Perimenopause and Skin Changes

Have you noticed that your skin just does not feel the same anymore?

It is not just about wrinkles—that is a natural part of aging. But somewhere around 40, you might start to see your skin losing its usual glow, plumpness, and elasticity. It may begin to look dull, feel dry or sensitive, and just not as healthy as it once did. This subtle but frustrating change often flies under the radar, yet it is a common symptom of perimenopause that deserves more attention. In this post, I will explore how hormonal shifts affect your skin, why these changes happen, and what you can do to support your skin’s health during this transitional phase.

One day you look in the mirror and something feels…off. There is a random breakout on your chin, your skin looks dull and feels drier than usual, and fine lines that were not there yesterday seem to have appeared overnight (some of which might not be that fine). You might wonder whether this is some sort of cruel joke. Acne, again? When your teenage years feel like a lifetime ago? But these skin changes are actually a common part of perimenopause, and you are not imagining things. In fact, 46-83% of women report experiencing skin symptoms caused by perimenopausal/menopausal hormonal changes.[1,2] However, these often receive less attention than other perimenopausal symptoms despite significantly impacting quality of life.

As perimenopause unfolds, your skin may become noticeably drier, itchier, and more prone to sensitivity. Breakouts that resemble teenage acne, especially around the jawline or chin, can suddenly reappear, despite decades of clear skin. At the same time, your skin might start to look less plump or radiant than it once did. You may notice it becoming thinner, more fragile, and slower to heal. Fine lines and wrinkles begin to appear or deepen, and areas of hyperpigmentation (like sunspots or age spots) may become more prominent.

Pre-existing skin conditions, such as eczema, rosacea or urticaria, can also flare up more frequently during this time. Your skin may react more easily to products or environmental triggers that never bothered you before. For many women, this combination of dryness, breakouts, sensitivity and uneven tone feels not only unexpected but deeply frustrating.

These changes can vary in severity, but they are all part of the shifting skin landscape during perimenopause. And you are definitely not alone in noticing them. I did not ask to enter, but I seem to have won the full perimenopausal skin symptom sweepstakes. While I can manage most of them with healthy eating, good hygiene and moisturising, the most debilitating for me is the worsening of my eczema. What is especially frustrating is that it does not seem to follow the usual pattern or respond to the typical triggers. No matter how hard I try to get it under control, there are times when I feel real despair because nothing seems to work.

During perimenopause, the decline in oestrogen levels profoundly affects the skin’s structure and function, leading to a variety of visible and uncomfortable changes. Oestrogen is essential for maintaining the skin’s natural hydration and resilience because it stimulates the production of key substances: ceramides, hyaluronic acid, sebum, and collagen. Each of these plays a vital role in keeping skin healthy and youthful.

Ceramides are natural fats that hold skin cells together and keep the skin barrier strong, while hyaluronic acid is a sugar molecule that attracts and holds water to keep skin hydrated and supple. Together, these molecules act as the skin’s moisture magnets and barriers. When oestrogen levels drop, their production decreases, weakening the skin’s natural barrier and reducing its ability to retain water. This results in increased dryness and itchiness, which many women notice as one of the earliest signs of perimenopause. Without sufficient hydration, the skin’s surface becomes flaky and rough, setting the stage for irritation and discomfort.

Sebum is the skin’s natural oil that helps maintain moisture and provides a protective barrier. With hormonal changes, especially declining oestrogen and fluctuating androgen levels, sebum production can decrease, reducing the natural oils that keep skin supple and balanced. However, since androgen levels may decline less sharply than oestrogen, or even relatively increase, some women may experience increased sebum production, leading to breakouts.

Collagen is the protein responsible for skin strength and elasticity. As collagen production declines, the skin’s supportive framework weakens, leading to thinner, less resilient skin and the appearance of fine lines and wrinkles. This thinning also increases sensitivity, making skin more vulnerable to irritants and sun damage. The loss of collagen and moisture also leads to a duller complexion and the gradual loss of the youthful glow many once took for granted.

In addition, uneven pigmentation and dark spots often appear or worsen during this time, influenced not only by hormonal shifts but also by increased skin sensitivity to sunlight. These pigmentation changes can be distressing as they further alter the skin’s overall tone and texture.

Pre-existing skin conditions may flare up more frequently and with greater intensity during perimenopause. This is not only due to a compromised skin barrier and increased dryness. Oestrogen plays a crucial immunomodulatory role by calming inflammation and maintaining balanced immune responses. When oestrogen levels decline, this regulatory effect diminishes, resulting in heightened immune activity. This increase in immune responsiveness can exacerbate inflammatory skin conditions, leaving many women struggling with discomfort and visible irritation.

For dry and itchy skin, it is best to avoid products that lather, foam, or bubble, as these tend to strip away the natural oils your skin needs. Instead, opt for a gentle, non-foaming cleanser for your body (avoid traditional soaps). If your skin still feels dry after cleansing, try using a moisturising lotion as a soap substitute.

