Skin in menopause: what changes, why it happens and what you can do

The Pausetiv team in collaboration with Dermaself

Have you noticed that your skin no longer responds the way it used to? That it dries out more quickly, that wrinkles have deepened in a short time, or that acne has appeared even though you did not have it at twenty? If you are in perimenopause or menopause, what you are experiencing has a solid physiological explanation.

The skin is one of the organs most sensitive to hormonal change. And during the menopausal transition, hormonal change is radical. In this article we explain what happens to your skin, why it happens, and above all what you can do today to care for it in an informed and effective way.

Estrogen and the skin: a deep connection

To understand skin changes during menopause, we need to start with estrogen. These hormones do not only regulate the menstrual cycle: they perform an active protective and maintenance function on almost every tissue in the body, including the skin.

Estrogens stimulate the production of collagen and hyaluronic acid, maintain skin hydration, regulate sebum production, support the epidermal barrier function and reduce inflammation. They are, in essence, the main architects of the structure and appearance of adult female skin. A systematic review published in International Journal of Women’s Dermatology by Rzepecki et al. (2019) documents in detail how estrogen deficiency translates into measurable changes in every component of the skin. (DOI: 10.1016/j.ijwd.2019.01.001)

When estrogen levels begin to decline, already during perimenopause the skin registers it almost immediately. The effects accumulate over time, but early signs can appear as early as the age of 40.

Perimenopause: when the skin begins to fluctuate

Perimenopause is the transition phase that precedes menopause. It can last from two to ten years and is characterized by irregular hormonal fluctuations, not by a linear decline. This variability has a direct impact on the skin, often confused with other problems. To learn more about perimenopause and its symptoms, read this article on the Pausetiv blog.

During perimenopause, the skin can show intermittent dryness alternating with phases of greater oiliness, precisely because estrogen levels fluctuate. Some women describe unpredictable skin that reacts differently to the same products from one day to the next.

A particularly common phenomenon at this stage is relative hyperandrogenism: as estrogen decreases, the contribution of androgens, hormones also present in women, becomes proportionally stronger. This can lead to increased sebum production, hormonal acne and, in some cases, slight facial hair growth. The permeability of the skin barrier increases already in this phase, making the skin more reactive to external agents, more prone to redness, itching and irritation.

Menopause: the structural changes of the skin

With the arrival of menopause itself, defined as 12 consecutive months without a period, estradiol levels decline steadily and the skin faces more pronounced structural changes.

Skin density decreases by 1-2% every year after menopause, according to data documented by Brincat and colleagues (PubMed: 1345134) and confirmed by Thornton in her review in Dermato-Endocrinology (DOI: 10.4161/derm.23872). The skin becomes thinner, less resistant and heals more slowly in the case of cuts or abrasions. This is not a superficial aesthetic effect: it is the result of a transformation of the extracellular matrix, the supporting tissue that gives the skin thickness and resilience.

Hydration decreases on two fronts: sebum production decreases and the skin’s ability to produce and retain hyaluronic acid declines. The result is skin that feels tight, rough and that shows signs of time in an accelerated way compared with previous decades.

Collagen and elastin: the silent collapse

Among all the changes that menopause brings to the skin, collagen loss is the one with the most visible and structural implications.

In the first five years after menopause, skin collagen levels can decrease by up to 30%. This figure, originally documented by Brincat et al. in Obstetrics & Gynecology in 1987 (PubMed: 3120067) and confirmed by numerous subsequent studies, including a recent 2025 narrative review on PMC (PMC12374573), explains why many women perceive an almost sudden change in their appearance during this period. After the first five years, the rate of loss stabilizes at around 2% per year, but the cumulative impact remains significant.

A key finding highlighted by Brincat’s research: skin collagen loss is correlated with menopausal age, not chronological age. This means that two women of the same chronological age can have very different skin conditions depending on when their transition began. Early menopause involves faster collagen loss at the same age.

