How Perimenopause Affects Your Skin

Everyone experiences aging. But for women, as we approach midlife, we undergo dramatic changes – especially menopause.

Perimenopause – often known simply as “peri” (pronounced like “perry”) – is the transition period before menopause. It usually begins a few years before menopause, but for some women, it can last for 10 years or even longer.

The hormonal changes that occur during perimenopause affect every system of the body, including the skin. For women living with chronic skin conditions, the impact of peri can be significant. So how does perimenopause change the skin? 

How your hormones change during perimenopause

The two main female hormones are estrogen and progesterone. (There are actually several different forms of estrogen, but because they all have similar effects, I’ll refer to them all as “estrogen” just to simplify things.) After a woman goes through menopause, the levels of both of these hormones drop dramatically.

During perimenopause, the levels of these hormones fluctuate. A woman in her reproductive years experiences monthly shifts in hormone levels, and this does have an impact on skin. Once she enters peri, the fluctuations become much larger and more unpredictable. After menopause, estrogen and progesterone levels drop very low and stay there.

Effects of a drop in estrogen on the skin

Estrogen has a huge impact on the skin. As estrogen levels start to drop, this affects the skin in several different ways: 

1. Drier skin

Estrogen has a strong hydrating effect on the skin. Once estrogen levels start to drop, the skin will begin to get drier. Many women notice this as they go through peri – they just can’t keep enough moisturizer on their skin.

Dry skin is much more likely to experience a flare. The dryness causes tiny breaks to appear in the skin’s surface. Allergens and toxins from the environment can enter through these tiny breaks, which can trigger the immune system and lead to a flare. (This is why skin flares become more common in the winter.) As peri causes estrogen levels to drop and the skin to dry out, some women find that they experience more frequent and more intense skin flares.

2. Thinner skin

Estrogen also promotes the skin’s production of collagen, which is the skin’s main structural protein. Without the influence of estrogen, the skin doesn’t produce as much collagen, causing it to become thinner. Thin skin is more vulnerable to damage, which can trigger skin flares. Many women also notice an increase in the visible signs of aging (like wrinkles and sagging skin) as their estrogen levels drop.

3. Breakouts

Although the absolute levels of hormones definitely do matter, the ratios between different hormones make a huge difference in how our bodies respond. As estrogen drops, another hormone starts to have greater effects – testosterone.

Testosterone is often thought of as a male hormone, and it’s true that men’s bodies make much higher levels of it. However, women’s bodies actually make some testosterone as well. During a woman’s reproductive years, the levels of estrogen are far higher than the levels of testosterone.

This shifts during peri. While estrogen levels drop dramatically, testosterone levels don’t drop as much – so that, proportionally, testosterone has a much greater effect. This causes the skin to make higher levels of sebum (skin oil), which in turn can lead to acne breakouts. 

4. More inflammation 

Estrogen also has an anti-inflammatory effect throughout the body, including on the skin. Before she starts peri, a woman’s higher estrogen levels will tend to help keep inflammation under control. As estrogen levels drop during peri and after menopause, this can sometimes trigger flares of inflammatory skin conditions (such as eczema, rosacea, and psoriasis).

How to care for your skin during peri

If you’re experiencing skin challenges during perimenopause, there are ways to help support the health of your skin during this period.

• Use moisturizer. Because your skin isn’t as naturally hydrated once your estrogen levels drop, it’s important to make sure that you’re using a good moisturizer. For extra hydration, you might want to choose one that contains hyaluronic acid, a natural substance that’s been shown to significantly improve skin hydration levels. It’s not just your facial skin that’s affected by hormonal changes – the skin everywhere on your body may need a moisturizer.

• Use a gentle cleanser. As your relative proportion of testosterone increases and your skin starts to make higher levels of sebum, cleansing your face twice every day becomes very important. Choose a gentle cleanser, so it won’t cause skin dryness. If you’re experiencing a lot of acne breakouts, you might want to use a cleanser with an anti-acne ingredient, like salicylic acid or benzoyl peroxide.

• Be diligent about sunscreen. UV light breaks down collagen. Because your skin’s collagen levels are lower during peri and after menopause, it becomes even more important to ensure that you’re using sunscreen every single time you go out in the sun. 

• Watch out for irritating substances. Without the anti-inflammatory effect of estrogen, your skin may be more likely to have a response to irritating substances (such as fragrances and dyes) in skincare products. You may need to be more careful about the products that come in contact with your skin. Beyond your skincare products, you'll want to consider things like your laundry soap and dish soap, as these may also end up touching your skin.

• Consider hormone replacement therapy (HRT). This involves taking estrogen (and often progesterone as well) in order to replace what the body is no longer producing on its own. HRT has been shown to improve skin thickness, elasticity, and hydration. There are both benefits and risks to HRT, and it’s important to discuss these with your physician in order to make an informed decision about whether taking HRT is a good idea for you.

Above all, remember that perimenopause is a natural part of every woman’s life. It’s very important to practice acceptance. It can be easy to get caught in a negative thought spiral, wishing that you had your youthful skin back. Don’t deny your feelings, but do your best to love yourself exactly as you are now.

If you're currently in perimenopause (or even if you've already entered menopause), I encourage you to take some time to journal about the positive aspects of this time of your life, like wisdom and increased confidence. Remember that your worth doesn’t come from what your skin looks like – or any other part of you, or that matter. There are many positive things that come with aging, and you deserve to enjoy every stage of your life.