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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 will impact your skin.

Part of the trouble is that perimenopause, the stage before menopause when women first begin to experience these shifts, doesn’t follow a set script. Some women notice their skin is 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 easy and flawless skin was her family’s “best feature.”  

But at 42, her period began to get 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

During perimenopause, which can last anywhere from four to eight years, your monthly cycle can become inconsistent, causing alterations in the levels of estrogen, progesterone, and testosterone in the body. In healthy women of childbearing age, the three sex hormones are secreted in fairly consistent ways throughout the menstrual cycle. But perimenopause changes that.

Perimenopause is the transitional period before menopause when hormone levels first begin to fluctuate. On average, this phase lasts 4 years. 

As hormones levels, particularly estrogen, begin to fluctuate, a host of symptoms can appear. There are those that are known associates of “the change”: hot flashes, mood swings, sleep problems, and a decreased sex drive, all attributed to low estrogen, while bloating and heavy periods are courtesy of increased levels. But there are also more subtle symptoms that can be caused by your newly temperamental hormones, including muscle stiffness, tingling fingers and toes, brain fog, and changes in your body odor and allergies.

It can be tricky to pinpoint whether or not you are entering the realm of perimenopause. Some women experience no symptoms, while others deal with several. An added complication is that many of the more common symptoms also mimic those of other sources of hormonal disruption like stress.

A good first step in determining if you have officially entered perimenopause is to have your hormone levels tested. But beyond taking stock of the state of your estrogen, progesterone, and testosterone, there is no definitive test that will tell you one way or the other. Gynecologists and endocrinologists will take a look at the full picture – your hormone levels, symptoms, other lifestyle factors that could be at play, and the length and strength of your period – to decide if the changes you’re experiencing are the start of this next life phase.

Skin Out of Sync

Tarlecki Trimble’s experience isn’t surprising to doctors, who say that skin changes are also common symptoms for women entering perimenopause.

“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,” Tarlecki Trimble says. In addition to the dryness, she has also faced acne for the first time in her life. An avid swimmer, Tarlecki Trimble began to notice that sunscreen, even gentle brands, caused her to break out instantly.

Early Signs of Perimenopause:

  • A more erratic period (not on your regular 28-3x day time frame

  • Sleep problems, including night sweats

  • Brain fog & memory problems

  • Hot flashes & mood swings

  • Vaginal dryness & decreased sex drive

  • Tingling in your fingers and toes

  • Changes in allergies

In some women, testosterone is at the root of these changes. When testosterone drops off, it can cause increased dryness and hair thinning; when levels are elevated, it can make the skin oilier and cause acne and unwanted hair growth.

Waning estrogen, on the other hand, can lead to dryer skin, or skin that has lost what Dr. Alyssa Dweck calls “turgor” or elasticity, as well as vaginal dryness. Estrogen plays a crucial role in the production of collagen, a protein that is a major component of skin and that keeps things smooth and firm. According to Dr. Diane Berson, women will experience an estimated 30% reduction in collagen in the first five years following menopause.

When it comes to aging skin, chronological aging and “photo aging,” or the amount of sun exposure we accumulate over a lifetime, get the most attention. But the way hormone levels impact the look and feel – or “age” – of our skin is just as important.

“Estrogen has a lot to do with pigment change,” Dweck says. “Sun damage can be exacerbated by hormone changes.” Research shows that estrogen and progesterone affect pigment production. Changing levels of these hormones during phases like perimenopause can lead to an increase in dark patches like melasma and age spots.

Perimenopausal Skin Is All About the Pampering

Like birthdays, perimenopause may be inevitable, but there are ways to care for your skin so that it doesn’t feel like your temperamental hormones are in control. “Most women want the least intrusive treatments possible,” says Dweck. “And lifestyle modifications like these can make a difference and help prevent further damage.”

  • Hydration: This is the most important factor to address. In addition to increasing your water intake, Dr. Berson recommends a moisturizer that contains ingredients like glycerin, hyaluronic acid, and alpha-hydroxy acids to keep your skin nice and moisturized.

  • Retinol/Retinoids: Adding a product with retinol to your skincare routine is also a good idea as this ingredient promotes collagen production. Consider using it sparingly until you see how your skin reacts, as it can also cause dryness.

  • Sunscreen: Daily sun protection may be the universal skincare recommendation, but it’s especially important during perimenopause when decreased estrogen can exacerbate problems caused by sun damage. If you’re dealing with perimenopausal acne, choose a noncomedogenic option to avoid formulas that will clog your pores.

  • Collagen supplement: Definitive proof on the effectiveness of taking a collagen supplement is still outstanding, but there is some evidence that it can help support healthy skin aging as your body begins to lose its natural supply. Look for a product that contains hydrolyzed collagen, which is easier for your body to break down and absorb.

  • Diet: It may be a trite saying, but it’s true: the best medicine is food. In addition to eating a balanced diet to support your hormones and prevent weight gain during perimenopause, it’s also important to increase your consumption of protein and calcium. Keep an eye on certain things like sugar and caffeine that can exacerbate symptoms of hormonal imbalance.

  • Exercise: Developing a consistent workout routine will not only help to support hormone regulation, which has ripple effects for skin health, but it will also stave off stress, which can further disrupt your internal balance.

  • Hormone testing: Having your hormones tested is also a good way to identify any specific fluctuations that you may need to address in your skincare routine.

Tarlecki Trimble’s skin may be a little higher maintenance than it used to be, but she has found skincare solutions that work for her. In addition to drinking more water, she is religious about exfoliating, uses a moisturizer made for eczema to combat dryness, and applies a barrier repair gel before swimming to stave off outbreaks. Two years after her symptoms began, she says her skin is back to its original state: glowing and beautiful.  

Our Experts

Alyssa Dweck, MD

Gynecologist, author of "The Complete A to Z for Your V," and medical advisor to Veracity

Diane Berson, MD

Dermatologist in private practice in NYC and faculty member at NewYork-Presbyterian/Weill Cornell Medical Center

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