Collagen and elastin, which decrease in parallel, are the structural proteins that give the skin consistency, thickness and the ability to return to its place after deformation. When both decrease, the skin appears looser, with deeper wrinkles and loss of tone affecting the face, neck, décolleté and hands. The International Menopause Society (IMS) recognizes skin changes in its clinical toolkits as an integral part of the menopausal symptom picture, with a real impact on quality of life.

Acne in menopause: why it appears (or comes back)

One of the least pleasant surprises menopause can bring is the appearance of acne, often in women who have never had it before. It is a phenomenon directly linked to hormonal imbalance.

As estrogen decreases, the balance between female hormones and androgens shifts. Androgens stimulate the sebaceous glands to produce more sebum. Excess sebum, combined with slower cell turnover and a reduced ability of the skin immune system, creates the conditions for clogged pores and bacterial proliferation.

Menopausal acne has different characteristics from teenage acne: it appears more often on the chin, jawline and neck, tends to be inflammatory and nodular, and responds differently to traditional topical treatments. Recognizing it as hormonal acne is the first step toward treating it correctly.

Dark spots and hyperpigmentation

Dark spots, known in dermatology as hyperpigmentation or senile lentigo, become more frequent and visible during and after menopause.

The reduction in estrogen alters the regulation of melanogenesis, the process of melanin production by melanocytes. This makes pigment distribution less uniform, encouraging the appearance of darker areas, often in the areas most exposed to the sun such as the hands, décolleté and face. At the same time, the reduction in the skin’s antioxidant capacity makes it more vulnerable to UV damage, which leaves longer-lasting traces than in previous decades.

This underlines the importance of daily sun protection, all year round, as a non-negotiable element of skincare in menopause, regardless of the season.

Dryness, itching and a compromised skin barrier

Dry skin in menopause is one of the most common and bothersome symptoms. It needs to be understood at its physiological root in order to be addressed with the right tools.

The skin barrier is made up of corneocytes and a mixture of lipids: ceramides, cholesterol and fatty acids. Estrogens actively regulate the synthesis of these lipids. When they decline, the barrier becomes more permeable: water disperses more easily through the skin, a process called TEWL (Trans-Epidermal Water Loss), and irritating substances penetrate more easily. Rzepecki et al. document this mechanism in detail, highlighting how estrogen deficiency compromises all components of the barrier function at the same time. (DOI: 10.1016/j.ijwd.2019.01.001)

The result is dry, tight, sometimes itchy skin. Itching in menopause is often not linked to allergic dermatitis, but to barrier impairment, which makes superficial nerve endings more reactive. In these cases, the solution is to restore the barrier with specific ingredients, not an antihistamine. Among the most useful active ingredients: ceramides, niacinamide, essential fatty acids and jojoba oil.

What you can do: skincare, aesthetic medicine and technology

Science-based skincare

An effective routine in menopause focuses on four core goals: restoring the skin barrier, stimulating collagen production, protecting against oxidation and ensuring deep hydration.

The ingredients with the strongest scientific evidence include retinol and retinoids (the most studied for collagen stimulation and cell turnover, with decades of literature behind them), vitamin C (an antioxidant and essential co-factor in collagen synthesis), signaling peptides, ceramides, niacinamide and chemical exfoliants such as glycolic acid and lactic acid to improve texture and reduce dark spots.

Daily SPF 50+ sun protection remains the intervention with the best ratio between simplicity of application and real impact on the prevention of skin aging and dark spots, in any season.

A personalized routine that respects the specific characteristics of your skin at this stage makes a concrete difference. Dermaself offers a free dermatological quiz based on artificial intelligence and validated by dermatologists, which produces a tailor-made routine for your real skin profile.

Aesthetic medicine and advanced technology

In recent years, aesthetic medicine has developed specific protocols for menopausal skin with growing clinical evidence. The treatments with the strongest support in the literature include hyaluronic-acid-based biostimulators, new-generation fillers, fractional radiofrequency and fractional CO2 laser, the latter documented in clinical studies published in Biomedicines (DOI: 10.3390/biomedicines11051304) and in a systematic review in Journal of Sexual Medicine (Filippini et al., 2022, PubMed: 35027299).

