Perimenopause and Menopause Skin Changes: What's Really Going On

In short: Perimenopause is the lead-up to menopause, usually starting in your 40s and lasting four to eight years. Perimenopause skin changes happen as oestrogen swings and then falls.

Skin often becomes drier, thinner, more reactive and slower to heal, and products that used to work can start to sting.

At SANA we bring together topical skincare, in-clinic treatments, naturopathy and nervous system support, and refer for pathology testing or to other practitioners when you need it.

If you've landed here, chances are you've already done a bit of reading on this topic. Maybe you've changed cleansers three times this year, bought the serum everyone's talking about, and still can't work out why your skin feels tight, stings when you put things on it and breaks out at the same time. Maybe your sleep has gone, your joints ache and your patience is shorter than it's ever been, and each of those has been looked at on its own, if it's been looked at at all.

September was Perimenopause Awareness Month, and this is a conversation we have in our treatment rooms most weeks. What we see again and again is women trying to fix each symptom one at a time, when so many of them lead back to the same hormonal changes.

This blog pulls it all together: what happens through perimenopause and menopause, how you find out, the symptoms that rarely get talked about, what it all means for your skin, and how we approach it at SANA.

What is perimenopause, and how is it different from menopause?

Perimenopause is the transition before menopause, when your hormones start to fluctuate and your cycle changes.

Menopause itself is a single point in time: twelve consecutive months without a period. Knowing which stage you're in helps a lot of other things make sense.

The four stages of menopause: premenopause, perimenopause, menopause at an average age of 51 in Australia, and postmenopause

Menopause before 40 is called premature menopause, and between 40 and 45 it's called early menopause. They can happen for a range of reasons, including primary ovarian insufficiency, surgery or cancer treatment, and are worth talking through with your doctor.

What surprises most women is that perimenopause is often the harder stage.

Hormones go up and down on their way down, sometimes a lot from one month to the next, and your body, including your skin, has to keep adjusting. Experiences vary enormously too - estimated that around one in four women have no menopausal symptoms, around one in four have severe symptoms, and everyone else sits somewhere in between.

In the 2023 National Women's Health Survey, a quarter of Australian women aged 45 to 64 said their symptoms made it hard to do their daily activities.

How do you know if you're in perimenopause?

For most women over 45, perimenopause is diagnosed from your age, your symptoms and changes to your cycle, not from a blood test.

The Australasian Menopause Society says diagnostic blood tests, including FSH, aren't necessary for women 45 and over. Because oestrogen and progesterone swing up and down so much during perimenopause, a single blood test only shows what was happening on the day it was taken.

If you're under 45, it's different, and your GP will usually check your hormone levels, including FSH.

Either way, the appointment goes much further if you walk in with information. Before you go, it's worth noting down:

• your cycles over the last few months, including length, flow and any skipped periods

• every symptom you've noticed, including the ones that seem unrelated

• roughly when things started to change

• any medications, contraception or past surgery

• what you most want help with

If you feel like you're not being heard, the Australasian Menopause Society has a Find an AMS Doctor service listing practitioners with a special interest in menopause.

What are the symptoms of perimenopause?

Most of us know the well-known ones: hot flushes, night sweats, irregular periods, mood swings and poor sleep. They're real and they can be exhausting.

What doesn't get talked about enough is the long list of symptoms that often get blamed on something else, so women end up at the physio, the dentist or the optometrist without anyone connecting it back to hormonal change.

Perimenopause symptoms that often get missed, including joint pain, heart palpitations, dry eyes, itchy skin, burning mouth, bloating, brain fog and thinning hair, and what they often get blamed on

Some of these are very common.

Cleveland Clinic notes that up to 42% of perimenopausal women experience heart palpitations, which is frightening if nobody has told you it can be hormonal. The other causes in that right-hand column can still be real, though, so anything new or worrying should always be checked by your doctor.

The emotional changes are often the hardest for women to talk about.

Fluctuating oestrogen and progesterone can mean a much shorter fuse, getting irritated by things that never used to bother you, crying more easily, feeling flat or low, anxiety that comes on for no clear reason, far less patience, and a drop in confidence that can be unsettling if you've always felt capable.

A lot of women put it down to stress or being tired, and those can contribute, but hormones are often involved too. Around 20 to 30% of women experience depression during the menopause transition, so if low mood is hanging around, please talk to your GP.

Nature also didn't plan this very well, because for a lot of us this stage lines up with raising hormonal teenagers. Two lots of hormones in one house, and somehow only one of you is allowed to slam a door.

