Treating Skin Changes During Perimenopause


What could be more frustrating than having wrinkles AND pimples? It is not uncommon for an esthetician to see a client in her 50s coming in for both anti-aging and acne treatments. And as with so many of life’s irritating moments, women can blame it on hormones. Hot flashes, moodiness and sleep disorders are some of the uncomfortable symptoms every woman going through perimenopause has experienced to some degree.

While these symptoms are well-known, the hormonal changes ushering in menopause can cause a wide spectrum of skin disorders, ranging from acne to extreme skin dryness. Lower levels of vital female hormones such as estrogen can also accelerate skin aging. While some women go through perimenopause without problems, others experience great changes, especially with their skin.

This article will look at how fluctuating hormones can affect the skin, as well as suggest effective treatments and ingredients to mitigate conditions brought on by these unavoidable hormonal changes. It also will offer suggestions to help soothe perimenopause symptoms such as sleep disruption and hot flashes, which can affect skin health.

Hormones and the Skin

Perimenopause is the time period during which a woman’s body is transitioning to complete loss of fertility—menopause. A woman can enter perimenopause at different ages. It usually starts in the mid-40s, but can begin as early as the mid-30s. During this time, the ovaries gradually shut down, which results in the fluctuation of hormones.

Although perimenopause may not commence until the 40s, a gradual decrease in ovarian activity already has begun, which leads to reduced estrogen and progesterone production. These lower levels of hormones lead to decreases in collagen and elastin fibers, in turn causing wrinkling and sagging known as elastosis.

The woman’s body is thrown off balance due to the declining production of the dominant female hormones such as the common estrogen β-estradiol and progesterone. Conversely, although women produce only a small amount of male sex hormones (androgens), the effects become more dominant due to the depletion of estrogen and progesterone. This can lead to skin becoming excessively oily as well as excessively dry during different times of the month, a kind of skin schizophrenia that can really add insult to injury.

Perimenopausal Skin ConditionsPerimenopausal Skin Conditions

Some of the main skin conditions that can manifest and recur during perimenopause are addressed here. Also suggested are topically applied ingredients to calm the related skin symptoms.

Wrinkles. Skin is a composite tissue, consisting of a fibrous matrix containing elastin and collagen. Collagen provides strength to the skin structure, and elastin provides the snap or resiliency, allowing the skin to move about and assume conformational changes as required. When elastin fibers undergo changes that cause them to lose resiliency or snap, the skin no longer is able to return to its original state. As a result, sagging and crinkling occur in a pattern, forming wrinkles.

Treatment-wise, palmitoyl oligopeptide (Pal-GHK) restructures cutaneous tissues. Research has shown it can increase collagen, elastin, hyaluronic acid and glucosaminoglycan production. When the synthesis of these proteins is stimulated, smoother, wrinkle-free, rejuvenated-looking skin results.

Ulva lactuca is a green seaweed and a key source of aosine, an enzyme that neutralizes the elastase responsible for breaking down elastin in the skin. Biopeptides of Ulva lactuca also are rich in proline, glycine and lysine, which are similar to elastin and can block or partially block the action of elastase.

In addition, biomimetic messenger peptides are patterned on a specific natural collagen fragment. They signal the cells to firm the epidermal/dermal junction. These pentapeptides work through a wound-healing pathway, activating genes associated with collagen cross-linking. Clinical studies show they can reduce the mean surface area of deep wrinkles by 68%.1 It should be noted that such peptides have the anti-wrinkle efficacy of retinols, without the irritation.

Dry skin. Hormonal changes in perimenopause decrease sebum production, so the average moisture content of the stratum corneum is slightly decreased each year.

To address this moisture loss, Laminaria digitata is a brown seaweed that provides hydrating, nourishing and antioxidant properties. Its essential fatty acids help to maintain the skin barrier while the polysaccharide alginic acid helps to lock moisture in the skin. It is also known to help increase cell proliferation.

Also, Codium fragile subsp. atlanticum is a green seaweed that re-establishes and locks moisture into skin while balancing and repairing the skin barrier.

Thin skin. During perimenopause, blood flow through the skin’s capillaries is reduced since they are partly controlled by estrogens. This results in fewer nutrients and less oxygen feeding the skin and is a contributing factor to both the thinning of skin and reduced cell turnover rate, leading to water loss and dry skin.

As far as treatment, red clover extract (Trifolium pratense) is rich in plant hormones that mimic a phytoestrogen hormone to help stimulate skin thickness for the appearance of younger, plumper-looking skin.

Sensitivity. As skin ages it becomes thinner and more sensitive to irritants. As women enter perimenopause, they may notice their skin reacts to products that never bothered them in the past. For example, certain cosmetics, soaps, perfumes or laundry detergents may suddenly cause rashes.