These treatments work best when guided by a personalized clinical evaluation that considers the phase of hormonal transition, individual medical history and the patient’s goals. Before starting any aesthetic pathway, a conversation with your doctor specialized in menopause is the right starting point.

An integrated approach

The skin is not an isolated organ. What happens on its surface reflects what is happening inside: hormone levels, nutrition, sleep quality, systemic inflammation. In perimenopause and menopause, caring for the skin means first of all caring for your hormonal balance and overall wellbeing.

At Pausetiv we work on this: a multidisciplinary clinical pathway that integrates gynecology, endocrinology, nutrition and physical activity, because skin wellbeing at this stage starts from within.

To begin understanding where you are in your transition and build a personalized pathway, you can take the PauseTest: our digital assessment that analyzes your profile across four areas and supports you in building a path toward the answers most suitable for you.

The role of hormone replacement therapy on the skin

Hormone replacement therapy (HRT), when indicated and prescribed by a specialist doctor, has documented effects on the skin, as well as on vasomotor symptoms and bone health.

Scientific literature shows that HRT can slow collagen loss, improve skin hydration, reduce wrinkle depth and increase skin thickness. Rzepecki et al. (2019) document how women taking estrogen therapy show significantly thicker and more elastic skin compared with women of the same age without therapy. (DOI: 10.1016/j.ijwd.2019.01.001). Brincat and colleagues had already shown in the 1980s that skin collagen loss was preventable with hormone therapy, with an effect directly proportional to treatment duration. (PubMed: 1345134)

HRT is not indicated for all women. Its prescription requires a thorough clinical evaluation of the individual risk profile, and the decision must always be shared between the woman and her doctor, in line with IMS and EMAS guidelines. To learn more, you can read our dedicated article: Guide to hormone replacement therapy. For a personalized evaluation with a Pausetiv specialist, you can book a visit here.

Nutrition, lifestyle and skin in menopause

Nutrition has a direct impact on skin health, and during menopause this connection becomes even more relevant. A diet rich in antioxidants counters the oxidative damage that accelerates skin aging: leafy green vegetables, berries, tomatoes and carrots are among the most effective sources. Omega-3 fatty acids, found in oily fish such as salmon, mackerel and sardines, but also in walnuts and flaxseeds, contribute to barrier function and skin hydration from within. Vitamin C, abundant in citrus fruits, kiwis and peppers, supports collagen synthesis. Vitamin E, found in extra virgin olive oil, almonds and sunflower seeds, has a synergistic antioxidant action. Zinc, found in legumes, pumpkin seeds and lean meat, regulates sebum production and supports healing.

Some studies also document the positive role of hydrolyzed collagen supplementation on skin quality in postmenopausal women. The IMS recognizes its potential in its guidelines, while noting that the data require further confirmation in larger samples. If you want to understand how to optimize nutrition at this stage, our team includes specialists in nutrition for menopause: book a nutrition consultation.

Learn more about the connection between nutrition and menopause in our article dedicated to nutrition.

Physical activity indirectly contributes to skin health: it improves circulation, promotes tissue oxygenation, reduces cortisol (which damages collagen) and supports sleep quality. Smoking accelerates collagen degradation in a documented way and synergistically with estrogen decline: quitting smoking is one of the interventions with the greatest positive impact on skin in menopause. Read how physical activity supports health in menopause.

Awareness is the first step toward a care pathway

Skin changes during perimenopause and menopause are real, physiologically grounded and often underestimated. The skin responds to a hormonal transformation that has measurable effects on collagen, hydration, barrier, pigmentation and structure. And the first years after menopause represent the most important time window for intervention: collagen loss is faster during this period, and preventive strategies have the greatest impact.

Understanding these mechanisms is the first step toward acting in an informed way. Skincare at this stage is not vanity: it is an act of attention toward your own wellbeing, supported by solid scientific evidence.

At Pausetiv we work every day to bring Italian women the clinical care they deserve, in a personalized, multidisciplinary way based on the best scientific evidence available. If you are in perimenopause or menopause and want to better understand what is happening to your body, the PauseTest is the starting point.

