Midlife Skin Havoc

Hormonal changes during the perimenopause and menopause often trigger unexpected changes in your skin. About 64% of women attending menopause clinics report skin concerns, so if you are noticing differences, it’s not just you. This article aims to inform you exactly what is happening and why, and what you can do about it.

Loss of volume

Oestrogen supports collagen production, which gives your skin structure and firmness. As oestrogen declines, collagen and elastin reduce, leaving skin thinner and less able to hold its shape. This often shows as lines, sagging around the eyes, or a slackening of the neck. How is oestrogen connected to collagen? On a cellular level, your skin’s fibroblasts, – the cells responsible for producing collagen and elastin, have receptors that are stimulated by oestrogen. This stimulation keeps the production of collagen high. As oestrogen levels fall during perimenopause and menopause, the signal to the fibroblasts weakens. As a result, collagen production slows dramatically.

What helps – Daily use of broad-spectrum sunscreen, a diet with enough protein, and stopping smoking can slow collagen breakdown. Treatments such as radiofrequency microneedling or dermal fillers can help restore structure when loss is more pronounced.

Dryness

Oestrogen plays a fundamental role in keeping your skin naturally hydrated and supple. It does this by regulating the production of sebum, the natural oil produced by your sebaceous glands. Sebum is a component of your skin’s protective barrier, a fat layer on the surface that performs two vital jobs – it seals moisture into the skin and protects it from external irritants. As oestrogen levels decline during perimenopause and menopause, sebum production decreases. With less of this natural oil, the skin’s barrier becomes compromised and less effective. This weakening allows for an increase in “transepidermal water loss,” a process where moisture evaporates from the skin’s surface. The result is skin that feels progressively drier, rougher, or uncomfortably tight. This diminished barrier function is also a key reason why your skin can become more sensitive during this time.

What helps – Use a gentle, non-foaming cleanser and apply moisturiser containing ceramides or hyaluronic acid. Avoid long, hot showers (and saunas) which strip natural oils.  Treatments in clinic involving hyaluronic acid that help with hydration can restore comfort and resilience.

Sensitivity

Increased sensitivity is a direct consequence of the structural changes happening within the skin. As mentioned, declining oestrogen leads to thinner skin and reduced oil production. These two factors critically weaken the skin’s protective barrier, – the stratum corneum.

This compromised barrier allows external irritants, such as fragrances, preservatives in skincare, and pollution, to penetrate more deeply into the skin than it did before. Once inside, these irritants can trigger an inflammatory response from the skin’s immune cells. This is the stinging, itching, or redness you may now experience from products that were once perfectly fine.

This period of hormonal flux is also a common trigger for the development or worsening of rosacea,  persistent facial redness, flushing, and the appearance of small, visible blood vessels (telangiectasias). The exact link is complex, but the compromised barrier and hormonal influence on blood vessel regulation are thought to be behind rosacea.

What helps – Your main goal is to calm inflammation and rebuild the skin’s barrier. Switch over to a minimalist routine with fragrance-free, soothing skincare formulated for sensitive skin. Avoid harsh physical scrubs or strong chemical exfoliants that can further damage the fragile barrier. Sunscreen, as UV exposure is a powerful inflammatory trigger that can dramatically worsen both general sensitivity and rosacea. Mineral-based sunscreens containing zinc oxide are often better tolerated. At The Doctors Laser clinic, light and laser treatments (IPL with the Harmony XL Pro), can be highly effective. They work by targeting and collapsing the tiny, visible blood vessels that cause persistent redness, which calms the skin’s appearance and, over time, can help with resilience.

Acne

It can seem particularly unfair to experience acne breakouts in midlife, sometimes for the very first time. This frustrating development is a direct result of changing hormones. Throughout your life, your body produces both oestrogens and androgens (like testosterone). In your younger years, oestrogen helps to keep the effects of androgens in check.

