Perimenopause Skin Changes: Dryness, Acne, Sensitivity and What Helps
Updated: 1 day ago
Dry and itchy skin are recognised perimenopause skin changes, and some people also notice new sensitivity, breakouts, flushing or a loss of firmness. [1] Skin responds to oestrogen and other hormones, which influence how much water it holds, its collagen and its oil production. [8, 9] For most of these changes, a simple, gentle routine with daily sun protection is the sensible place to start.
Each change has other possible causes too, so a skin change on its own cannot tell you whether you are in perimenopause. Persistent itching, a new rash, painful or scarring spots, or a changing mole are different, and need their own assessment.
The sections below start with what perimenopause is and how hormones affect skin, then go through each common change in turn. Later sections cover HRT, where aesthetic treatments fit, and when to see a GP.
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Perimenopause, menopause and postmenopause
Perimenopause is the stage when periods start to become irregular, leading up to their end. Menopause is defined as not having had a period for 12 months, when you are not using hormonal contraception. [2] Postmenopause describes the years that follow. Menopause usually happens between 45 and 55, but it can happen earlier, and symptoms typically last for 7 to 9 years, sometimes longer. [3, 1] Menopause before 45 is called early menopause, and before 40, premature menopause. [4]
Hormone levels do not simply fall steadily during perimenopause. They can vary widely, even from hour to hour, which is one reason symptoms can come and go. [5]
How perimenopause is identified. There is no routine test. [2] NICE recommends that, in otherwise healthy people aged 45 or over with symptoms, perimenopause is identified from symptoms and changes in the menstrual cycle without blood tests. [6, 7] Because hormone levels fluctuate so much, a single result can be normal or raised, and urine and saliva hormone tests have not been clinically validated. [5] Hormonal contraception and some other treatments can make menopause harder to identify. [6] If you are under 45, or your symptoms are unusual, a GP can advise on whether any tests are appropriate.
What your skin cannot tell you. Dry skin, spots or fine lines are common at many ages and have many causes. They do not show which stage you are in, or what your hormone levels are. If you think you have symptoms of perimenopause, the NHS advises seeing a GP to talk about your options. [1] Noting what has changed and when, including your skin, periods, sleep, mood and any medicines, helps that conversation.
How perimenopause hormones affect the skin
Skin cells respond to oestrogen and other hormones, which influence how much water skin holds, the fats in its outer barrier, its collagen and thickness, oil production and healing. [8, 9] Most of what is known comes from studies of women after menopause, often comparing them with younger women or with women taking HRT. There is very little research on skin during perimenopause itself, when hormone levels fluctuate rather than settle. [10]
Collagen and thickness. Collagen is the protein that gives the dermis, the deeper layer of skin, its strength. In early studies of postmenopausal women, skin collagen and skin thickness fell by about 1 to 2% a year after menopause, in step with the years since menopause. [11] Reviews often quote a loss of nearly a third in the first five years. [8] These figures come from small skin-biopsy studies, so they are group averages. They cannot predict how much any one person's skin will change, or what you will see in the mirror.
The skin barrier. The outermost layer of skin holds water in and keeps irritants out, helped by fats called ceramides. In a small study of 28 women, the outer skin of postmenopausal women contained fewer ceramides than that of premenopausal women, a change not seen in women taking HRT. [12] This may help explain why skin can feel drier or less tolerant of products, but it has not been shown to apply to everyone.
Oil and breakouts. Oil (sebum) production generally falls with age. [10] During perimenopause, oestrogen falls faster than androgens (hormones such as testosterone), which may tip the balance towards breakouts in some women. Most women with a few spots around menopause have normal androgen levels, so breakouts alone are not usually a sign of high testosterone. [13]
Healing. Lower oestrogen levels have been linked to slower wound healing. [10, 8]
Beyond hormones. Sun exposure is the main cause of visible skin ageing. In a randomised trial, people who used sunscreen every day showed 24% less skin ageing over four and a half years. [14] Smoking, genetics, weight change, sleep, medicines, skincare products and existing skin conditions all play a part too. In a study of identical twins, the twin who smoked had more visible signs of ageing. [15]
Common perimenopause skin changes and what may help
Each of these changes can have several causes, and more than one can happen at once. The suggestions below are starting points, not a diagnosis.
Dry, tight and itchy skin
What you may notice: skin that feels tight after washing, rough or flaky patches, or itching. Dry and itchy skin are recognised symptoms of perimenopause and menopause, and itching is common after menopause. [1, 16]
Other possible causes: hot showers, soap, cold weather, eczema, psoriasis, an allergy, or a medicine. Occasionally, itching is a sign of a thyroid, liver or kidney problem. [16]
What may help: use lukewarm rather than hot water, swap soap for a gentle, non-soap cleanser, and apply a fragrance-free moisturiser (emollient) as soon as you have patted your skin dry after washing. Emollients cover the skin with a protective film that traps water. [17] For more on dry and sensitive skin, see the guide to how the skin barrier works.
