Rewriting Menopause Skin Care 

Many factors influence healthy, vibrant skin. One of the most significant structural changes in women’s skin occurs during perimenopause, menopause, and postmenopause. Skin’s structural integrity depends largely on the architecture of collagen, elastin, and hyaluronic acid, as well as a complex interplay of hormonal, metabolic, and environmental factors. 

THE DERMAL SLOWDOWN 

During perimenopause, the body begins to experience a decline in both systemic and skin estrogen levels. This hormonal shift has a direct impact on skin’s structural matrix, resulting in noticeable changes in appearance and texture. Estrogen plays a vital role in the synthesis of collagen, the maintenance of elastin fibers, and the overall hydration of skin. Additionally, estrogen influences the glycosaminoglycans (GAGs) found in the dermis, which are important for retaining moisture and supporting skin structure. As estrogen levels decrease, the cumulative effect is a weakening of skin’s foundational elements, contributing to visible signs of aging such as fine lines, wrinkles, and loss of elasticity. 

As estrogen levels shift, collagen production slows, existing collagen fibers become thinner and more fragmented, elastin loses resilience, and natural hydration diminishes. These changes lead to visible alterations in firmness, elasticity, thickness, and overall vitality, accelerating the appearance of aging.  

CHANGING CONVERSATIONS 

Perimenopause, menopause, and postmenopause are now trending topics. Historically, this life stage was considered taboo and rarely addressed in the media. Today, women are reclaiming the narrative, bringing menopause to the forefront and challenging outdated beliefs. With this shift, more clients are seeking actionable and targeted support. 

Key Statistics 

• Globally, about 1.2 billion women are in some stage of menopause. 

• In the United States, 3.2 million women enter menopause each year. 

• There is an approximate 30% decrease in collagen within the first five years of menopause, followed by a loss of about 2% per year. 

TO THE NAKED EYE 

Many changes and levels of decline are noted during transitions of perimenopause and menopause to postmenopause, both in appearance and texture. These include increased appearance of fine lines and wrinkles, progressive loss of firmness and elasticity, reduced hydration due to declining hyaluronic acid levels, and decreased moisture retention, resulting in crepiness, increased transepidermal water loss (TEWL) and barrier fragility. Additionally,women may experience an increase in vascularity with the appearance of telangiectasia accompanied by erythema and declining sebum production. Clients with naturally sebum-deficient (alipoid) skin will notice increased dehydration, sensitivity, and impaired barrier function. Fluctuations in sebum may lead to acne-type breakouts, sometimes for the first time in a client’s life. 

Accelerated Skin Aging 

As menopause progresses, estrogen levels decline sharply. Fibroblasts, responsible for collagen and elastin synthesis, enter cellular senescence, reducing their ability to maintain and repair the extracellular matrix (ECM). This results in accelerated collagen and elastin degradation, loss of dermal density and resilience, uncreased fragility, and delayed repair mechanisms. The cumulative decline in extracellular matrix integrity is a key driver of menopausal skin aging and requires targeted support. 

UNDERNEATH THE SURFACE 

Perimenopausal and postmenopausal skin differ primarily due to the nature of hormonal changes at each stage. During perimenopause, unpredictable fluctuations in estrogen and other hormones disrupt cellular communication, especially in fibroblasts. This can lead to abrupt changes in texture, hydration, firmness, and a rapid emergence of fine lines. While estrogen’s effects are most prominent, progesterone and testosterone also play roles, sometimes leading to estrogen dominance during this transition. 

Skin itself functions as an endocrine organ, with keratinocytes, melanocytes, and fibroblasts converting circulating androgens into estrogens (primarily estradiol). The only estrogen made by the body after menopause is called estrone; this estrogen is considerably weaker but does act as a precursor to estradiol. This localized estrogen production provides some support during perimenopause but is insufficient to fully maintain skin integrity as systemic estrogen declines. 

Postmenopausal skin reflects the cumulative effects of sustained estrogen decline. Though hormone levels are lower, they are more stable, leading to a gradual weakening of the extracellular matrix, reduced collagen and elastin production, and diminished hyaluronic acid synthesis. Skin’s appearance becomes more uniformly aged, in contrast to the abrupt changes seen in perimenopause. 