FAQ: frequently asked questions about skin in menopause

Can the skin really change so much in menopause?

Yes. The skin is rich in estrogen receptors. The reduction in estrogen triggers measurable structural changes: collagen loss of up to 30% in the first 5 years, thickness reduction of 1-2% per year, barrier impairment and reduced hydration. Changes begin already in perimenopause and intensify in the first years after menopause.

When do menopause-related skin changes begin?

Often already in perimenopause, which can begin around the age of 40-45. Hormonal fluctuations are reflected in the skin irregularly, with periods of dryness, increased sensitivity or the appearance of acne.

Can acne in menopause be treated?

Yes, but it requires a different approach from teenage acne. Since it is hormonal acne, it responds better to an intervention that considers the overall hormonal picture. Dermatologists and doctors specialized in women’s health can offer targeted topical treatments, and in some cases an endocrinological evaluation is useful.

Which skincare ingredients really work in menopause?

Those with the strongest scientific evidence are: retinol and retinoids, vitamin C, ceramides, niacinamide, hyaluronic acid, chemical exfoliants such as glycolic acid, and signaling peptides. Daily SPF 50+ sun protection is essential and non-negotiable.

Does hormone replacement therapy improve the skin?

Scientific literature shows that HRT has documented positive effects on the skin: greater thickness, better hydration, wrinkle reduction and slower collagen loss. HRT requires an individualized medical evaluation. For a personalized consultation, book a visit with Pausetiv specialists.

What can I eat to support my skin during menopause?

A diet rich in antioxidants (colorful vegetables, berries), omega-3s (oily fish, walnuts, flaxseeds), vitamin C (citrus fruits, peppers, kiwis) and zinc (legumes, pumpkin seeds) supports skin health. Read the complete article on nutrition in menopause to learn more.

Are aesthetic treatments safe and useful in menopause?

Yes, if performed by qualified professionals with approved devices. Biostimulators, fractional radiofrequency and fractional CO2 laser have growing clinical evidence of efficacy and safety for menopausal skin. The key is a personalized clinical evaluation that considers the individual profile.

How quickly does the skin lose collagen in menopause?

In the first five years after menopause, loss can reach 30% of total skin collagen (Brincat et al., 1987). After this period, loss stabilizes at around 2% per year. Loss is correlated with menopausal age, not chronological age: intervening early has the greatest impact.

Scientific sources

• International Menopause Society (IMS). 2023 Practitioner’s Toolkit for Managing Menopause. link
• EMAS (European Menopause and Andropause Society). Position statements and guidelines. link
• Rzepecki AK et al. Estrogen-deficient skin: The role of topical therapy. Int J Womens Dermatol. 2019;5(2):85–90. DOI: 10.1016/j.ijwd.2019.01.001
• Brincat M et al. A study of the decrease of skin collagen content, skin thickness, and bone mass in the postmenopausal woman. Obstet Gynecol. 1987;70(6):840–845. PubMed: 3120067
• Brincat M et al. Skin collagen changes related to age and hormone replacement therapy. Maturitas. 1992. PubMed: 1345134
• Thornton MJ. Oestrogens and ageing skin. Dermato-Endocrinology. 2013;5(2):264–270. DOI: 10.4161/derm.23872
• Stevenson S, Thornton J. Effect of estrogens on skin aging and the potential role of SERMs. Clin Interv Aging. 2007;2(3):283–297. PMC: 1963576
• Piquero-Casals J et al. Managing Menopausal Skin Changes. J Cosmet Dermatol. 2025. PMC: 12374573
• Filippini M et al. CO2-laser therapy and genitourinary syndrome of menopause: A systematic review and meta-analysis. J Sex Med. 2022;19:452–470. PubMed: 35027299
• Woźniak A et al. Efficacy of Fractional CO2 Laser Treatment for GSM. Biomedicines. 2023. DOI: 10.3390/biomedicines11051304
• NICE Guideline NG23: Menopause diagnosis and management (updated 2024). link

Article written by the clinical team at Pausetiv in collaboration with Dermaself. The information provided is for educational purposes and does not replace medical advice.