Close-up of purple flowers with the word HORMONES overlayed in white text.

Skin During Menopause & Perimenopause - A Guide

NOTE: This document is not intended to treat any skin conditions or be a replacement for medical advice. It is solely for information purposes and to guide your conversations with your health care providers and facial practitioners.

Perimenopause is a natural process where the creation of an egg for fertilization is less frequent until menopause where it stops completely. This entire process is controlled by hormones.

During perimenopause hormones shift erratically causing a host of sensations in the body. High spikes can lead to breast tenderness and bloating, while lower than normal dips lead to hot flashes, sleep disturbances and vaginal dryness - which can lead to a host of other issues.

It also affects how often one cycles; the cycle length itself can be erratic, as is the frequency or time between cycles. Changes in skin are also affected by perimenopause and menopause as estrogen receptors in the skin are higher than in other parts of the body Source

Estrogens (there is more than one kind) have an effect on the following parts and processes in the skin:

How frequently skin cells turn over (slough off the top and grow from the basal layer)
The production of collagen and elastin through the fibroblasts, and control of the enzymes that break these two proteins down (collagenase and elastinase)
Melanocytes and skin color changes begin to increase (due to thinning of skin, increase in inflammation, weakened barrier is more susceptible and recovery is slower)
Hair growth (and the hair follicles throughout the body) shift and change
How much oil is created in the skin changes
Skin healing slows
A thinning of the skin barrier can lead to a host of irritations and rashes, pH shifts can exacerbate already existing conditions like eczema and psoriasis
Skin becomes more sensitized to everything
Increase in number and depth of wrinkles.

Studies show that women’s skin loses about 30% of its collagen during the first five years of menopause. After that, the decline is more gradual. Women lose about 2% of their collagen every year for the next 20 years.
‍It’s about this time, typically between 40-50 years old, that women will search out for various skin care solutions.
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Important factors to note in perimenopausal skin:

It will be changing until menopause (1 full year after the stopping of menses) so a product that used to work might suddenly stop
Symptoms can come and go so you won’t 100% feel certain that using anything is causing the results you’re looking for
Due to skin thinness, it’s important not to over-strip and to be cautious about new product introductions
Introduce new products one at a time so you can sort out any skin responses or sensitivities
Avoid harsh chemicals, overdrying or overstripping the skin
Don’t over treat menopausal skin -a slow and grow approach is best here.

Life factors that affect menopausal skin:

Diet and nutrition - glycation is more visible and more likely in menopause
Stress Levels - cortisol levels affect oil and skin recovery is already slowed
Sleep Quality
Exercise and Circulation - a healthier body = healthier skin
Sun Exposure - lifetime habits will show more readily in menopausal skin
Skincare Habits - see what to Avoid and Reach For below

What to avoid:

Aggressive treatments
Retinoic Acid in high percents
Harsh physical exfoliants
Ingredients that dehydrate skin: alcohols, astringents
Overuse of hot treatments
Anything that exacerbates sensitivity

What to reach for:

Gentle Skin Resurfacing Actives: Niacinamide, Lactic Acid, Azelaic Acid
Retinol Alternatives during the day or night; retinol in lower concentrations for nighttime
Hydrating Creamy, Milky and Oil Cleansers (vs. gel or foaming)
Barrier Protecting / Restoring Ingredients like facial oils and humectants
Tyrosinase Inhibitors: Licorice Root, Bearberry, etc.
Antioxidants: Vitamins C, E, polyphenols
Phytoestrogens: Lavender, Soy, Red Clover Extract, Ginseng
Anti-Inflammatory Helpers: Adaptogens, Probiotics (Pre & Post)

Skin goals for menopausal skin:

Improve Barrier strength through protection (both SPF & occlusive based products) as well as microbiome focused products.
Prevent Dryness - Oils are a girl's best friend.
Maintain as much collagen and elastin as possible with peptides and more active ingredients: stem cells, growth factors and collagen induction therapies
Maintain skin cell turnover rate with gentle and regular exfoliation at home and consistent professional treatments for deeper work.
Ensure skin is not deficient in vitamins and minerals by working with a skin care professional

Discoloration-specific information:

Estrogen affects melanocyte activity, skin structure and barrier function. Melanocytes can by HYPER or HYPO:

Hyper:

Erratic - leads to uneven pigmentation / more reactive
Skin can’t recover as quickly from UV damage so pigmentation lasts longer
Cellular turnover rate slows so pigmentation stays longer
Melasma can reactivate (if existed during puberty, pregnancy or on hormone-based birth control)
Skin is more susceptible to PIH

HYPO:

Hypo:

iopathic guttate hypomelanosis- small flat white benign spots on skin that affect 50-80% of people over 40 years of age regardless of gender, phototype or ethnicity /race. Source
Vitiligo can occur or be exacerbated by menopause

To Treat Discoloration Specifically :

SPF - ideally UVA / UVB and Blue Light HEV
Tyrosinase Inhibitors
Antioxidant Support
Skin Cell Turnover Boosting Ingredients
Gentle Resurfacing: Enzymes, Chemical Peels, Lasers etc.

Definitions and Ingredients:

Estrogen: (a family of more than 20 hormones)

Phytoestrogen (plant versions) found in soy, wild yam, raspberry & licorice root
On skin: collagen stimulator, combats thinning skin, photodamage and dryness. Upregulates collagen and glycosaminoglycans (including HA) decrease TEWL

Xenoestrogens - industrial and cosmetic chemicals (sunscreens, preservatives, solvents and fragrances) that have estrogen-like effects. Cause bad things in the body including fibromyalgia, cancers of the breast, reproductive organs and colon. The body in menopause is more susceptible to xenoestrogens. Ideally avoid: Parabens, Phthalates, Benzophenones, Triclosan, plastics containing BPA, conventional meats and dairy that contain hormones. Eliminating all is impossible - aim for limiting the load.

Progesterone:

Key player in conception / pregnancy
Steroid hormone
Stimulates production of moisture factors and sebum
Too much progesterone - breakouts / hyper sebaceous secretions (overly oily skin)
Plumps skin, reduces pore size
Can help combat menopause’s effect on skin in older women
Improves elasticity and firmness. Available OTC - transdermal penetration can improve levels in blood and tissues.

Insulin: Often associated with sugar hormone, plays an important role in the circulatory system and heart, brain and nervous system and immune system.

Insulin for skin: Critical for growth and maturation of skin cells and fibroblasts, helps skin to heal from burns, wounds and other cutaneous traumas and the production of collagen and connective tissues. Elevated insulin can cause skin tags, oily skin, acne and hirsutism (excessive growth of hair).
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Insulin resistance can lead to:

Psoriasis
Hidradenitis suppurativa (painful skin condition resulting from blocked hair follicles)
Vitiligo- a skin disorder that leads to patches of differing skin color
Glycation - tissues stiffen from an interaction of glucose and collagen/elastin resulting in deeper wrinkles and vascular issues
delayed wound healing
hair loss

Vitamin D: - actually a hormone - directly modifying biochemical reactions inside cells. - involves the intestines and absorption of calcium.

Vitamin D in Skin: Plays a major role in the keratinization cycle from basal cell layer (creation of new skin cells) to the upper most stratum corneum. Directly affects cell turnover rate (CTR). Critical for treating acne, eczema, psoriasis and skin cancer.

Vitamin D is critical in fibroblast functionality, suppresses inflammation and for melanocyte functionality - can help with vitiligo or stabilize skin while more susceptible to melanocyte disruptions.

DHEA - dehydroepiandrosterone - prized by weight lifters for muscle building and performance enhancing. Known for its immune system properties and decrease as we get older.

DHEA For skin: stimulates collagen and elastin