See a GP if the itch is all over your body, severe, affecting your daily life, or not getting better with self-care, or if you see a rash. [16]
New sensitivity or stinging
What you may notice: products you have used for years start to sting, burn or make your skin red.
Possible causes: drier skin can make the same product feel harsher. Stinging can also come from irritation, for example from too many active ingredients, or from an allergy to an ingredient. Products are sometimes reformulated, so a familiar name does not always mean the same contents. A new reaction is not proof of hormonal change.
What may help: pause any new or active products, and go back to a simple cleanser, moisturiser and sunscreen. Reintroduce products one at a time, a week or two apart. Trying a product on a small area first can show whether it irritates, but it is not the same as the allergy patch testing that a dermatologist can arrange. If a rash appears, or the reaction keeps happening, seek advice.
Acne, breakouts and oiliness
What you may notice: spots, often around the chin and jawline, sometimes alongside dry patches elsewhere.
Possible causes: acne can be linked with hormone changes around menopause. [18] Dryness and spots can coexist, because one depends on oil glands and the other on the skin's outer barrier. Heavy products, some medicines and conditions such as rosacea can also cause spots or look like acne.
What may help: a gentle cleanser twice a day, non-comedogenic (non-pore-blocking) products, and not picking or scrubbing. Pharmacy acne treatments can help mild acne, but can be drying, so use them sparingly on skin that is already dry. Exfoliating more, or having a cosmetic procedure, does not replace acne treatment. For skin that is both spot-prone and dry, the clinic also offers acne consultations in Kent.
See a GP if you have lots of spots, if they are deep, painful or leaving scars, if they are affecting your mental health, or if self-treatment is not working. [18] New acne together with rapid growth of thick, dark facial hair, a deepening voice or hair thinning should also be checked. [13, 19]
Flushing and redness
What you may notice: hot flushes, when your face, neck and chest suddenly feel very hot, [1] or redness that stays.
Possible causes: a hot flush usually passes within minutes. Persistent redness on the cheeks, nose and forehead, sometimes with spots or visible blood vessels, may be rosacea, which is a separate skin condition. [20] Some women find that flushing makes existing rosacea worse. [8]
What may help: noticing and limiting triggers such as alcohol, spicy food, hot drinks, heat, sunlight and vigorous exercise, [20] plus daily sun protection and gentle skincare. If hot flushes are troubling you, a GP can discuss treatment options.
See a GP if redness is persistent. Ask for an urgent appointment or call 111 if you also have eye pain, blurred vision, sensitivity to light, or a red or gritty eye. [20]
Pigmentation
What you may notice: brown patches or spots, or an uneven skin tone.
Possible causes: melasma (patchy, symmetrical brown pigment, often on the cheeks, forehead and upper lip) is triggered or worsened by sunlight, and it is linked with hormones, including hormonal contraception and HRT. Visible light may also contribute. [21] Sun spots build up with lifetime sun exposure. Dark marks can also be left after spots or irritation.
What may help: a broad-spectrum sunscreen of SPF 30 or above with high UVA protection, reapplied regularly, plus a wide-brimmed hat. [21] Avoid harsh scrubs and irritating products, which can worsen marks. Different pigment problems need different approaches, and a changing or unusual patch needs checking, so it is worth having pigmentation assessed before choosing a treatment. The page on hyperpigmentation and uneven skin tone describes the clinic's pigmentation consultations.
Texture, fine lines and loss of firmness
What you may notice: finer lines, crepey texture, or skin that feels less springy.
Possible causes: the collagen and barrier changes described above, together with sun exposure, which is the main driver of visible skin ageing, and normal ageing. [14] These surface changes are different from changes in facial shape, such as hollowing or a softer jawline, which involve deeper fat, muscle and bone.
What may help: daily sunscreen, a moisturiser, and, if your skin tolerates it, a retinoid (see below). Hydration can make lines look softer, but it does not reverse changes in facial shape. The guide to what helps crepey skin covers texture in more detail, and the guides to early jowls and neck wrinkles explain those deeper changes.
Hair changes
Hair thinning or hair loss is a recognised symptom of menopause. [1] More fine, light facial hair is also common after menopause. [19] Ask for an urgent GP appointment if thick, dark hair suddenly starts growing on your face or body, or your voice deepens. [19] See a GP about hair loss if you are worried by it. [22]
Vaginal and vulval symptoms
Dryness, itching or discomfort in and around the vagina are common menopausal symptoms. [1] They need their own care, separate from any facial skincare. Lubricants and vaginal moisturisers are available without a prescription. See a GP if dryness lasts more than a few weeks and your own measures are not helping, because effective treatments, including low-dose vaginal oestrogen, are available. [23, 24]
A simple perimenopause skincare routine
A short routine you can keep to is more useful than a long list of products.
