How Menopause and Perimenopause Affect Your Skin—A Dermatologist’s Guide

I’m a 46 year old dermatologist. Not only have I treated women going through perimenopause and menopause for over 15 years in my practice, but I’m living through it myself!  Our bodies, and our skin, are changing in very dramatic ways, but the more we understand what’s happening, the more empowered we will feel.  

In my opinion, the scariest part is feeling like things are changing and out of your control.  So let’s dive in and talk about what’s actually happening in our bodies, how those changes show up on our skin, and simple steps we can take to age and enter this new stage of our lives on our own terms.

Understanding Menopause Skin Changes

As women enter perimenopause and menopause, a cascade of hormonal shifts takes place inside the body—and the skin often reflects those changes first. Even if you're not experiencing night sweats or brain fog, you might notice that your skin feels drier, becomes more reactive to products you previously tolerated, and begins showing visible changes: your creases are getting deeper, your eyes look tired even if you slept well, and your jawline is not as defined as it once was.  

During perimenopause, estrogen levels start to decline, often fluctuating along the way, and continue to decrease throughout menopause, when estrogen levels reach their lowest point and remain low afterwards. This decline in estrogen has profound effects on skin hydration, elasticity, collagen production, and overall skin aging. 

Here’s what’s really happening beneath the surface, and five evidence-based strategies to keep your skin healthy and resilient through this transition.

First, When Do Perimenopause and Menopause Typically Occur?

• Perimenopause: This transitional phase typically begins in a woman's mid-40s but can start earlier. It usually lasts about four years before menopause.
  

• Menopause: Defined as the absence of menstrual periods for 12 consecutive months, menopause typically occurs around age 51 in the United States. However, it can happen earlier or later, with a normal range between ages 45 and 55.

How Hormonal Changes Affect the Skin

• Collagen Decline: Estrogen helps regulate the production of collagen, the protein that keeps skin firm and smooth. Starting in our mid-20s, we  lose about 1% of our collagen every year, but within the first five years after menopause, women can lose up to 30% of skin collagen. As collagen levels drop, the skin's supportive scaffold, called the extracellular matrix, gets thinner and weaker, showing up as visible fine lines, wrinkles, sagging, and loss of elasticity in the skin. 

• Reduced Hydration: Hormonal fluctuations—especially the drop in estrogen during perimenopause and menopause—have a major impact skin hydration. Estrogen supports the synthesis of hyaluronic acid in the skin's dermal layer, and hyaluronic acid is a key component in maintaining skin moisture and plumpness. So if your skin feels drier or less plump during menopause, it's a very real reflection of how shifting hormones affect your skin. 

• More sensitive, reactive skin: Women over 40 are more likely to experience sensitive, reactive skin due to hormonal shifts, structural changes, and barrier function decline. Your skin’s production of natural oils and lipids, like ceramides, declines significantly– so you’ll notice your skin not only feels more dry during menopause, but it's also more prone to irritation. 

• Slower skin cell turnover = dull skin: As the rate of skin cell turnover slows down, dead cells will accumulate on the surface of your skin. This buildup makes skin feel rough and causes the complexion to look dull and less radiant since those piled up dead cells scatter light in all directions.

Perimenopause + Menopause Skincare Routine

Now that we know what is happening both on the surface of our skin, and in the deeper layers, here is exactly how to get started on a powerful, streamlined perimenopause/menopause skincare regimen.  

You may be tempted to jump straight to the big guns with retinoids and exfoliating acids like AHAs, but it’s critical to acknowledge that your skin is more sensitive and more reactive at this stage of your life. Instead, start by using skincare ingredients and products that will wake up your fibroblasts while keeping your skin barrier healthy and hydrated.

Weeks 1 & 2: A Sensitive-Skin Friendly Routine

Start with these 3 critical steps to kickstart skin regeneration while repairing and restoring the skin barrier:

1. Cleanse: I recommend starting with a gentle, creamy cleanser that purifies the skin without stripping the skin barrier. Your skin should never feel tight or dry after you cleanse—-that’s a sign your face wash is stripping your skin barrier. 

2. Lift + Plump: Immediately after cleansing, use a serum that not only hydrates and plumps the skin with ingredients like hyaluronic acid and polyglutamic acid, but also leverages the power of peptides to lift the skin and improve laxity over time.

I love peptides for perimenopausal and menopausal skin because, when you have the right combination of peptides , plus the right technology to deliver them effectively into the skin, you can help visibly turn back the clock in a dramatic way—without causing irritation, even in the most sensitive, vulnerable skin.