Understanding these distinctions is essential for addressing skin health. Perimenopausal skin requires support for hormonal fluctuations, while postmenopausal skin benefits from long-term structural and barrier-focused interventions. Postmenopausal skin continues to experience a steady estrogen decline over time. 

Barrier Dysfunction, Inflammation, & Sensitivity 

Barrier function and inflammation may be problematic even before perimenopause. However, increased transepidermal water loss and cortisol activity during hormonal decline can further disrupt the barrier, leading to heightened sensitivity to ingredients and exacerbated symptoms for those with pre-existing issues. 

TURNING POINTS 

There are two primary estrogen receptors found in skin: estrogen receptor alpha (Alpha ER) and estrogen receptor beta (Beta ER). Both receptors bind to estradiol. Estrogen receptor beta is considered the main mediator of estrogen in skin, expressed in fibroblasts and sebocytes of the sebaceous gland. 

Perimenopause: Estrogen, progesterone, and androgens fluctuate unpredictably, causing abrupt changes in texture, hydration, firmness, and wrinkles. 

Menopause: Defined as the cessation of the menstrual cycle for one year. This signifies a moment in time and immediately becomes post-menopause. 

Postmenopause: Estrogen levels are significantly reduced but stable, leading to a gradual, cumulative aging process rather than sudden changes. 

Distinguishing between these stages is key. Support strategies must accommodate hormonal fluctuations in perimenopause and focus on long-term structure and barrier maintenance in postmenopause. 

THE SURGICAL SHIFT 

Skin aging is inevitable; there is a marked difference between chronological aging and aging through intrinsic or extrinsic factors. Clients who have had hormonal disruptions due to a partial or full hysterectomy will see a decline in their skin sooner, particularly if not taking menopausal hormone therapy. There are levels of hysterectomy surgically performed that will make a difference to the concentration of available estrogen.  

Total hysterectomy with bilateral oophorectomy (removal of both ovaries) causes immediate surgical menopause due to a sudden drop in estrogen, progesterone, and androgens. Hysterectomy without ovarian removal does not induce immediate menopause, but earlier estrogen decline may occur due to lack of ovarian activity. Partial hysterectomy during perimenopause (removal of part of the uterus while leaving the cervix intact) increases hormonal fluctuations. 

TREATING THROUGH TRANSITION 

A thorough consultation is necessary to determine a woman’s stage of menopause. Women may enter perimenopause as early as their thirties, with the typical onset in the mid-to-late forties. Many clients will be in some stage of menopause. Risk factors for earlier menopause include smoking, poor diet, chronic stress, and specific hormonal or medical conditions. 

Many clients may also use hormone replacement therapy (HRT), also referred to as menopausal hormone therapy (MRT), which can benefit skin by supporting collagen density, hydration, and overall integrity. However, menopausal hormone therapy is not prescribed solely for skin health, but for managing menopausal symptoms. If a client is experiencing additional symptoms like night sweats, hot flushes, poor sleep, and fatigue, direct them to chat with their primary care physician or OBGYN to discuss if menopausal hormone therapy is appropriate based on their entire medical history. 

Foundational Treatment Principles 

A barrier-first approach is essential throughout the menopausal transition. Barrier repair establishes the foundation for treatment tolerance and efficacy. Even with barrier restoration, menopausal skin remains prone to hyper-reactivity, so caution is needed with exfoliation, heat-based treatments, and overstimulation. As women age, cellular turnover naturally decreases due to intrinsic aging and hormonal changes. While exfoliation remains a vital step for encouraging healthy cell renewal, it must be carefully customized during the menopausal transition and beyond. The degree of skin fragility at each stage determines what type of exfoliation is appropriate. For many, gentle enzymatic exfoliation may be preferable, while other methods like microdermabrasion or strong chemical peels require thoughtful consideration of skin’s resilience. Ultimately, the frequency and intensity of exfoliation should always be guided by the condition of the skin barrier. Prioritizing barrier repair and maintenance, as previously emphasized, is crucial for achieving optimal results and minimizing adverse reactions in all stages of menopausal skin. 

