Skin & Hair Changes

Why Skin & Hair Change

Declining estrogen affects skin structure, collagen production, oil glands, and hair growth cycles. These changes are visible and can impact self-esteem, but many are manageable with the right strategies.

Role of Estrogen

• Collagen production: Estrogen stimulates collagen synthesis; loss leads to thinning skin and wrinkles
• Skin hydration: Estrogen helps skin retain moisture; declining levels cause dryness
• Oil gland activity: Reduced sebum production makes skin drier
• Hair follicle regulation: Hormonal shifts affect hair growth and loss patterns

Common Skin Changes

1. Dryness & Itching

• Cause: Reduced oil production and decreased skin barrier function
• Symptoms: Flaky, rough, itchy skin, especially on arms, legs, and hands
• Management:
  • Use gentle, fragrance-free cleansers
  • Apply thick moisturizers (creams or ointments, not lotions) immediately after bathing
  • Use a humidifier, especially in winter
  • Avoid hot showers and harsh soaps
  • Consider ceramide-rich moisturizers (CeraVe, Cetaphil)

2. Wrinkles & Loss of Elasticity

• Cause: Collagen and elastin breakdown, slower cell turnover
• Prevention & Treatment:
  • Sunscreen daily: SPF 30+ broad-spectrum; single most important anti-aging step
  • Retinoids: Prescription tretinoin or over-the-counter retinol increase collagen production and cell turnover
  • Vitamin C serum: Antioxidant that brightens and supports collagen synthesis
  • Hyaluronic acid: Humectant that draws moisture into skin
  • Peptides: May stimulate collagen production
  • Procedures: Chemical peels, microneedling, laser resurfacing, Botox, fillers (consult a dermatologist)

3. Thinning Skin & Bruising

• Cause: Reduced collagen makes skin more fragile
• Symptoms: Skin tears easily, bruises more readily, slower wound healing
• Management:
  • Moisturize regularly to maintain skin barrier
  • Protect skin from trauma (long sleeves, padding on elbows/shins)
  • Retinoids may help thicken skin over time
  • Adequate protein intake supports skin repair

4. Acne or Breakouts

• Cause: Shifting estrogen-to-androgen ratio can increase oil production or clog pores
• Management:
  • Salicylic acid or benzoyl peroxide cleansers
  • Retinoids (tretinoin, adapalene) for cell turnover
  • Avoid heavy creams on acne-prone areas
  • Hormonal treatments (HRT, spironolactone) if severe and hormone-related

5. Age Spots & Hyperpigmentation

• Cause: Cumulative sun damage, hormonal fluctuations
• Prevention: Sunscreen and sun protection
• Treatment:
  • Hydroquinone (prescription or OTC lightening agent)
  • Vitamin C, niacinamide, kojic acid (brightening agents)
  • Retinoids
  • Chemical peels, laser treatments

Hair Changes

1. Scalp Hair Thinning

• Patterns: Widening part, reduced volume, visible scalp (not typically complete baldness like male pattern)
• Cause: Declining estrogen and relatively higher androgens; hair follicles become more sensitive to dihydrotestosterone (DHT)
• Treatment:
  • Minoxidil (Rogaine): Topical treatment (2% or 5%); slows loss and may promote regrowth; requires ongoing use
  • Spironolactone: Oral medication that blocks androgens; effective for female pattern hair loss
  • HRT: May slow hair thinning in some women
  • Lifestyle: Adequate protein, iron, vitamin D, biotin; manage stress; avoid harsh styling
  • Procedures: Platelet-rich plasma (PRP) injections, low-level laser therapy (evidence is mixed); hair transplant for severe cases

2. Facial Hair Growth (Hirsutism)

• Pattern: Coarse, dark hair on chin, upper lip, jawline
• Cause: Relatively higher androgens as estrogen declines
• Management:
  • Temporary removal: Shaving, waxing, threading, depilatory creams
  • Laser hair removal: Most effective for permanent reduction; works best on dark hair and light skin
  • Electrolysis: Permanent hair removal; works on all hair and skin types
  • Medications: Spironolactone, eflornithine cream (Vaniqa) to slow growth

3. Body Hair Thinning

Some women notice less body hair on arms and legs—this is normal and related to reduced androgen activity in certain areas.

Role of Hormone Therapy

Systemic HRT

• Potential benefits: Improved skin hydration, elasticity, and collagen content; may slow hair thinning
• Limitations: Effects are modest and not the primary reason to use HRT; skin and hair changes are multifactorial

Topical Estrogen

Some evidence that topical estrogen (creams, serums) can improve skin thickness and hydration, but not FDA-approved for this use and limited data.

Evidence-Based Skincare Routine

Morning

1. Gentle cleanser: Fragrance-free, non-foaming
2. Vitamin C serum: Antioxidant and brightening
3. Moisturizer: Hyaluronic acid, ceramides, peptides
4. Sunscreen: SPF 30+ broad-spectrum (most important step!)

Evening

1. Gentle cleanser: Remove makeup and sunscreen
2. Retinoid: Tretinoin or retinol (start slow to avoid irritation)
3. Moisturizer: Thicker cream or ceramide-rich product

Optional Additions

• Niacinamide: Reduces redness, improves barrier function, brightens
• Alpha hydroxy acids (AHAs): Glycolic or lactic acid for exfoliation and brightness
• Eye cream: Peptide or retinol-based for fine lines

Lifestyle Factors

• Sun protection: Daily sunscreen, hats, seek shade—sun damage is the #1 cause of premature aging
• Hydration: Drink adequate water; moisturize skin externally
• Nutrition: Protein, healthy fats (omega-3s), antioxidants (fruits, vegetables) support skin and hair health
• Sleep: Skin repairs itself during sleep; poor sleep accelerates aging
• Stress management: Chronic stress accelerates hair loss and skin aging
• Avoid smoking: Smoking dramatically accelerates skin aging and hair loss
• Limit alcohol: Dehydrates skin and impairs repair processes

When to See a Dermatologist

What to Ask About

• Prescription retinoids for anti-aging
• Treatment for melasma or hyperpigmentation
• Minoxidil and spironolactone for hair loss
• Laser or light-based treatments
• Skin cancer screening

The Bottom Line

Skin and hair changes during perimenopause and menopause are normal but can be managed. Sunscreen, retinoids, and moisturizers are evidence-based staples for skin health. Hair thinning and facial hair growth can be treated with medications (minoxidil, spironolactone) and procedures (laser hair removal). Focus on what's most bothersome to you and work with a dermatologist for personalized recommendations.