Dear Dr. Lili,
I’m 51 and feel like my skin has changed completely over the past few years. It’s much drier, I have more fine lines, and it doesn’t seem as firm as it used to be. I’ve even noticed some breakouts again, which I definitely wasn’t expecting at this age! Products I’ve used for years don’t seem to work the same way anymore.
Is this really from menopause? And what should I be doing differently?
M.S. – Vancouver
Dear M.S.,
Yes, much of what you’re noticing is related to the hormonal changes of perimenopause and menopause. You are not alone!
Menopause and Your Skin: What Really Happens — and What You Can Do About It
If you have reached your 40s or 50s and suddenly feel as though your skin has changed, you are not imagining it.
The hormonal changes of perimenopause and menopause affect many parts of the body, and the skin is no exception. You may notice that your skin is drier, thinner or less firm than it used to be. Fine lines may become more noticeable. Products you have used for years may not seem to work as well anymore, and some women even notice acne appearing again.
There is a biological reason for many of these changes.
How Menopause Changes Your Skin
Estrogen, Collagen and the Skin
We often think about estrogen in relation to periods, but estrogen receptors are found all throughout the skin.
Estrogen helps support collagen production, skin thickness, hydration and elasticity. It also plays a role in maintaining the skin barrier and in wound healing.
As estrogen levels fluctuate during perimenopause and then decline significantly after menopause, the effects on the skin can become increasingly noticeable.
One of the most striking changes involves collagen.
Research suggests that women may lose as much as 30% of their skin’s collagen during the first five years after menopause, with collagen loss continuing more gradually afterward.
That is a significant structural change in a relatively short period of time!
Collagen provides much of the framework that gives our skin its firmness and support. As collagen declines, the skin gradually becomes thinner and less elastic, and fine lines and wrinkles may become more visible.
Of course, hormones are only one part of skin aging. Genetics, cumulative sun exposure, smoking, environmental exposures and our skincare habits over many years all contribute. But the decline in estrogen around menopause can accelerate changes that were already occurring.
What Do Menopause Skin Changes Look Like?
Every woman’s skin is different, but some of the changes we commonly see during perimenopause and menopause include:
- increased dryness
- loss of firmness and elasticity
- thinner or more fragile skin
- more noticeable fine lines and wrinkles
- changes in skin texture
- increased sensitivity or irritation
- slower healing
- changes in pigmentation or uneven skin tone
- adult acne or breakouts
Women will sometimes tell me, “I’ve used the same skincare for years, but suddenly my skin is completely different.”
That makes sense. Your skin at 50 is not going to have the same needs as your skin at 35.
Dry Skin and Menopause
Dry skin is one of the most common skin changes associated with menopause.
Estrogen helps the skin retain water and influences components of the dermis involved in hydration. Sebum production also generally declines with age.
As a result, skin may become drier, rougher or less supple after menopause.
This is why simply adding a heavier moisturizer is not always enough. A good menopause skincare routine should focus on protecting and restoring the skin barrier while also addressing other concerns such as pigmentation, collagen loss and texture.
Ingredients such as ceramides, hyaluronic acid and other barrier-supporting moisturizers can be helpful, depending on your skin type.
Does Menopause Cause Acne?
This is an interesting one because not every woman develops acne during menopause—in fact, acne generally becomes less common with age.
However, many women experience new adult acne during perimenopause and menopause.
This is in part due to the changing balance between estrogen and androgens in our bodies. Estrogen declines substantially during the menopausal transition, which can create a relative androgen predominance in some women. Other factors, including genetics, stress, skincare products and medications, can also contribute.
When acne occurs in adult women, it often involves the lower face, chin and jawline.
Pigmentation, Redness and Sun Damage
Menopause itself does not suddenly create decades of sun damage. Hormonal skin changes however, can make some of the effects of aging and cumulative UV exposure more apparent.
Brown spots, uneven pigmentation, redness and changes in skin texture may become increasingly noticeable during the same years that women are going through menopause.
This is one reason daily sunscreen remains one of the most important anti-aging skincare products at every age.
I recommend a broad-spectrum physical sunscreen with SPF 30 or higher every day—not only when it is sunny.