Estrogen-Based Topicals 

Prescription of topical estrogen may improve elasticity, hydration, and skin texture. These therapies are available only by prescription. Research on systemic absorption and interaction with menopausal replacement therapy is limited, and potential adverse effects, such as melasma, should be considered. 

Two types of estrogen are commonly used: estriol, a weaker form with less systemic effect, and estradiol, a stronger form that is more likely to impact the body systemically. Estradiol may not be suitable for clients who cannot tolerate systemic hormone replacement therapy. 

THE RESTORATION TOOLKIT 

Low-Level Red & Near-Infrared Light Therapy 

Low-level red and near-infrared light therapy supports barrier repair, modulates fibroblast activity, reduces inflammation, and promotes vascular health when used appropriately. 

Microcurrent Therapy 

Microcurrent therapy enhances adenosine triphosphate (ATP) production, improves muscle tone, supports circulation, and promotes collagen and elastin synthesis with consistent use. 

Non-Ablative Radiofrequency (RF) & Ultrasound 

Non-ablative radiofrequency and ultrasound address laxity by stimulating collagen and elastin remodeling; excessive heat should be avoided when treating stages of menopausal skin. 

Manual Therapy Integration 

Manual therapies can help manage stress in menopausal clients. Lower systemic estrogen causes an increase in cortisol, therefore reducing the body’s ability to handle stress, which disrupts circadian rhythms and results in a decline in circadian repair. An increase in anxiety during menopause is common due to hormonal fluctuations, particularly increased cortisol. Manual therapies play an integral role in stress management and the reduction of cortisol. In addition, these manual therapies will have specific targeted effects on skin.  

Manual lymphatic drainage supports detoxification and nutrient delivery. Gua sha improves fascial mobility and reduces tissue adhesions. Fascial release enhances circulation, lymphatic flow, and muscular relaxation. 

INGREDIENT ARSENAL 

Phytoestrogens 

Phytoestrogens are plant-derived compounds that bind to estrogen receptors in skin, offering antioxidant protection, hydration support, and modulation of hormonal signaling. Typical sources include genistein (soy), red clover isoflavones, and flaxseed lignan secoisolariciresinol digluoside (SDG). 

Barrier & Hydration Actives 

Ceramides and epidermal lipids are essential for barrier integrity. Humectants like hyaluronic acid and polyglutamic acid (PGA) support hydration. Polyglutamic acid also helps inhibit hyaluronic acid degradation. 

Multitasking Actives 

Niacinamide supports barrier repair, collagen synthesis, anti-inflammatory activity, and hyperpigmentation prevention. Antioxidants such as resveratrol and vitamin C protect against oxidative stress. 

Topical Peptides  

Topical peptides are a good addition. Peptides aid fibroblast signaling, hydration, and wrinkle softening, and are generally tolerated by sensitive skin. Paired with other actives to address perimenopausal and menopausal skin, peptides comprised of amino acids act as messengers to signal collagen and elastin production, leading to hydration and improvements in extracellular matrix structure and wrinkle depth. Matrixyl, a signaling peptide, for example, can be paired with hyaluronic acid to improve glycosaminoglycans of the extracellular matrix, therefore improving hydration. Peptides are also often used systemically to help with menopausal symptoms.  

Omega Fatty Acids 

A great addition for menopausal skin, omega fatty acids are used for their many properties, including anti-inflammatory, hydrating, and improved elasticity of skin. There are three types of omegas used in skin care formulations: omega-3 alpha linoleic acid (ALA) and docosahexanoic acid (DHA), omega-6 (linoleic acid), and omega-9 (oleic acid). Both avocado and castor oil, for example, contain a blend of all three omegas.  

Clinical Caution With Actives 

Retinoids and chemical exfoliation are valuable if used based on skin type and condition, customized protocols, and monitoring. Glycolic peels, abrasive exfoliation, and excessive thermal exposure are often contraindicated in compromised menopausal skin. 

DAILY DEFENSE 

Skin professionals can also support clients during these phases of transition by educating them on the importance of diet and sleep. Following a diet rich in protein, low in carbohydrates, and balanced in healthy fats can support clients by stabilizing hormone levels, alleviating stress, lowering cortisol, preventing insulin resistance, and enhancing circadian rhythms. Clients who do not receive sufficient nutrition or sleep may experience higher cortisol levels, which can further decrease the circulating estrogen that is already in decline. 

