Dermatologists Say These 5 Changes Will Save Your Skin During Menopause

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What the heck is going on with my skin?
It's my firm belief that that this question will be uttered at some point by every woman going through menopause. That's because issues like dryness, volume loss, adult acne, and wrinkles can all be happening during this time. I should know—I'm there myself.
I've been fortunate to sidestep the hot flashes, the breast pain, and the brain fog (all common menopausal complaints), but my skin has changed. I never considered my complexion to be particularly problematic, but when I turned 50, my outer layer became a super-sensitive desert of dryness from head to toe. Dune's Arrakis has nothing on me.
So, what is going on with your skin at this time in life—and what can you do about it?
The hormonal fluctuations during perimenopause—the transition period leading up to your final monthly menstrual cycle—are what trigger breakouts and dryness, says Ellen Marmur, MD, a dermatologist and the founder of Marmur Medical. The maddening part is that often many of the skin issues that crop up at this age occur at the same time.
Meet the experts: Ellen Marmur, MD is a dermatologist and the founder of Marmur Medical. Mona Gohara, MD, is a dermatologist in Connecticut and a member of the Women's Health medical advisory board. Amy Wechsler, MD, is a board-certified dermatologist in New York City.
That was certainly the case for Melissa Mattola-Kiatos. 'I've had oily to combination skin my entire life, but in the year leading up to turning 50, things started changing drastically, and my skin became dry, itchy, and sensitive,' says Mattola-Kiatos, who lives outside Boston. 'I also had acne—and it was different from the pimples I had as a teen. Out of the blue, I'd get one major cystic pimple on my lower face.'
What's behind this trouble: Estrogen is decreasing (which increases dryness), while the production of hormones such as testosterone is dropping. And though you'd think greater dryness would reduce acne, a condition often associated with oily skin, you'd be wrong, says Mona Gohara, MD, a dermatologist in Connecticut and a member of the Women's Health medical advisory board. 'Sebum is just one factor in the acne equation,' she explains. 'Hormonal acne triggered by perimenopause results in cystic lesions that are deep in the skin and less reliant on oil production.'
Once you reach menopause, which officially happens after 12 consecutive months without a period, studies show that a lot of 'aging' issues start to show up. 'Estrogen drops when menopause hits, and this hormone is responsible for stimulating skin cells, such as the fibroblasts that make collagen and elastin,' says Dr. Gohara. 'So when estrogen decreases, there's also less collagen, elastin, hyaluronic acid, and ceramides being produced, which triggers dryness, wrinkling, and sagging.' In fact, collagen, the natural protein that keeps your skin plump and firm, can decrease by up to 30 percent in the five years immediately following the onset of menopause, according to one study.
Eera Sharma experienced these changes firsthand. 'I started noticing a small shift when I was in my 40s, but by the time I turned 50, I felt like 10 years of aging had shown up on my face,' says Sharma, who lives in Farmington, Connecticut. 'I wasn't bugged by the hint of a wrinkle and wanted to age gracefully, but by 53, I said, 'Screw that.' '
Besides the effects of menopause, there's cumulative UV damage, which shows up as brown spots, and the natural aging process, which slows skin-cell turnover and makes a complexion look dull. What we're dealing with is a perfect storm for your skin, but the good news is that you can actually prepare for it—and deal with it once it's past you. 'The key to a vital, healthy-looking glow during perimenopause and menopause is to have an approach that counteracts existing damage while preventing new damage,' says Dr. Gohara.
Here are the five most common menopausal skin woes—and what to do about them.
Hormonal acne
These aren't the zits you had in high school. Dr. Marmur calls these pimples, which typically pop up on the jawline, 'dry skin acne' because they're accompanied by a reduction in hyaluronic acid and ceramides. 'Estrogen is going down so testosterone is dominating, and this hormone imbalance during perimenopause triggers hormonal acne breakouts,' she says. The challenge is to clear pimples without drying out your skin further, so it's important to blend pore-clearing active ingredients with hydrating ones to keep your skin balanced. Dr. Gohara is a fan of topping off these actives with an hyaluronic acid-based moisturizer.
Use an acne product with to keep pores unclogged. This beta hydroxy acid is oil-soluble, so it cuts through oil-blocked pores to clear out oil, dead skin cells and dirt. It also has anti-inflammatory properties to help prevent irritation. 'I have two teenagers at home, so I stole some of their acne products, including a salicylic acid face wash that I use nightly,' says Mattola-Kiatos.
Try a retinoid. If the salicylic acid isn't clearing your skin, dermatologists recommend a prescription retinoid to keep pores clear by regulating skin cell turnover. (Plus, it builds collagen over time too.) 'I prescribe topical tretinoin to improve everything from skin laxity and wrinkles to breakouts,' says Amy Wechsler, MD, a board-certified dermatologist in New York City.
Opt for Rx meds. To step up treatment of stubborn hormonal acne, dermatologists prescribe an oral medication called spironolactone, which works by blocking the male hormones that trigger hormonal breakouts.
Fine Lines
As many women begin to notice, wrinkles first make an appearance during perimenopause due to collagen loss. If you have a proactive skin routine in place, including daily SPF to prevent the UV damage that destroys collagen and creates wrinkles, stay the course. The add these.
Again, reach for a retinoid. These vitamin A derivatives stimulate fibroblasts to produce more collagen and elastin. They also regulate skin cell turnover (which slows with age), keeping pores clear and skin smooth.
Pick up peptides. If you can't tolerate a retinol serum, use a collagen-boosting peptide product instead, suggests Dr. Gohara. These products work similar to vitamin A derivatives like retinol and prescription retinoids, but tend to be gentler.