As oestrogen levels fall dramatically during perimenopause and menopause, the balance shifts. Your level of testosterone doesn’t necessarily increase, but its effects on the skin become unopposed and therefore, more dominant. Androgens directly stimulate the sebaceous glands, signalling them to produce more oil. To make matters worse, this hormonal surge can also make the sebum thicker and stickier. At the same time, cell turnover inside the pore lining can become irregular, causing dead skin cells to shed improperly. This combination of excess, sticky oil and dead skin cells creates the perfect storm for a blockage, or comedone. The blockage then traps bacteria (C. acnes), triggering an inflammatory response from your immune system that results in the red, sore blemishes typical of hormonal acne. You will often see this appear along the jawline, chin, and neck.

What helps – Use non-comedogenic skincare and avoid heavy, oily creams. Gentle cleansers containing salicylic acid can be useful, though they may not be enough alone. Clinic treatments involving medical-grade skincare can reduce outbreaks and support long-term control.

Pigmentation

The appearance of dark, blotchy patches on the skin, a condition known as melasma, is a common midlife condition. It is directly linked to how hormonal shifts affect your pigment-producing cells, (melanocytes). These cells produce melanin, the pigment that gives your skin its colour. Oestrogen and progesterone don’t create pigment themselves, but they can make melanocytes highly sensitive and over-reactive to triggers, the main one being ultraviolet (UV) light from the sun.

This is why melasma typically appears in a symmetrical pattern on the areas most exposed to the sun, such as the cheeks, forehead, and upper lip. Even small, incidental amounts of sun exposure can be enough to cause a flare-up. For women using HRT, the reintroduction of these hormones can sometimes trigger cellular sensitivity, which may worsen or prolong issues with pigmentation.

What helps – Because UV light is the key trigger, daily, year-round use of a broad-spectrum sunscreen is the single most important step in both preventing and managing melasma. To address existing discolouration, specific skincare ingredients can be very effective. Vitamin C protects against environmental damage and also helps to inhibit the enzyme that is critical for melanin production. Azelaic acid works in a similar way, helping to regulate pigment production for a more even skin tone. For persistent patches that don’t respond to skincare, advanced laser treatments can offer a solution. These lasers use specific wavelengths of light that are selectively absorbed by the excess melanin. This energy shatters the pigment into microscopic particles, which the body’s immune system can then naturally clear away.

Dullness

The natural radiance of your youthful skin is due to a constant, efficient process of cell turnover. In this cycle, new skin cells are born in the deepest layer of the epidermis and gradually journey to the surface, where they eventually die and are shed away to reveal the fresh, healthy cells underneath. This entire process is highly regulated and, in younger skin, takes around 28 days.

This cycle is influenced by hormones, and again, due to declining oestrogen levels, the rate of cell division slows down. The skin cells moving to the surface process takes longer, and more importantly, the natural process of shedding diminishes. This causes a build-up of old dead skin cells on the surface. A smooth and well-hydrated surface of new cells reflects light evenly, which our eyes perceive as a healthy glow or radiance. To contrast this, a surface covered in an uneven layer of old cells scatters light in all directions, hence skin that appears tired, flat, and less vibrant.

What helps – The key to restoring radiance is to assist the skin’s sluggish shedding process. At home, regular but gentle exfoliation is highly effective. Ingredients like lactic acid (an Alpha Hydroxy Acid) work by dissolving the ‘glue’ that holds the dead cells together, allowing them to be swept away. Enzyme-based products, often derived from fruits, offer an even gentler alternative by digesting the proteins in the outermost dead skin cells. For more of a  powerful reset, clinic treatments can dramatically boost cell turnover. Laser resurfacing uses focused light energy to remove the outer layers of dull, damaged skin, triggering a healing response that generates a completely new, radiant surface. RF Microneedling creates micro-channels that stimulate the skin’s regenerative processes, accelerating the production of new cells and bringing them to the surface faster, with the goal of faster renewal and improving overall skin texture.

Your next step

Midlife skin changes are common, but they do not have to be permanent. If you are noticing symptoms that affect your confidence or comfort, book a consultation at The Doctors Laser Clinic at 01603 360360. We will assess your skin and recommend a personalised plan using evidence-based treatments.

For patients needing menopause support, we hold a menopause clinic with Dr Kathy Kestin, our director and GP with a special interest in women’s health.