Menopausal skin benefits from consistent maintenance to counteract the negative effects of estrogen decline and delay the visible signs of aging. A customized homecare regimen – providing clients with morning and evening routines based on gentle cleansing, balancing, and moisturizing with a barrier-first approach – is the key to success in treating menopausal skin in the treatment room,. With the maintenance of a healthy skin barrier, clients may be able to include gentle exfoliation, targeted treatments, and actives at home to maintain clinical results. Regular use of a moisturizer and sunscreen is essential.   

NEW CARE STANDARD 

Menopausal skin aging is driven by hormonal fluctuation, particularly estrogen decline, extracellular matrix degradation, and barrier dysfunction. With approximately 6,000 women entering menopause daily in the United States and a widespread lack of menopause education, this population is significant and underserved. Fortunately, the menopause landscape is changing, and clients are becoming more open about the challenges they are facing. A physiology-driven, barrier-focused, and stage-specific approach enables professionals to provide effective and evidence-based care throughout the menopausal transition and beyond. 

References 

1. Sciencedirect.com | Science, Health and medical journals, full text articles and books., n.d. https://www.sciencedirect.com/.  

1. Lephart, Edwin D, and Frederick Naftolin. “Factors Influencing Skin Aging and the Important Role of Estrogens and Selective Estrogen Receptor Modulators (Serms).” Clinical, Cosmetic and Investigational Dermatology Volume 15 (August 2022): 1695–1709. https://doi.org/10.2147/ccid.s333663.  

1. Viscomi, Bianca, Mariana Muniz, and Sonja Sattler. “Managing Menopausal Skin Changes: A Narrative Review of Skin Quality Changes, Their Aesthetic Impact, and the Actual Role of Hormone Replacement Therapy in Improvement.” Journal of Cosmetic Dermatology 24, no. S4 (August 23, 2025). https://doi.org/10.1111/jocd.70393.  

1. Liu, Tao, Nan Li, Yi‐qi Yan, Yan Liu, Ke Xiong, Yang Liu, Qing‐mei Xia, Han Zhang, and Zhi‐dong Liu. “Recent Advances in the Anti‐aging Effects of Phytoestrogens on Collagen, Water Content, and Oxidative Stress.” Phytotherapy Research 34, no. 3 (November 20, 2019): 435–47. https://doi.org/10.1002/ptr.6538.  

1. Beck, V., U. Rohr, and A. Jungbauer. “Phytoestrogens Derived from Red Clover: An Alternative to Estrogen Replacement Therapy?” The Journal of Steroid Biochemistry and Molecular Biology 94, no. 5 (April 2005): 499–518. https://doi.org/10.1016/j.jsbmb.2004.12.038.  

1. Rzepecki, Alexandra K., Jenny E. Murase, Rupal Juran, Sabrina G. Fabi, and Beth N. McLellan. “Estrogen-Deficient Skin: The Role of Topical Therapy.” International Journal of Women’s Dermatology 5, no. 2 (June 2019): 85–90. https://doi.org/10.1016/j.ijwd.2019.01.001.  

1. The difference between MHT and HRT, n.d. https://www.medcentral.com/endocrinology/hormones/benefits-risks-menopausal-hormone-therapy.  

1. “What Is Circadian Rhythm?” Cleveland Clinic, December 26, 2025. https://my.clevelandclinic.org/health/articles/circadian-rhythm.  

Kirsten Sheridan has a higher national diploma in beauty therapy from the United Kingdom and is a licensed aesthetician. She has 20 years of experience as an aesthetician and educator, holds a teaching qualification through City and Guilds London, and is a CIDESCO diplomat. Sheridan’s other qualifications include massage therapy, aromatherapy, reflexology, and electrology. She has a personal training qualification through the National Academy of Sports Medicine (NASM), although not in active practice. In addition, she is the owner and founder of knowskin.com, an online learning hub for aestheticians. Sheridan has taught for Dermalogica, International Dermal Institute, San Francisco Institute of Esthetics and Cosmetology, San Jose City College, and The Dermal Sciences Institute.