How does perimenopause affect your skin?

Your skin responds to hormones.

The cells that build your barrier and the cells that make your collagen both have oestrogen receptors, so when oestrogen drops, your skin changes with it.

Collagen falls quickly in the early postmenopausal years, with research suggesting up to 30% can be lost in the first five years and roughly 2% a year after that. Lipid production slows too.

Those lipids (ceramides, cholesterol and fatty acids) are the mortar that holds your skin barrier together, so losing them has a big effect.

Cell turnover slows, inflammation increases and the skin loses more water than it used to. The result is a thinner barrier that reacts more easily.

In clinic, this often looks like:

• dryness or tightness that doesn't go away, even straight after moisturising

• stinging or burning from products that were fine last year

• flaky patches, rough texture or red, blotchy areas

• breakouts, often at the same time as dryness

• pigmentation that's more stubborn and more reactive to the sun

• slower healing, whether that's a breakout, a scratch or recovery after a treatment

  
  

Breakouts surprise a lot of women.

As oestrogen falls, the effect of androgens on the skin becomes relatively stronger, which can increase oil production and bring on acne you haven't had since your teens.

Why does skincare suddenly stop working in perimenopause?

Because the skin you're using it on has changed.

A routine that suited a thicker, well-lipidised barrier can be too much for a thinner one that's losing water and more prone to inflammation. The instinct for most women is to add more: a stronger serum, an extra exfoliant, a new active. On skin that's already struggling, that usually makes the reactivity worse.

Some women tell us that what they've been doing for years has stopped working.

Our clients are already on a progressive plan that we adjust along the way, and this stage is part of that. The skin changes as the body changes, and so does the way we treat it. For a lot of women, the most useful thing is to do less for a while and give the barrier a chance to recover.

Why it's never just your skin

We've been working with menopausal skin, and the internal side of it, for many years with our experienced naturopathy team, and it's very rare that the skin changes on its own.

A session we attended at this year's Corneotherapy Conference, presented by Chiza Westcarr, covered this well and matched what we see in clinic.

Menopause affects the body's barrier systems (the skin, the gut and the vaginal lining) along with the microbes that live on and in them.

These tissues have a lot in common.

They're made of specialised cells joined by tight junctions, they each have their own microbiome, and they all respond to oestrogen, so when oestrogen drops they tend to change together.

The vaginal microbiome is a good example. Oestrogen normally helps supply the glycogen that feeds protective Lactobacillus bacteria and keeps the environment acidic. As oestrogen falls, pH rises and the balance shifts toward bacteria linked with infection and inflammation. The skin goes through a similar change, with fewer lipids, a disrupted microbiome and a weaker barrier.

Then there's the gut. A group of gut bacteria called the oestrobolome helps metabolise oestrogen and affects how much is recycled back into circulation and how much is cleared. It works both ways, with hormones shaping the gut microbiome and the gut microbiome affecting hormone levels.

When gut diversity drops, inflammation tends to rise, and that inflammation can show up in the skin. Chronic stress and poor sleep push cortisol up and disrupt gut health and barrier repair even further, which helps explain why two women using the same skincare can get very different results.

It's a pattern we see often.

A woman comes in for dryness and reactivity, and when we look further she's also sleeping poorly, dealing with digestive discomfort, gaining weight around her middle and under ongoing stress. When those things are addressed alongside her skin, through our naturopaths, nervous system support and, where needed, a referral for pathology testing or to her doctor, her skin responds far better and holds.

This is why we talk about skin in context at SANA.

How we support perimenopausal and menopausal skin at SANA

Most women going through this stage end up seeing one person for their skin, someone else for their gut, another for sleep or stress, and nobody putting it all together.

At SANA, topical skincare, in-clinic treatments, naturopathy and nervous system support all sit under one roof, so your skin, your body and your stress levels are looked at together and your plan works on all of them at once. Where you need something outside our scope, we refer you to the right person.

Every plan follows the SANA Method: context, clarity, restore, correct and sustain.

Context and clarity mean understanding where you are in the transition and what else is going on in your body before we touch a treatment plan.

Restore comes next, because the barrier has to be calm and resilient before it can handle anything stimulatory.

Correction follows once the skin can tolerate it, and sustain is about adjusting as you keep moving through each stage.

