It’s like falling out of love. You can’t quite pinpoint when things started to shift, you just know you feel different.
And like a relationship that’s fizzling out, the skin changes in perimenopause can leave you feeling bewildered and searching for answers. Does your face feel dry and rough because of hormonal shifts, or because it’s winter? Are you breaking out because you’re getting your period soon, or because you’re actually inching closer towards menopause?
To help you navigate the complexion complexities that come with this phase of life, we asked top dermatologists how to identify perimenopause-related skin changes and manage them in the most effective ways possible, so your skin can remain soft, radiant, and resilient.
What is perimenopause?
Unlike menopause, which is defined by 12 consecutive months without a menstrual period, perimenopause doesn’t have a concrete timeline. Rather, it’s a transitional phase of shifting hormones as your body moves toward the end of your reproductive years.
During perimenopause, the reproductive hormones progesterone and estrogen fluctuate dramatically and unpredictably before beginning to decline. Progesterone drops off first and sharply, creating a hormonal imbalance that often impacts your period. Estrogen may dip more gradually throughout perimenopause, but as this happens, testosterone becomes more dominant, throwing things off balance even further.
How do you know when you’re in perimenopause?
Riddle us that, because there’s usually no ah-ha moment to signal when this transition has begun, nor do changes typically happen around the same time. Testing your hormones is not considered a reliable method of diagnosis, because your hormones continually fluctuate throughout perimenopause.
Your age isn’t necessarily a telltale marker, either. While the average onset of menopause is 51 years old, perimenopause can start as early as your mid-30s or not until your 50s. Which means, it can last as long as a decade, or only a few months. The average duration is four years, but like many aspects of perimenopause, the timeline tends to be unique for each person.
It doesn’t help that while some symptoms of perimenopause, like hot flashes and night sweats, are well-known menopause precursors, others are less obvious. Issues like trouble sleeping, weight gain, mood changes, brain fog, and a low libido are often dismissed as just signs of stress or being worn out. Some women have no perimenopause symptoms at all, or they’re so subtle or brief that they go unnoticed.
One common indicator of perimenopause is changes to your period, such as if it lasts longer or shorter than usual, is heavier or lighter than normal, or becomes irregular. That said, some women have always had irregular periods, so once you reach your 40s, it’s a good idea at your annual gynecologist visit to discuss your cycle and share anything out of the ordinary with your period or overall health and well-being.
How can perimenopause affect your skin?
As your hormones fluctuate, which can happen throughout your reproductive years, it can mess with your skin. When you’re going through puberty, your reproductive hormones surge, often leading to oiliness and acne. In perimenopause, these hormones wind down, which can trigger its own set of unwelcome skin effects like dryness, wrinkles, sagging, even breakouts.
One reason is estrogen’s central role in how the skin functions. “Estrogen helps promote the skin’s synthesis of collagen, elastin, and hyaluronic acid,” says Michael Krathen, M.D., a board-certified dermatologist in Natick, Massachusetts, and Chief Medical Advisor for Cottonball.
Collagen and elastin are the main structural elements of skin that keep it smooth and firm with good elasticity, while hyaluronic acid retains moisture to make skin soft, plump, and hydrated. As estrogen levels decline during perimenopause, the production of these fundamental structural and hydrating components slows, and you may experience the following skin changes:
Dryness and a rough feel. In addition to making less hyaluronic acid, your skin’s production of moisturizing oils and lipids, like ceramides, also decreases significantly in perimenopause. Your face may feel chronically dry and sandpaper-y, and your skincare may not seem as nourishing as it once was.
Wrinkles, crepiness, and sagging. With the skin generating less collagen and elastin, it loses firmness and becomes thinner and weaker. That’s when lines tend to creep up and the skin can become lax.
Increased sensitivity. With fewer ceramides in the skin and its outer later, the epidermis, becoming thinner, “the skin’s protective barrier can become compromised, making your skin more sensitive and reactive, even to products you’ve always used,” says David E. Bank, M.D., a board-certified dermatologist in Mount Kisco, New York.
Dullness. Your skin’s natural exfoliation process, or cell turnover rate, begins to slow down in perimenopause. This allows dead cells to build up, which can muffle radiance and make your complexion seem blah.
Breakouts. This one can really catch people off guard, because even if you never had adult acne, it can come on during perimenopause. Waning estrogen levels create a hormonal imbalance that allows testosterone—which influences the skin’s sebum production—to become more dominant, often sending your oil glands into overdrive. Combined with the slowdown in skin cell turnover that can lead to clogged pores, it’s a recipe for breakouts.
What are the best ways to treat perimenopause-related skin changes?
We promise it’s not all doom. There’s plenty you can do to combat these complexion changes and revitalize your skin. The right blend of clinically proven ingredients can help rev up the slowed-down skin functions to stimulate collagen and elastin, replenish hyaluronic acid and lipid levels, and resolve acne. And if you start addressing these issues now, your skin will be more resilient going into menopause, when estrogen drops to its lowest levels and signs of skin aging can worsen.
These are some of the best ingredients to consider adding to your skincare routine in perimenopause.
Prescription Ingredients
Tretinoin: “This synthetic form of vitamin A is the ultimate multitasker for treating and preventing fine lines, crepiness, skin laxity, and acne,” says Dr. Bank. “It regulates your skin’s cell turnover rate, which stimulates collagen and elastin and keeps pores clear. It also balances skin’s oil production to help reduce breakouts.”
