Many women tell me their skin seemed to change almost overnight in their late forties. It feels drier, looks a little thinner and duller, makeup sits differently, and for some, spots come back for the first time since their teens.
That isn't simply "getting older". Hormones play a big part. As a GP and aesthetic doctor, I look at skin as part of the whole picture, so here's an honest guide to what menopause does to your skin and the steps that are actually worth your time and money.
Why menopause affects your skin
Your skin is full of receptors for oestrogen. Oestrogen helps your skin make collagen (which keeps it firm), hold on to water, maintain its protective barrier and heal well.
During perimenopause, which usually starts in your 40s, oestrogen levels go up and down. After your final period (on average around age 51 in the UK), they stay low. Your skin notices.
Skin collagen falls by around 30% in the first five years after menopause, then by about 2% a year after that.Brincat et al., 1987 (reference 1)
The changes you might notice
- Dryness and itching. Skin makes fewer of the natural oils and moisture-holding molecules that keep it comfortable, so it loses water more easily.
- Thinner, less firm skin. With less collagen, fine lines deepen and skin can look crêpey, especially on the neck, chest and hands.
- Changes in face shape. Ageing isn't only skin deep. Fat pads, ligaments and bone change too, which is why I look at all the layers (my 360° Approach to ageing skin).
- Breakouts and facial hair. Oestrogen falls faster than testosterone, so the balance shifts. Some women get spots along the jaw or a few coarse chin hairs.
- Redness and flushing. Hot flushes can trigger or worsen facial redness, including rosacea.
- Pigmentation. Years of sun exposure become more visible, and patches of melasma can appear or change.
- Slower healing. Skin can take longer to recover and may bruise more easily.
New itching all over, a rash that won't settle, a mole that is changing, or sudden, heavy hair growth shouldn't be put down to menopause. Please get these checked.
What actually helps
1. Daily sun protection
This has the strongest evidence of anything here. In a large trial, adults who used sunscreen every day showed no detectable increase in skin ageing over four and a half years (reference 3). Use a broad-spectrum SPF 30 or higher (I prefer 50) every morning, all year round, even in London in November.
2. Look after your skin barrier
Switch to a gentle, non-foaming cleanser and lukewarm water. Choose a moisturiser with ceramides, glycerin or hyaluronic acid, and apply it to slightly damp skin. Be wary of scrubs and of layering lots of strong acids: over-exfoliating is one of the most common reasons I see irritated skin.
3. Vitamin A (retinoids)
Retinoids are the best-studied creams for supporting collagen. Even over-the-counter retinol has been shown to improve fine lines in naturally aged skin (reference 4). Start two or three nights a week and build up slowly. Stronger retinoids need a prescription and a proper skin assessment.
4. HRT: what it can and can't do for your skin
Hormone replacement therapy (HRT) is recommended for menopausal symptoms such as hot flushes, night sweats and low mood, and it also helps protect your bones (reference 5). Studies suggest it may slow collagen loss and help skin thickness and hydration (reference 2), but it isn't prescribed for skin alone. If you have other symptoms, talk to your GP or a menopause specialist about whether the benefits outweigh the risks for you. I don't prescribe HRT in my aesthetic clinic.
5. The everyday basics
Not smoking, good sleep, enough protein, and keeping alcohol moderate all show on your skin. They aren't glamorous, but no treatment can make up for them.
6. When in-clinic treatment makes sense
Once the basics are in place, some treatments can improve skin quality:
- Skin boosters to help hydration and fine lines.
- Collagen-stimulating injections to gradually improve firmness over several months.
- Microneedling or skin peels for texture, glow and uneven tone.
They work best alongside a good routine, results vary from person to person, and none of them stops ageing. Not everyone needs them, and I'll always tell you honestly if I don't think a treatment will help you.
How I approach menopausal skin
At a skin consultation (£75), I look at your skin, your current routine and products, your lifestyle and your medical history. If anything needs checking by your GP first, I'll tell you. You leave with a written, personalised skincare plan, and we only talk about in-clinic treatment if it's likely to make a real difference.
Frequently asked questions
Does menopause cause wrinkles?
Not on its own. Sun exposure and your genes play a big part. But falling oestrogen speeds up collagen loss, so lines that were already there often become more noticeable in the years around menopause.
When does skin start to change?
Often during perimenopause, which usually begins in your 40s and sometimes earlier. Changes tend to be fastest in the first few years after your periods stop.
Will HRT reverse skin ageing?
No. HRT may help skin thickness and hydration, but it isn't a treatment for wrinkles. Whether HRT is right for you should be decided with your GP or a menopause specialist, based on your symptoms and your health.
Is retinol OK for sensitive menopausal skin?
Usually, if you start slowly (two or three nights a week) and use a good moisturiser alongside it. If your skin becomes very red, sore or flaky, stop and get advice.
Can I have injectable treatments during menopause?
Menopause on its own isn't a reason not to. I'll check your medical history, medicines and skin at a consultation first, and tell you honestly whether a treatment is likely to help.
GP & aesthetic doctor (MBBS, MRCGP) at 10 Harley Street, London. About Dr Farah
References
- Brincat M, Kabalan S, Studd JW, et al. A study of the decrease of skin collagen content, skin thickness, and bone mass in the postmenopausal woman. Obstetrics & Gynecology. 1987;70(6):840–845.
- Thornton MJ. Estrogens and aging skin. Dermato-Endocrinology. 2013;5(2):264–270.
- Hughes MCB, Williams GM, Baker P, Green AC. Sunscreen and prevention of skin aging: a randomized trial. Annals of Internal Medicine. 2013;158(11):781–790.
- Kafi R, Kwak HSR, Schumacher WE, et al. Improvement of naturally aged skin with vitamin A (retinol). Archives of Dermatology. 2007;143(5):606–612.
- National Institute for Health and Care Excellence. Menopause: identification and management (NG23).
This article is general information, not personal medical advice. If you're worried about your skin or your health, please speak to your GP.