Make it a habit to moisturise your skin twice daily, ideally immediately after showering or bathing. Moisturisers help your skin retain water and prevent dryness. Use a lighter moisturiser during the day and a richer, heavier one at night for best results.

Itching can also be caused by factors other than dry skin. For example, the release of histamine or irritation of skin nerves may create sensations like insects crawling on your skin, known as “formication.” Other possible causes include iron deficiency and thyroid problems, so it is worth discussing these with your healthcare provider.

Hormone replacement therapy (HRT) can help restore oestrogen levels. It often leads to noticeable improvements in skin texture and hydration within a few months.

Rosacea symptoms, such as redness and flushing, often improve with simple lifestyle changes. Reducing alcohol and caffeine intake, avoiding spicy foods, and protecting your skin from sun exposure can help minimise flare-ups. In some cases, additional treatments like topical creams, prescription medications, or specialised therapies (e.g., laser treatment for rosacea) may be necessary to control symptoms and improve skin appearance.

Eczema symptoms, such as redness, dryness, and itching, can worsen during perimenopause due to hormonal changes and skin barrier disruption. Lifestyle adjustments can help reduce flare-ups. For example, avoiding known irritants like harsh soaps, fragrances, and certain fabrics, and protecting your skin from extreme temperatures. Maintaining regular moisturisation is crucial to support the skin barrier and prevent dryness. Wearing breathable clothing and managing stress can also help reduce eczema exacerbations. For more persistent or severe flare-ups, topical treatments, such as corticosteroid or calcineurin creams, prescribed by a dermatologist may be necessary. In some cases, phototherapy or systemic treatments might also be recommended. It is important to protect your skin from the sun, but choose gentle, eczema-friendly sunscreens to avoid irritation.

Psoriasis symptoms, including red, scaly patches and itching, may also worsen during perimenopause as hormonal fluctuations affect immune responses and skin renewal. Managing triggers such as stress, smoking, and certain medications can help reduce flare-ups. Maintaining skin hydration with regular use of emollients is essential to soothe and protect psoriatic skin. Avoiding harsh soaps and hot water can prevent further irritation. Sunlight can benefit psoriasis for some, but it is important to balance sun exposure with skin cancer risk and use appropriate sun protection. For moderate-to-severe flare-ups, topical treatments like corticosteroids, vitamin D analogues, or phototherapy may be required.

Urticaria (hives) symptoms, such as itchy, red, raised welts on the skin, may be caused by triggers including certain foods, stress, and temperature extremes. Avoiding known triggers can help reduce flare-ups. Keeping the skin well-moisturised and using gentle, fragrance-free products can minimise irritation. Antihistamines are often effective for controlling itching and swelling.

Consulting a dermatologist can help tailor the best approach for your individual condition.

Carefully review your makeup and sun protection products to ensure they are suitable for oily or combination skin and labelled non-comedogenic—meaning they won’t clog pores or worsen acne. Use a gentle cleanser with salicylic acid to exfoliate and help keep pores clear. Incorporating active ingredients like retinol and niacinamide into your skincare routine can also help manage breakouts and improve skin texture. Remember, these products often take several weeks to show results, so patience and consistent use are key.

To minimise the risk of sun damage, it is essential to apply a broad-spectrum sunscreen with a high sun protection factor (e.g., SPF 50) daily, especially when spending extended time outdoors. Sunscreen should be reapplied every 2 hours or immediately after swimming to maintain effectiveness. Physical barriers, such as wide-brimmed hats and protective clothing covering the arms and neck, provide additional defence against UV exposure and are recommended by dermatology guidelines.[3] Have regular skin self-examinations and professional skin checks, particularly if you notice new or changing pigmented lesions. Early detection of skin abnormalities can significantly improves outcomes.

The key to reducing wrinkle formation lies in addressing lifestyle factors that accelerate collagen breakdown. Avoiding harmful sun exposure and quitting smoking are the most impactful changes you can make to preserve your skin’s collagen and maintain its elasticity. Topical treatments containing scientifically supported anti-aging ingredients can also help support collagen production and improve skin texture. Ingredients such as retinoids (vitamin A derivatives) and vitamin C have been shown to stimulate collagen production and reduce the appearance of fine lines and wrinkles.

Please note: These tips are general suggestions and not medical advice. If you have concerns about your symptoms, it is important to consult your healthcare provider. For overall perimenopause symptom management, maintaining a healthy lifestyle—including a balanced diet, good sleep habits, and regular exercise—is your best foundation.

Accepting the natural process of ageing is key to embracing change and shifting toward a more holistic, mindful way of living—one that prioritises good nutrition, quality sleep, and stress reduction. Striking a healthy balance in life means putting your well-being first, not last. To learn more, read my blog post ‘Pause, Play, Replenish: The Power of Putting Your Well-Being First’.