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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.

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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