October is World Menopause Month and World Menopause Day is on 18 October, so it feels like the perfect time to talk about something I’m seeing and discussing more and more in clinic, how our skin changes through perimenopause and menopause.
I recently attended the NZSCM conference, where menopausal skin was a major topic of discussion. One of the biggest messages was that we shouldn’t wait until menopause to start thinking about these changes.
In fact, some of the earliest signs can appear in our skin years before menopause itself.
Skin changes can start years before menopause
Menopause is defined as 12 consecutive months without a menstrual period, with the average age being around 51. But the hormonal transition leading up to menopause - perimenopause - can begin several years earlier.
And often the first skin changes aren’t dramatic.
You might simply notice that your skin suddenly feels drier, more sensitive, less hydrated, or that it has lost some of its usual glow. Products you’ve happily used for years may suddenly feel too strong, or your skin may seem less tolerant and slower to recover.
Many women don’t necessarily connect these changes with hormones, particularly if they’re not experiencing the symptoms we traditionally associate with perimenopause, such as hot flushes.
But there is very real biology behind what’s happening.
Why does dryness often come first?
One of the most interesting things discussed at the conference was why dryness and sensitivity can be some of the earliest signs of hormonal skin change.
As progesterone and oestrogen fluctuate and decline, changes occur in sebum production and the lipids, including ceramides, that help maintain a healthy skin barrier.
When that barrier isn’t functioning as effectively, the skin has more difficulty retaining water. Transepidermal water loss (TEWL) increases, which can leave the skin feeling dry, tight, flaky, or more sensitive.
This is important because it can happen during perimenopause, before we start seeing the more obvious structural changes associated with menopause, such as wrinkles, laxity and thinning of the skin.
So if you’re in your 40s and suddenly wondering why your previously uncomplicated skin has become dry, reactive or just doesn’t seem quite like your skin anymore, hormones may be part of the picture.
What happens as oestrogen declines?
Oestrogen has an important role in maintaining skin structure, hydration and function. As levels decline through the menopausal transition, we can see several changes:
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Collagen decreases. This contributes to thinner skin, fine lines and a gradual loss of firmness and resilience.
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Elasticity reduces. Skin doesn’t spring back quite as well and laxity becomes more noticeable.
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Skin becomes drier. Changes in sebum, ceramides and barrier function make it harder for skin to retain moisture.
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Cell turnover and healing slow. Skin can appear duller and rougher and may take longer to recover.
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Skin can become thinner and more fragile. Bruising and sensitivity may become more noticeable.
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Pigmentation can change. Hormonal changes combined with cumulative UV exposure can contribute to uneven pigmentation and, in some women, melasma.
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Redness and sensitivity may increase. Some women notice more flushing or changes in rosacea.
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Hair can change too. Scalp hair may become finer while some women notice increased facial hair.
And these changes matter because we’re living much longer after menopause than previous generations. For many women, a third or more of our lives may be spent post-menopause. Looking after our skin through this transition isn’t about trying to stop ageing but about keeping our skin healthy, resilient and functioning well for the decades ahead.
Hormones aren’t the whole story
Although hormonal change is an important part of skin ageing at this stage, it isn’t the only factor.
Genetics and our cumulative exposome — particularly UV exposure, smoking, nutrition, alcohol consumption, stress and sleep — all influence how our skin ages.
That’s why two women of exactly the same age, even at the same stage of menopause, can have completely different skin.
And it’s one of the reasons I don’t believe in a single “menopause skincare routine”. I treat the skin I see in front of me.
What if you’re already using an oestrogen patch or MHT?
This is an important part of the conversation that often gets missed.
If you’re using menopausal hormone therapy (MHT), including a transdermal oestrogen patch, it doesn’t mean you won’t experience skin ageing or any of the changes above.
However, replacing oestrogen may have beneficial effects on some of the skin changes associated with oestrogen deficiency. Research examining systemic MHT has found improvements in measures including skin hydration, thickness, collagen content and elasticity in postmenopausal women.
MHT isn’t prescribed as a cosmetic treatment for skin ageing, and whether it is appropriate for you is a medical decision that should be made with your GP or menopause specialist based on your symptoms, health and individual risk factors.
From my perspective in clinic, I still assess the skin that’s in front of me.
Someone using an oestrogen patch may still experience dehydration, sensitivity, pigmentation, collagen loss or changes in facial structure. We can then address those individual concerns through appropriate skincare and, where indicated, in-clinic treatments.