Consider injections. Dr. Wechsler typically uses an injectable neuromodulator like Botox Cosmetic to smooth lines temporarily, as well as injectable fillers to add volume and soften wrinkles. Needles did the trick for Sharma: 'I had Botox a few months ago, and it diminished the appearance of my fine lines,' she says. 'I also got filler to lift my sagging skin and contour my face.'
Hair thinning
Hair and skin are two separate things, but considering scalp health is directly related to you hair health, it's only right to call this one out. 'Hair loss is probably one of the biggest issues that I see during perimenopause,' says Dr. Gohara. (About half of women experience accelerated hair loss at this stage in life.) It's a condition called 'androgenetic alopecia' or 'female pattern baldness,' and like hormonal acne, it's triggered by dropping estrogen levels that leave male hormones unopposed. 'In addition to causing breakouts, androgens may make you lose strands at the hairline and the crown of your head,' says Dr. Gohara.
That was Jaime Maser Berman's experience. The 47-year-old from New Jersey noticed thinning around her temples and part. 'Since this is where my gray roots are, it only exacerbated the look of thinness,' Berman says. She reached for the fast fix of root cover-up sprays, but there are preventive measures and medications you can take to stop the shedding.
Keep strands strong. Unfortunately, you may have to slow down or cut out some hair styling practices that cause damage. 'To prevent more hair loss, think about not over-processing the hair with bleach, or overusing hot tools like blow-dryers,' says Dr. Gohara. All that heat, pulling, and processing can weaken vulnerable strands by causing dryness, breakage, split ends, dullness, and more.
Try an OTC medication. Derms universally recommend topical minoxidil to curb hair loss. 'I suggest using the 5% solution, as opposed to the lower 2% version for women. It's more effective, and just as safe,' says Dr. Gohara. 'You apply this to your scalp twice a day, every single day to help grow hair locally.' One caveat: Once you stop using the product, your hair will start shedding again. This also might not treat other forms of hair loss, so make sure you run this option by your doctor before committing.
Seek a doctor's help. Dr. Gohara recommends seeing a dermatologist (yes, they treat hair issues, too) to get started with a plan of action. 'A higher dose of oral spironolactone can treat perimenopausal hair thinning, as well as hormonal acne. And in-office treatments such as platelet-rich plasma (PRP) injections can help stimulate hair growth too,' she says.Effaclar Salicylic Acid Acne Treatment
A serum made to treat acne, prevent new breakouts, and reduce the appearance of pores while preventing post-acne scarring.
$33.74 at amazon.comEvening Wear Ectoine + Retinoid Firming Night Cream
This retinol was created to address the look of fine lines and wrinkles that occur during menopause.
$80.00 at amazon.comThickening Shampoo
Suds up with a biotin- and keratin-infused shampoo that preserves what you've got and thicken it over time.
$7.34 at amazon.comDeep Hydration Restorative Cream
Dealing with hot flashes and dryness? This cream has ceramides and lipids, plus a red algae extract that cools skin on contact.
$132.00 at phosis.comUltra Gentle Balm
A blend of coconut oil, shea butter, and hyaluronic acid, this rich balm tackles dehydration all over, including the delicate skin of the vulva.
$19.99 at amazon.comFountain Of Glow Vitamin C Facial Serum
An 8 percent vitamin C serum that improves uneven tone and leaves a dewy finish.
$29.99 at ulta.com
Dryness
Getting back to my Arrakis-dry skin barrier. Plummeting estrogen not only impacts collagen and elastin, but the production of natural ceramides and HA. This means that the stratum corneum, the outermost layer of the skin, has a harder time keeping moisture in and irritants out.
You've heard of double cleansing? Now's the time for double- and triple-moisturizing. Look for hydrators like hyaluronic acid and glycerin, that bring water to the skin and emollient lipids like ceramides, squalene, or shea butter to help seal in that moisture.
Moisturize at every step. 'You need to transition to more hydrating and emollient formulas of everything—cleanser, body moisturizer, richer face creams, oils, and balms,' says Dr. Wechsler. And don't be afraid to layer. 'This is when you can slug and sandwich like crazy,' says Dr. Gohara. 'In menopause, you can't moisturize too much.'
Consider hormone therapy. Talk ing to your gynecologist about hormonetherapy can be a game changer for treating menopausal symptoms such as dry skin (in addition to vaginal dryness). So, if you experience either (or both), this option is worth trying.
Think twice about . 'While these are used to treat vaginal atrophy, I wouldn't prescribe them for facial antiaging,' Dr. Gohara says. 'The formulas use estriol, a weaker form of estrogen, but there's not enough science to show this ingredient is safe or efficacious on the face.'
Laxity
With less support from collagen and fat in the picture, your skin loses its firmness and begins to sag. 'There's also less elastin, the rubber band-y connective tissue that holds collagen in place so everything can flex and move,' explains Dr. Marmur. The result is a loss of volume in the face, the neck, and the jawline (the dreaded jowls!). Retinol and sunscreen are key, but there are other firming options.
Apply antioxidants. 'Estrogen also acts as an antioxidant that protects against free radical damage, so now that it's low, you should up your topical antioxidants, especially with vitamin C that's proven to help build collagen too,' says Dr. Gohara.
Consider these treatments. 'I'll do a series of fractionated laser treatments to help stimulate collagen and elastin formation over time,' says Dr. Marmur. 'This also works well on hyperpigmentation, dullness, and has a firming effect.' To firm skin on the lower face and neck, both experts recommend having an in-office procedure like Thermage, which uses radio frequency energy to stimulate collagen and elastin production and tighten skin. Sofwave is an ultrasound-based heat treatment that also stimulates the production of firming collagen deep in the dermis.
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