To address this, Pelvetia canaliculata, a brown algae, has anti-inflammatory and antioxidant properties. It helps to prevent aging, protects against DNA deterioration and treats pigmented spots for a more even-toned complexion.

Rosacea. According to the National Rosacea Society (NRS), rosacea can worsen during perimenopause.2 Many women report more flushing episodes and increased numbers of bumps and pimples during these times.

According to Wilma Bergfeld, NRS consulting dermatologist, “It’s been widely observed that rosacea is often aggravated at menopause.”3 Treating the underlying hormonal fluctuations can therefore help to treat the rosacea.

Acne. As mentioned, during perimenopause, estrogen levels decline but male androgens such as testosterone remain relatively high. This creates a hormone imbalance that can lead to excess testosterone and greater sebum production, a common cause of adult acne. Brought on by a reaction to androgens, acne can remain a problem until postmenopause, when the production of androgens finally falls.

Enlarged pores. As skin loses its elasticity, pores on the face become bigger. If good cleansing is not maintained, a buildup of oil and cells can cause the pores to expand even further.

Hyperpigmentation. Estrogens also moderate melanin production. As perimenopause begins, melanin synthesis increases due to a lack of estrogen. Any areas of the skin that have been exposed to UV rays can generate brown age spots, most likely appearing on the face, neck, hands, arms and chest.

To treat these spots, glabridin is a brightening agent. It is known to help reduce melanin activity, provide even pigmentation and make age spots less visible. It also reduces the UV-stimulated induction of melanin biosynthesis.

Tyrosinase is an enzyme that catalyzes the production of melanin and other pigments by oxidation. While most brightening products work through tyrosinase inhibition, it is possible to influence the process at multiple points, providing a multidimensional approach. Glabridin not only inhibits tyrosinase activity, but also controls the messengers to inhibit melanosome transfer.

Sagging skin. Lower estrogen levels during perimenopause redistribute fat to the stomach, thighs and buttocks. This leads to a loss of supportive fat below the skin of the face, neck, hands and arms.

Perimenopause Symptoms

While some of the worst symptoms of perimenopause are not directly related to hormonal changes in the skin, they can indirectly affect the skin. Following are some of the “ugliest” symptoms that can rear their heads during this time, and suggestions on how to abate them.


Hot flashes. These passing episodes of intense sweating can result in extreme redness and flushing of the skin. This is particularly exacerbating to rosacea conditions. To help soothe overheated skin, offer 8 oz. of ice water and continually spray the client’s face with a hydrating mist containing anti-inflammatory phlorotannins.

Sleep disorders. Humans need at least seven to eight hours of deep sleep to feel truly rested and restored. Sleep is also the time when all the cells in the body regenerate, including skin cells. Insomnia or repeatedly waking up in the middle of the night can result in dark circles under the eyes and sallow skin.

Advise the client to take a warm bath, no more than 38°C or 98°F, for 15 min. before going to bed to help reduce insomnia. Wearing an eye mask and ear plugs can also help to reduce sensory stimulation, which might also contribute to a lack of sleep. Clients should be sure to use a brightening eye cream in the morning to help counteract dark circles.

Mood disorders. Mood swings are reported during these hormonal changes. To counteract them, dark chocolate high in pure cocoa content can help to release mood-enhancing endorphins. It is a myth that chocolate causes acne but you can eat too much. Balance chocolate therapy with a good exercise program. Walking or light jogging for 30 min. can help to release endorphins as well.

Loss of bone mass. Perimenopause can bring with it a reduction in calcium absorption. This can be combatted by calcium consumption via supplements. Weight training can also help to reduce the amount of bone loss.

Increased facial hair. Lower levels of estrogen can cause testosterone-related increases in facial hair growth, resulting in increased hair in the chin, lip and nose areas. Both laser hair removal and waxing can be used to remove this unwanted hair. These should be incorporated into facial treatments. Advise clients not to tweeze, which is not only time-consuming but can cause infection if not properly cleaned and sterilized.

Be Knowledgeable

As seen above, a perimenopausal client can experience not only a number of skin changes, but also body and lifestyle changes. It is important to be knowledgeable on the skin conditions and symptoms associated with perimenopause to recommend the right course of action. Doing so establishes trust with your client and ensures their return during this stressful time in their life.



(Accessed Jan 5, 2016)

Si Authors L Sarfati 3001

Lydia Sarfati, president and founder of Repêchage, is an internationally recognized skin care expert quoted in Vogue, InStyle, Glamour and The New York Times, and she has been featured on CNN, CBS and Fox. Sarfati has more than 30 years of experience as an esthetician, spa owner, manufacturer and consultant, and is a member of Skin Inc.’s 2014–2015 Editorial Advisory Board.

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