3. Hydrate + Nourish: Use a clinically-proven moisturizing cream with ceramides, squalane, and prebiotics to support the skin barrier and help rebalance the skin microbiome.

I deliberately formulated my Procedure Enhancement Program to address these three critical skincare steps, because what works for post-procedure skin is also exactly what works best for perimenopausal and menopausal skin.  Why?  It’s simple.  

Perimenopausal/menopausal skin, just like post-procedure skin, is especially sensitive, reactive, and vulnerable, so you want to use products that are fragrance-free, essential-oil free, and clinically-proven to be beautifully tolerated by even the most sensitive skin. It’s critical to repair and restore the skin barrier while minimizing exposure to any potentially irritating ingredients.

Post-procedure skin is in a state of active repair. When I do a procedure in my office such as laser resurfacing or microneedling, I’m creating a microenvironment that allows skin cells to start regenerating, and tells fibroblasts to start pumping out more collagen. This is the ideal time to introduce powerful bioactive peptides that work synergistically with procedures, enhancing results to lift, firm and smooth the skin. Matrikine peptides can mimic cellular signals released into the skin during intense times of cellular repair, making treatments more effective while also coaching skin cells to behave more youthfully on their own.

Weeks 3 and 4: Skin Cycling with Actives

Now you can introduce Skin Cycling—my streamlined approach to your evening skincare routine that rotates nightly use of skincare actives to prioritize your skin barrier’s health, maximizing results and minimizing irritation. 

• Night one, Exfoliation Night, will help speed skin cell turnover, visibly brightening skin overnight, and setting skin up to get the most out of Night 2, which is Retinoid Night. 

• Retinoids not only speed skin turnover, but also work in a very complimentary way with peptides to firm and smooth skin texture over time. 

• Continue to use your peptide serum—it should always be the first step after cleansing no matter what night of Skin Cycling you are on.

Weeks 5 and 6: Layer in Your Vitamin C Serum

If you’re not already using a vitamin C serum, now is the time to introduce one. Vitamin C is actually a critical cofactor in your skin’s production of collagen. If you’re new to vitamin C, start with a patch test. Apply one pump to one area of your face (eg: just in front of one ear), and if your skin tolerates that overnight, you can start using it all over the following day.

So here’s the take home message:

During perimenopause and menopause, hormonal changes drive visible skin shifts—thinner, drier, less elastic skin with accelerated collagen loss. The good news? You’re in the drivers seat and you now completely understand exactly what is happening and how to take control of the process on your own terms.  It might feel like you’re aging overnight, but within 6 weeks, if you follow this skincare routine, you might be surprised that your skin looks healthier and more radiant than ever.  You’ve got this.

Disclosure: This information is for educational and informational purposes. It is not intended to diagnose, treat, cure, or prevent disease or medical condition. All product recommendations are intended for cosmetic purposes only and are not a substitute for medical advice. Always consult with a qualified healthcare professional or dermatologist regarding any concerns about your skin, health, or treatment options. Individual results may vary.

Resources: 

Kanda, N., & Watanabe, S. (2005). Regulatory roles of sex hormones in cutaneous biology and immunology. Journal of dermatological science, 38(1), 1–7. https://doi.org/10.1016/j.jdermsci.2004.10.011 

Zouboulis, C. C., Blume-Peytavi, U., Kosmadaki, M., Roó, E., Vexiau-Robert, D., Kerob, D., & Goldstein, S. R. (2022). Skin, hair and beyond: the impact of menopause. Climacteric, 25(5), 434–442. https://doi.org/10.1080/13697137.2022.2050206 

Reilly DM, Lozano J. Skin collagen through the lifestages: importance for skin health and beauty. Plast Aesthet Res. 2021;8:2. http://dx.doi.org/10.20517/2347-9264.2020.153 

Kamp, E., Ashraf, M., Musbahi, E., & DeGiovanni, C. (2022). Menopause, skin and common dermatoses. Part 2: skin disorders. Clinical and experimental dermatology, 47(12), 2117–2122. https://doi.org/10.1111/ced.15308 

Falcone, D., Richters, R. J., Uzunbajakava, N. E., Van Erp, P. E., & Van De Kerkhof, P. C. (2017). Sensitive skin and the influence of female hormone fluctuations: results from a cross-sectional digital survey in the Dutch population. European journal of dermatology : EJD, 27(1), 42–48. https://doi.org/10.1684/ejd.2016.2913