinol, salicylic acid, and benzoyl peroxide alongside hydrators. Dr. Downie puts her perimenopausal patients who are acneic and oily on an alpha hydroxy acid and beta hydroxy acid cleanser.

If over-the-counter solutions aren't cutting it, oral antibiotics, prescription-strength acne creams like clindamycin and tretinoin, androgen blockers such as spironolactone, and even, in some cases, Accutane can help effectively manage acne.

"The most important thing is never to pick these breakouts since that can prolong the infection, spread it, and cause hyperpigmentation," Dr. Downie advises. "I also tell my patients to avoid soy at all costs because it has an estrogenic component, which can flare hormonally-induced acne and cause inflammation."

Get Rid Of Facial Hair

If the occasional solo dark, wiry hair pops up on your chin, jawline or upper lip, you can quickly tweeze it. But when facial hair is more of a recurring problem, you will want a more reliable solution. Dermaplaning is a quick and easy way to remove facial hair while also exfoliating dead skin — it kills two birds with one stone. But because this method cuts the hair that grows from the follicle and doesn't halt its growth, it requires regular maintenance. For a more permanent option, consider laser hair removal, which kills the hair in the follicle, so it no longer grows.

Thinning Hair

When menopause causes hair on the head to start thinning — Dr. Downie says this is usually attributed to a genetic component — the best way to treat it is thru a multi-prong approach.

To stimulate growth, it's essential to coerce the hair to stay in the growing phase for as long as possible with topical or oral minoxidil, red light stimulation (which also helps reverse the effects of hair miniaturization), and vitamin-rich, nutrient-dense hair supplements. Caring for the scalp and treating it akin to the skin on the face and body also sets the stage for healthy hair growth, so exfoliate and condition it regularly to support the follicles. Leave-in styling products with volumizers like rice proteins and starch powder can create the illusion of thicker, fuller hair until your next shampoo.

To tame frizzy, coarse hair, load up on conditioners with natural oils like argan, coconut oil, and avocado, or splurge on a keratin treatment, which makes hair smoother and more manageable.

Finally, Dr. Garshick says in-office procedures like platelet-rich plasma (PRP) can help mitigate the effects of hair thinning and hair loss around menopause.

Age Spots & Sun Damage

Stubborn discoloration can be hard to treat during menopause, but it's not impossible. Dr. Garshick says that brown spots and sun damage can often be addressed with chemical peels or lasers like laser resurfacing or IPL, which can help erase pigmentation that can age the skin. "You can use treatment products containing retinoids, vitamin C, and niacinamide at home." Of course, to prevent more discoloration and protect the skin from skin cancer, apply sunscreen every single day without fail.