Tretinoin is available by prescription only, as it’s the most potent type of retinoid—up to 20 times more potent than over-the-counter retinol, according to one study. (To learn more about tretinoin, read “Why Nearly Everyone Should Use Tretinoin—And How It Compares to OTC Retinol.”)
Cottonball VX.2 Wrinkle-Smoothing & Prevention Complex contains our highest levels of tretinoin, in personalized concentrations up to 0.10%. If you’re dealing with perimenopausal breakouts, the formula can be customized to include azelaic acid, which kills zit-causing bacteria, aids in preventing clogged pores, and tampers down the inflammation that can lead to post-acne spots.
Rapamycin: All eyes are on this longevity molecule for its potential to slow or even reverse cellular aging. Rapamycin works by helping clear away senescent skin cells, which are aging, dysfunctional cells that release highly inflammatory molecules that damage surrounding tissue. (Similar to how in a pint of berries, one rotting berry can quickly spoil the rest.) This makes room for newer, healthy cells that produce high-quality collagen and elastin to flourish, which in turn helps firm, smooth, and strengthen the skin.
One small study showed how rapamycin, which has long been used in medicine, can reduce cellular senescence in the skin. (To learn more about rapamycin, read “Meet Rapamycin: The Next Game Changer for Skincare Longevity.”)
Cottonball VX.1 Advanced Anti-Aging & Repair Complex combines a customized level of prescription tretinoin with prescription rapamycin and bakuchiol, another collagen stimulator, to battle signs of aging at the cellular level and rejuvenate the skin.
Estriol: Topical estrogen treatments have been shown to improve collagen and elastin levels in the skin as well as increase moisture levels. Estriol—one of the three types of estrogen our bodies naturally produce—is considered the mildest prescription topical, but its skin benefits are mighty.
“Topical estriol can help counteract the skin effects of declining estrogen levels in perimenopause and menopause,” explains Dr. Bank. “It interacts with estrogen receptors in the upper levels of skin to increase hydration and firmness and soften fine lines. And it does so with little systemic absorption,” meaning it doesn’t appear to absorb significantly into the bloodstream when used at low concentrations. (Always check with your doctor, though, before starting any estrogen-based product.)
Cottonball VX.3 Hormone Renewal Complex contains 0.3% estriol. In one study, perimenopausal women who applied 0.3% estriol to their face for six months had markedly firmer skin with improved elasticity and moisture levels and significant reduction in wrinkle depth and pore size. Their skin also showed a measurable increase in collagen.
Dr. Bank notes that pairing estriol and tretinoin in your regimen can be especially impactful. “Together, these prescription ingredients work synergistically to tackle multiple skin issues from different angles,” he says. “It’s a full-spectrum approach to supporting the skin throughout perimenopause and beyond.” (To learn more about estriol, read “Meet Estriol: a New Option for Menopausal Skin.”)
Over-The-Counter Ingredients
Hyaluronic acid: Our skin’s production of hyaluronic acid slows way down in perimenopause, contributing to the chronic dryness that women often experience around this time. As a skincare ingredient, hyaluronic acid (HA), works as a humectant to draw water to the skin and hold it in. There’s low molecular weight HA, which refers to small molecules that penetrate the skin’s surface to deliver sustained hydration, and high molecular weight HA, which is larger molecules that sit on the skin’s surface to deliver immediate moisture and plumpness.
Every Cottonball product contains both types of hyaluronic acid to help soften and nourish the skin and maintain lasting hydration.
Niacinamide: Increased sensitivity can rear its ugly head in perimenopause, and this type of vitamin B3 is proven to boost hydration and strengthen the skin barrier, making skin more resilient against irritation. Niacinamide also increases the skin’s production of lipids—key moisturizing agents that deplete during perimenopause—and is a potent antioxidant that protects against collagen degradation, is anti-inflammatory, and helps boost radiance.
Niacinamide is in nearly every Cottonball product, and the concentration is customized to your specific skin needs.
Ascorbic acid and Resveratrol: Ascorbic acid is a powerful form of vitamin C that nixes dullness and sallowness by accelerating skin cell turnover and helping regulate melanin production, which evens out skin tone. Resveratrol is a polyphenol (a plant-derived compound) that has been shown to boost collagen production, and its anti-inflammatory properties soothe irritation.
Both ascorbic acid and resveratrol are potent antioxidants that protect against environmental aggressors that damage skin. When paired together, the ingredients turbocharge each other’s anti-aging benefits to deliver maximum skin support and protection.
Cottonball VX.3 Hormone Renewal Complex has both ascorbic acid and resveratrol to brighten, soothe, and protect skin.
Mineral sunscreen: You already know that wearing broad-spectrum SPF 30 or higher on your face, neck, and exposed upper chest every day is the best way to protect UV-induced skin aging. But since skin often becomes more sensitive in perimenopause, Dr. Bank recommends avoiding chemical sunscreens and using a mineral formula instead.
“The SPF ingredients in mineral sunscreens, zinc and titanium dioxide, have anti-inflammatory benefits that help prevent irritation,” he explains.
“Skincare can do a lot to counteract perimenopause-related changes, but keep in mind that your complexion also reflects your overall health," Dr. Bank adds. "Following a sensible diet, getting enough sleep, exercising regularly, and minimizing stress as best you can are all critical to maintaining healthy skin.”
Thankfully, it’s never too late to start practicing good habits, or to create a product regimen that will support your skin through perimenopause. and for years to come.
If you’re in perimenopause, are Cottonball’s prescription treatments right for your skin? Take this short quiz to find out.