Where should we start? With the skin barrier
When skin starts changing, it’s tempting to throw more active ingredients at it. Often, I recommend doing the opposite.
Hydration and barrier function come first.
If the barrier is compromised and the skin is already dry and sensitive, adding multiple strong actives can simply make it more reactive.
Ingredients I commonly look for include hyaluronic acid for hydration, ceramides and barrier-supporting ingredients, and appropriate emollients to help reduce moisture loss.
And there is one ingredient I recommend again and again.
Vitamin B: one of my favourite skincare ingredients
Vitamin B3, or niacinamide, is one of my favourite ingredients and something I recommend to so many of my clients.
It is particularly relevant during perimenopause and menopause because niacinamide can help support the skin barrier and ceramide production, improving the skin’s ability to retain moisture and reducing transepidermal water loss.
My go-to is Synergie Skin Vitamin B, which contains 13% niacinamide.
What I like about Vitamin B is that it isn’t just a “menopause ingredient”. It’s a very versatile ingredient that can support hydration, barrier function, redness, uneven pigmentation and overall skin resilience, which makes it particularly useful when skin is beginning to behave differently.
Rather than simply adding a heavier moisturiser when skin becomes dry, I want to improve how effectively the skin barrier functions and holds onto water.
That’s why Vitamin B is a staple in so many of the skincare routines I prescribe at Precision Skin.
Then we can think about collagen and skin quality
Once the skin is hydrated and the barrier is functioning well, we can introduce ingredients that support collagen, texture, pigmentation and overall skin quality.
Retinoids / Vitamin A — One of our best-studied topical ingredients for supporting collagen, fine lines and texture. But more isn’t necessarily better. If skin has become sensitive or dry, I introduce Vitamin A gradually and adjust the strength and frequency to the individual.
Vitamin C — An antioxidant that helps protect against oxidative stress while supporting collagen and helping with pigmentation and dullness.
Peptides — Useful for supporting skin repair and overall skin quality.
Daily SPF — Still one of the most important things you can do. Cumulative UV exposure contributes significantly to collagen breakdown, pigmentation and skin ageing, so daily sunscreen remains essential throughout perimenopause, menopause and beyond.
Other products I often use depending on the skin include Synergie Skin PressPause, which has been specifically formulated for hormonal skin changes; Dermiotic for microbiome and barrier support; and the Anti-Redness Kit when sensitivity, flushing and redness are significant concerns.
But again, not everybody needs everything.
What about treatments?
Skincare is our foundation, but this is also a stage where carefully chosen treatments can make a meaningful difference.
The treatment isn’t determined by the client’s age or whether she’s menopausal. It’s determined by what has actually changed and what we’re trying to improve.
Depending on the individual, I may recommend:
Dermal needling to stimulate collagen and improve overall skin quality and texture.
Skin boosters when hydration, elasticity and skin quality are the priority.
Chemical peels to support cell turnover, pigmentation and texture where appropriate.
Profhilo or Profhilo Structura where improving skin quality or structural support is indicated.
Anti-wrinkle treatment to soften dynamic lines and maintain balance while still keeping natural movement.
Strategic dermal filler where there has been genuine volume or structural change. This isn’t about simply adding volume everywhere. As our faces change, small amounts placed thoughtfully can sometimes restore support and balance without changing the way someone looks.
The important distinction is why and when we use these treatments, rather than presenting menopause as a list of treatments.
My biggest takeaway
The biggest message for me is that menopausal skin doesn’t suddenly begin at menopause.
The transition may have been happening quietly for years.
Dryness, sensitivity, dehydration, and loss of radiance can be some of the earlier signals during perimenopause, followed later by more obvious changes in collagen, skin thickness, elasticity, and facial structure.
That allows us to be proactive, not because we need to “fight” menopause or ageing, but because understanding why our skin is changing allows us to look after it appropriately.
At Precision Skin, my approach is always to assess where your skin is now: your barrier, hydration, pigmentation, redness, collagen and facial structure, and then decide what it actually needs.
Sometimes that means changing your skincare. Sometimes it means adding a treatment. And sometimes it means simplifying everything and getting the skin healthy again first.
If you’ve noticed your skin changing through your 40s, perimenopause, or menopause and aren’t sure where to start, book a skin consultation, and we can build a skincare and treatment plan around your skin rather than your age!