Your skin, at home and in clinic

At home, we usually simplify the routine, make sure cleansing is gentle and doesn't strip, and focus on putting back the hydration and lipids the skin is losing. If the skin is reactive, we pull back on stronger actives for a while and reintroduce them gradually once the barrier has settled. Daily SPF is a must, because hormonal changes leave skin more prone to inflammation and pigmentation from the sun.

In clinic, we prioritise barrier repair and calm before anything stimulatory, and adjust the intensity, spacing and sequencing of treatments as the skin changes.

Internal support with our naturopaths

Skincare can only do so much if what's happening inside the body is working against it.

Our naturopathy team has been supporting women through perimenopause and menopause for many years, and no two women they see need the same thing. Two women of the same age can have completely different hormone patterns, gut health, stress levels and nutritional needs, which is why general advice found online so often misses the mark.

Our naturopaths start by understanding you.

That can include pathology testing where it's needed, along with a close look at your diet, digestion, sleep, energy, stress and how your symptoms have changed over time. From there, they build a plan around what your body needs, whether that's nutrition, gut support, lifestyle changes or targeted supplementation, and adjust it as you move through the transition.

Nervous system support

Perimenopause often brings more stress and worse sleep, and both push cortisol up, which adds to gut disruption, inflammation and slower barrier repair.

It's one of the most overlooked drivers of reactive skin at this stage. Our in-clinic nervous system practitioner works with clients on this side of things, which supports everything else we're doing for the skin and the body.

When we refer

We know where our scope ends. Where needed, we refer for pathology testing and to your GP, a menopause specialist or other practitioners who can help.

That includes menopause hormone therapy (MHT). Prescribing or recommending MHT sits outside our scope, and it's a decision for you and your doctor. The research does show it can influence skin thickness, hydration and collagen as well as sleep and hot flushes, so it's worth raising with your GP or a menopause specialist, and we're always happy to refer.

What we're watching closely

The longevity space, and peptide research in particular, is one we're keeping a very close eye on. There's a lot of interesting work happening around how the skin and body age and repair, and some of it could change how women are supported through this stage of life.

Much of it is still early and still being tested, so we're following it with a lot of curiosity and a healthy dose of caution. Staying across where this research is heading is part of our commitment to our clients, and if something proves itself and would help you, we'll make sure you know about it and connect you with the right people through our network.

Frequently asked questions

At what age does perimenopause start?

Most women start perimenopause in their 40s, although it can begin as early as the mid-30s. It usually lasts around four to eight years, and the average age of menopause in Australia is 51.

Can a blood test tell me if I'm in perimenopause?

If you're 45 or over, usually not. Australian guidelines say perimenopause in this age group is diagnosed from your age, symptoms and cycle changes, because hormone levels fluctuate too much for one test to be reliable. If you're under 45, your GP will usually check your hormone levels, including FSH.

Can perimenopause cause acne?

Yes. As oestrogen falls, androgens have a relatively stronger effect on the skin, which can increase oil production and trigger breakouts, often at the same time as dryness. Harsh acne products can make this worse, so the barrier needs looking after too.

Why is my skin so itchy during perimenopause?

Lower oestrogen means thinner skin with fewer lipids, so it holds less water and gets irritated more easily. Itchiness is a common but rarely mentioned symptom. Anything persistent or severe should be checked by your doctor.

Does menopause hormone therapy help your skin?

Research shows MHT can improve skin thickness, hydration and collagen, alongside benefits for hot flushes and sleep. Whether it's right for you is a decision to make with your GP or a menopause specialist.

Should I change my skincare in perimenopause?

Usually, yes. Most women do better with a simpler routine that protects the barrier, with stronger actives reduced while the skin is reactive and brought back gradually. The best plan depends on your skin and where you are in the transition.

What can a skin clinic do for menopausal skin?

A skin clinic can calm and rebuild a weakened barrier, adjust your home routine and time treatments to what your skin can tolerate. At SANA, we also offer naturopathy and nervous system support in clinic, and refer for pathology testing or to your GP and other practitioners when needed.

If this sounds like you

If you've read this far and recognised yourself more than once, you're far from the only one, and you don't have to fix everything at once.

Your skin changes as your hormones change, and the way it's treated needs to change too. You don't need more products. You need clarity about what's changing and why.

If you'd like us to take a look, book a skin consultation at our Berwick clinic or virtually. We'll go through your routine, your treatment history, how you're sleeping and where you are in this transition, then bring in our naturopaths, nervous system support or a referral where it will help, so your plan covers everything that's affecting your skin.