Facing Sudden Skin Changes? Perimenopause Could Be to Blame
There’s one stage of life that all women must go through: menopause. Yet beyond offhand remarks about mood swings and hot flashes, there’s a lot left to be desired in mainstream conversation about “the change.” This is especially true when it comes to how hormonal fluctuations during perimenopause can impact your skin.
Part of the trouble is that perimenopause, the transitional stage before menopause when women first begin to experience these hormonal shifts, doesn’t follow a set script. Some women notice their skin becomes oilier and more acne-prone than it used to be; some experience more dryness, itchiness, and sensitivity. And others, like Christine Tarlecki Trimble, 44, a writer and content strategist for the food industry, experience a combination of both.
"I never had skin issues growing up. I couldn’t relate to those Noxzema and Sea Breeze commercials where people were really broken out,” Tarlecki Trimble says, noting that clear, flawless skin was her family’s “best feature.”
But at 42, her period became heavier and her skin started to act up. “Something went haywire and I was bleeding a lot. I started getting breakouts. I was like, 'What's going on here?’”
What Lies Beneath: Hormones and Skin in Perimenopause
During perimenopause, which can last anywhere from four to eight years, cycles often become irregular as estrogen, progesterone, and testosterone levels shift. In healthy women of childbearing age, these hormones are secreted in fairly consistent patterns throughout the menstrual cycle. But perimenopause disrupts that rhythm.
As hormone levels — particularly estrogen — begin to fluctuate, a host of symptoms can appear. Some are well-known markers of “the change”: hot flashes, mood swings, sleep problems, and a decreased sex drive, often tied to low estrogen. Others, like bloating and heavy periods, are linked to increased levels. But there are also subtler symptoms caused by hormonal imbalance, including muscle stiffness, tingling fingers and toes, brain fog, and even changes in body odor and allergies.
It can be tricky to pinpoint whether you are entering perimenopause. Some women experience no symptoms, while others deal with several. An added complication is that many common signs mimic other sources of hormonal disruption, like chronic stress.
A good first step in determining whether you’ve entered perimenopause is to test your hormone levels. Beyond that, gynecologists and endocrinologists will typically evaluate the full picture — hormone testing, symptoms, lifestyle factors, and changes in menstrual cycles — to determine if this next life phase has begun.
Skin Out of Sync: Perimenopause and Dermatological Changes
Tarlecki Trimble’s experience isn’t surprising to doctors, who say that skin changes are among the most common perimenopause symptoms.
“My skin is definitely dryer, so I’m carefully washing every other day and using an oil serum to calm any redness or dry patches,” she says. In addition to dryness, she has also faced perimenopause acne for the first time in her life. An avid swimmer, she noticed that even gentle sunscreens began to trigger breakouts instantly.
In many women, testosterone plays a role in these changes. When testosterone declines, it can cause dryness and hair thinning. When elevated, it can make skin oilier, leading to acne and unwanted hair growth.
Declining estrogen, on the other hand, can result in dry skin in perimenopause, loss of elasticity, and even vaginal dryness. Estrogen supports the production of collagen, the protein that keeps skin smooth and firm. According to Dr. Diane Berson, women experience an estimated 30% reduction in collagen in the first five years after menopause, which accelerates visible aging.
Melasma, Pigmentation, and Hormonal Shifts
When it comes to aging skin, chronological aging and sun exposure (photoaging) get the most attention. But hormone levels are equally important.
“Estrogen has a lot to do with pigment change,” says Dr. Alyssa Dweck. Hormonal fluctuations during perimenopause can exacerbate sun damage, leading to hyperpigmentation, age spots, and melasma.
Research shows that estrogen and progesterone directly influence pigment production. As their levels rise and fall, many women experience dark patches of melasma during perimenopause, particularly on the face. Combined with lifetime sun exposure, these hormonal shifts often create noticeable pigmentation changes that can be difficult to manage.
Key Takeaway
Whether it’s perimenopause melasma, dryness, or unexpected acne, skin changes during perimenopause are a normal part of the transition — but they’re rarely talked about openly. Understanding the role of hormones in skin health helps women prepare, manage symptoms, and protect their skin through targeted skincare, sun protection, and lifestyle support.