Noticing changes in your skin during perimenopause, menopause or post menopause?
Even when you’re young, you lose collagen. Starting in early adulthood, you lose 1% of your collagen each year. As you get older, this percentage accelerates. For example, women lose 30% of the thickness of their collagen in the first five years after menopause. Those collagen losses increase 2% a year after those first five years.
The Estrogen Effect
Estrogen affects the creation and preservation of collagen, elastin, the hyaluronic acid in your skin and your sebaceous glands.
Estrogen receptors are found in the epidermis, fibroblasts, blood vessels and hair follicles. Estrogen builds healthy fat, suppresses inflammation and preserves volume. When estrogen levels fall, there is inflammation, accelerated collagen loss, thinning skin, loss of firmness and development of wrinkles.
Thinner skin is more fragile, susceptible to bruising, tearing, injury and hair thinning. Estrogen plays a role in maintaining the skin’s ability to retain water and maintain the skin barrier. Midlife skin changes are also evident with a shifting estrogen-to-androgen ratio, resulting in adult acne, hair loss and facial hair growth.
Hormone Replacement Therapy
The thinking about estrogen replacement therapy has changed dramatically in the past few years. In November 2025, the FDA removed the boxed warning on estrogen regarding cardiovascular, stroke and breast cancer risk. What the evidence has shown is that hormone replacement therapy (HRT) is associated with 50% less coronary artery disease, 75% fewer hot flashes, plus fewer fractures and genitourinary relief when started before the age of 60.
Topical Skincare for Aging Skin
I often get questions about using topical or vaginal estrogen as an anti-aging skin cream and the possible benefits on perimenopausal and post menopausal skin. This important hormone has a profound effect on the skin and can influence how skin looks, feels and behaves. Understanding the relationship between estrogen and the skin can help women make informed decisions about treatment options as they age.
Studies on applying estrogen to the face (an off-label use) are very limited. The few controlled studies showed patients perceived an improvement, but no studies are comparing it to topical retinoids (the gold standard proven to improve aging skin). It is very important to note that topical estrogen creams (estriol 0.3 % and estradiol 0.01%) can worsen melasma-prone skin. And a visible “clinical improvement” is still not proven.
Although there is some encouraging microscopic improvement showing more pro-collagen, fibroblast activation, and suppression of collagen-degrading enzymes, I recommend the treatments that are scientifically proven as effective.
Proven Topical Skincare That I Recommend
The proven topicals can be broken down into five categories:
- Sun protection – the very best anti-aging cream there is!
- Retinoids stimulate collagen, improve texture and discoloration
- Antioxidants repair and protect
- Barrier repair ingredients such as hyaluronic acid and ceramides for dryness
- Messengers – peptides, exosomes and growth factors to drive cells into an ideal metabolic state
The good news is that hormonal changes are only one part of the aging process. And there are many ways to support healthy skin. My recommendation for peri- and postmenopausal skin is a good regimen consisting of antioxidants, sunscreen, moisturizers, retinoids, peptides and exosomes or growth factors.
Sunscreen is the most important thing you can do at any age to prevent wrinkles, pigmentation, collagen breakdown and skin cancer. Look for moisturizers that contain ceramides and hyaluronic acid. Consider retinoids, which support collagen production and don’t forget to apply to the neck, hands and chest.
I also recommend collagen-building treatments like topicals, energy devices and biostimulators.
I offer Biostimulators such as poly L-lactic acid filler or calcium hydroxylapatite filler, followed by radio frequency microneedling and/or a resurfacing laser.
Addressing Hair Loss
If you are experiencing hair loss, I can prescribe oral minoxidil, and you can buy topical 5% minoxidil over the counter. If you have excess facial hair, we can discuss oral spironolactone.
Protein and Exercise Help to Increase Muscle Mass
Without estrogen, there is accelerated muscle wasting compounded by rising visceral fat. You should also maintain a satisfactory protein intake to support muscle mass. Eat one gram of protein per kg of body weight. Good protein sources are whey, eggs, poultry, fish and Greek yogurt. Exercise is very important to meaningfully increase muscle mass.
I tell my patients that hormone therapy should be individualized and discussed with a qualified healthcare professional like their ob/gyn for systemic estrogen therapy. Hormone therapy is not prescribed solely as an anti-aging treatment. Estrogen is important for your brain, bones, heart and muscles.
Taking Action on Skin Changes Caused By Aging
If you are noticing changes in your skin during perimenopause or menopause, a personal consultation can help identify the treatments that are right for you.
You can book your cosmetic consultation with me online.