Building a Skincare Routine During Menopause
The answer is not necessarily to use more products.
It is to use the right products for your skin.
A menopause skincare routine will often include some combination of:
- a gentle cleanser
- a good moisturizer and barrier-supporting ingredients
- antioxidants such as vitamin C
- a retinol or retinoid, as tolerated
- ingredients directed at pigmentation or redness when needed
- daily broad-spectrum SPF 30 or higher
Retinols and retinoids are particularly valuable because they have good evidence for improving photoaging and stimulating collagen production. However, menopausal skin can sometimes be drier and more easily irritated, so the strength and frequency need to be individualized.
More is not always better. The goal is not to have the most complicated skincare routine—it is to have the right routine for your skin.
If your skin barrier is constantly irritated, peeling or inflamed, adding another active ingredient is usually not the solution.
Professional Treatments for Menopausal Skin
Skincare is the foundation, but there are changes that skincare alone cannot completely address.
Professional treatments can be used selectively depending on what we are trying to improve.
For example, microneedling can stimulate collagen remodeling and improve texture and fine lines. Chemical peels may help with pigmentation and texture in appropriately selected patients. IPL (intense pulsed light) can help improve certain types of brown pigmentation, sun damage and facial redness.
Other treatments may be considered when the primary concern is volume loss, deeper wrinkles or changes in facial structure.
The important point is that there is no single “menopause facial” or treatment that is right for every woman.
At Healthy Skin Centre, we look at the skin itself—its pigmentation, hydration, texture, collagen loss, redness, acne and sun damage—and build a treatment plan around what that individual woman actually needs.
What About Menopausal Hormone Therapy and the Skin?
This is another area where it is important to separate evidence from marketing.
Research suggests that menopausal hormone therapy (MHT) may have beneficial effects on several measures of skin health, including collagen content, skin thickness and elasticity.
However, MHT should not be started solely as an anti-aging treatment for the skin.
The decision to use menopausal hormone therapy should be based on a woman’s symptoms, medical history, risks, benefits and personal preferences.
Any potential skin benefits should be considered an additional effect of treatment rather than the primary reason for prescribing MHT.
Looking After Your Skin Is Part of Looking After Yourself
One of the messages I want women to understand about menopause is that the changes they notice are real.
Your skin is an estrogen-responsive organ, and it changes as your hormonal environment changes.
That does not mean we can—or need to—stop every sign of aging.
What we can do is understand what is happening, protect the skin we have, treat specific concerns when appropriate and make evidence-based choices rather than chasing every new product or treatment marketed to women in midlife.
If you have noticed significant changes in your skin during perimenopause or menopause, the team at Healthy Skin Centre in New Westminster, BC can help you understand what may be contributing and develop an individualized skincare and treatment plan.
You can also learn more about our Healthy Menopause Program, which takes a comprehensive, physician-led approach to helping women navigate perimenopause and menopause.
When Should I See a Physician About Skin Changes During Menopause?
If you notice a new or significant skin change, persistent acne, unusual pigmentation, a changing mole or lesion, significant itching or irritation, or something that simply isn’t improving, have it assessed.
And remember: not every skin change that happens in your 40s or 50s is menopause.
Sometimes the most important part of an assessment is figuring out what isn’t hormonal.
Have a Question for Dr. Lili?
Menopause, skin, hair, sleep, hormones and healthy aging—there are so many questions women have that don’t always get answered.
Ask Dr. Lili is a place for real questions and evidence-based answers.
Have a question you’d like me to answer in a future column? Send your question through our Contact Us form. Questions may be edited for length or clarity, and identifying details will not be published.
If you have concerns about your own skin, you can also learn more about Healthy Skin Centre’s skin consultations and our Healthy Menopause Program in New Westminster, BC.
Ask Dr. Lili provides general health information for educational purposes and is not a substitute for individualized medical advice.
About Dr. Lili
Dr. Lili Nasseri is a family physician with more than 20 years of clinical experience, a menopause practitioner, Clinical Instructor at the University of British Columbia and co-founder of Healthy Skin Centre in New Westminster, BC. She is the author of the upcoming book, The Menopause Method, an evidence-based guide to helping women better understand perimenopause, menopause and the years that follow.