We hear a lot about unpleasant theries of perimenopause: hot flashes, brain fog, lagging libido—all due to dwindling levels of the female sex hormone estrogen. But what does it do to your complexion? turn out, a lot. Studies have shown that estrogen plays a role in collagen production, skin’s elasticity, thickness, and moisture levels, as well as healthy blood vessels (hello, rosy glow). When you produce less estrogen, you may see the opposite: lines and wrinkles, dryness, sensitivity, dullness, and sagging.
And even skin experts—board-certified dermatologists—aren’t immune to these shifts. But they don’t wait to take action, and neither should you. Estrogen begins to decline during perimenopause, the four to 10 years before menstruation ceases, which can begin as early as the mid-40s for some women. But that decline happens somewhat unevenly, bringing on erratic skin behavior. “During this time, it can feel like you’re part-teenager, with breakouts that pop up out of nowhere, and part-senior citizen with extreme dryness,” says Doris Day, MD, a dermatologist in New York City.
It can feel like you’re part-teenager, with breakouts that pop up out of nowhere, and part-senior citizen with extreme dryness.
Estrogen levels continue on their trajectory downward until you hit menopause, when you’ve stopped menstruating for at least 12 consecutive months. Then you’re considered post-menopausal. Your skin issues may be more subtle in perimenopause and more severe post-menopause, but skin pros treat them equally. “When it comes to my patients’ skin, I don’t delineate between perimenopause, menopause, and post-menopause—they all affect the skin similarly,” says Leslie Baumann, MD, a dermatologist in Miami.
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Day had a partial hysterectomy in her late 40s, leaving her ovaries. At age 50, she wasn’t feeling like herself and saw a doctor to confirm that she was, in fact, in perimenopause. She went on hormone therapy (HT) right away and felt better within days. And because of HT, Day didn’t notice significant changes in her skin. Her message to women: Have your hormone levels checked in your late 30s and early 40s, and discuss HT options with your doctor.
In addition, there’s plenty you can do at home to help soften and even reverse some of these menopause-related skin changes. Here’s the 411:
The Issue: Dryness
Dryness is a sign that your skin’s outer protective barrier isn’t up to snuff. As estrogen levels fall, the skin’s epidermis thickens, reducing oil production. Skin becomes drier, and tiny microtears can form, allowing moisture to escape and irritants and allergens to enter. As a result, skin becomes easily irritated, and you may also see an increase in inflammatory skin conditions. “My eczema got worse during perimenopause,” says Debra Jaliman, MD, a dermatologist in New York City and author of Skin Rules: Trade Secrets from a Top New York Dermatologist.
The fix: Switch to a mild or gentle cleanser that won’t strip dry skin of its essential oils (ideally a creamy cleanser, not a bubbly one). Then shore up the skin’s barrier with a moisturizer featuring ingredients such as ceramides, shea butter, fatty acids, squalene, glycerin, and hyaluronic acid, which add moisture and help keep it there.
The Issue: Dullness
Menopause-induced dryness coupled with lagging cell turnover due to age makes skin look lackluster. “This happens when dead skin cells heap up on the surface—it looks like hills and valleys,” says Baumann. “That doesn’t reflect the light so well.” Light reflection is what gives skin glow.
The fix: Exfoliate dead, dull skin: “Exfoliation is key to keeping skin looking luminous,” says Audrey Kunin, MD, a dermatologist in Kansas City, Missouri, and founder of DERMAdoctor, who was shocked to see the development of fine lines and wrinkles and a change in overall complexion with dullness, drabness, and loss of radiance after experiencing surgical menopause from a hysterectomy. Alpha hydroxy acids (AHAs) will help slough off dead skin to reveal brighter skin. Glycolic acid, an AHA, is ideal because it’s a humectant, which means it attracts moisture. Use a glycolic-containing serum every other day if your skin can tolerate it.
The Issue: Fine Lines and Wrinkles
The culprit here is the dwindling collagen supply. You start to lose about one percent of your collagen annually in your 30s, but that depletion quickly escalates during post-menopause. “You lose 30 percent of your collagen in the first five years after menopause,” says Day. “So it’s important to keep building collagen while you still can.”
The fix: Reach for topical retinoids (prescriptions or OTC retinol serums), which stimulate collagen production and rev cell turnover, making the skin smoother. Baumann also suggests applying a topical vitamin C serum and taking an oral vitamin C supplement (500 mg twice a day). The antioxidant vitamin is essential for collagen production. “I wasn’t about to wait until I lost all my collagen and got wrinkled,” says Baumann, who has been on collagen-stimulating retinoids for decades. “Because of that, I didn’t see a change in my skin except for the tell-tale dryness,” she says.
The Issue: Acne
Your skin is getting dry, yet you’re still breaking out. How can that be? “As estrogen levels go down, your ratio of female-to-male hormones changes—male hormone levels go up,” says Baumann. And those male hormones, called androgens, are one of the main causes of pimples.
The fix: Again, this is a job for retinol. Because it revs up cell turnover, pores stay clear and are less likely to clog and form a pimple. Plus, you can clear breakouts and soften lines at the same time.
The Issue: Sagging
Just as collagen depletes with age, so does its partner elastin—and that’s the stuff that keeps skin taut. “With menopause, I was most surprised by the loss of skin elasticity around my jawline and neck,” says Kunin. According to Baumann, loss of elastin is especially an issue for women of color during menopause. “The pigment in the skin protects their collagen fibers from damage, so their issue is more with skin fragility and sagging than lines and wrinkles,” she says.
The fix: To prevent sagging, sunscreen and antioxidants (vitamins C, E, Co-Q10, to name a few) are essential. Research has shown that estrogen protects against photoaging, so preventing sun damage is especially important as estrogen wanes. Unfortunately, treating sagging at home is tough. In-office, Baumann likes Ultherapy, which uses ultrasound waves to tighten skin. “When you heat collagen to a certain temperature, it shrinks—the fibers shorten, creating a tightening effect,” she says.
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