Step | Purpose | What to look for |
Cleanse gently | Remove sunscreen, make-up and grime without stripping the skin | A mild, non-soap cleanser; lukewarm water |
Moisturise | Hold water in the skin and support the barrier | A fragrance-free cream or lotion; richer textures for very dry skin |
Protect from the sun | Reduce sun damage, pigmentation and visible ageing | SPF 30 or above with at least 4-star UVA protection, every day on exposed skin [25] |
Review | Notice what helps and what irritates | Change one product at a time, and seek advice for persistent symptoms |
Moisturiser ingredients. Ceramides, glycerin and hyaluronic acid are common moisturiser ingredients that help skin hold water and support its barrier. There seem to be no independent, controlled trials showing that any one of them works better for perimenopausal skin. One open study of about 200 peri- and postmenopausal women using a commercial skincare routine for eight weeks reported better hydration, improved wrinkles and better quality of life, but it had no comparison group, tested specific products and was run by the manufacturer. [26] A product labelled for menopause is not necessarily better than a simple, well-tolerated moisturiser.
Sunscreen. Apply it generously, including to the neck and backs of the hands, and reapply regularly when outdoors. [25] Shade and a hat help too.
If you would like help putting a routine together for your own skin, the guide to personalised skincare advice explains what that involves.
Active ingredients: when and how
Active ingredients are worth adding only for a specific concern, and only once your skin is comfortable. If your skin is stinging, red or flaky, simplify first.
Retinoids (vitamin A derivatives) have the strongest evidence for fine lines and sun damage. Prescription tretinoin improved wrinkling and blotchy pigmentation in a review of seven randomised trials. [27] Cosmetic retinol improved fine wrinkling in a small trial of very elderly people. [28] Retinoids often cause dryness and irritation at first, so start with a low strength a few nights a week, and use a moisturiser. Prescription retinoid creams and gels should not be used in pregnancy, [29] and pregnancy is still possible in perimenopause.
Niacinamide (vitamin B3) at 5% improved fine lines and blotchiness in a 12-week trial of 50 women with sun-damaged skin. [30] It is usually well tolerated, though not menopause-specific.
Exfoliating acids and vitamin C are widely used, but they can sting dry or sensitive skin. They are best introduced slowly, one at a time.
Acne ingredients such as benzoyl peroxide are available from pharmacies for mild acne. They can be drying, so use the smallest effective amount, and see a GP if acne is moderate, painful or scarring. [18]
Do not stop or change a prescribed medicine to make room for skincare, and check with a pharmacist if you are unsure whether a product suits you.
Contraception still matters. Contraception is needed until two years after your last period if you are under 50, or one year after it if you are over 50. HRT does not work as contraception. [31]
Lifestyle and supplements
Sun, smoking and sleep. Daily sun protection and not smoking are the lifestyle changes with the clearest skin benefits. [14, 15] Sleep may also matter: in one small study of 60 women, poor sleepers had slower barrier recovery, although two of the authors worked for a cosmetics company. [32] Night sweats, low mood and broken sleep are menopausal symptoms in their own right, and a GP can discuss treatments for them. [1] There is more on sleep during perimenopause and menopause in the sleep guide.
Collagen supplements. A 2025 meta-analysis found that collagen supplements had no effect on skin ageing when only trials without industry funding, or only high-quality trials, were considered. [33]
Soy, isoflavones and "hormone-balancing" products. Plant oestrogens (phytoestrogens), such as soy isoflavones, have been tested in only a few small studies with weak designs, one of them run by a soy-product manufacturer. [34, 35] The NHS says herbal and complementary products for menopause are not tested in the same way as medicines, so it is not known how safe and effective they are, and some can cause serious side effects if taken with other medicines. [36] "Natural" does not mean safe, and no supplement has been shown to rebalance hormones.
HRT and the skin
Hormone replacement therapy (HRT) is a medical treatment for menopausal symptoms. Its main benefit is relieving symptoms such as hot flushes, and NICE recommends that it is offered to people with menopause-related hot flushes and night sweats after a discussion of the benefits and risks of each option. [37, 6] Its risks depend on the type of HRT and on the individual. For example, combined HRT slightly increases the risk of breast cancer, and HRT tablets (but not patches, gels or sprays) can increase the risk of blood clots, although the risk is still very low. [37] Low-dose vaginal oestrogen is a different, local treatment for vaginal symptoms such as dryness, burning or pain during sex. It does not carry the usual risks of HRT, and it does not help hot flushes. [24]
What the skin research shows. Studies of HRT and skin give a mixed picture. A 2023 meta-analysis of 15 studies found that hormone therapy improved measured skin elasticity, thickness and collagen, but the studies varied widely, and several used hormone creams applied to the skin rather than HRT taken by mouth or through the skin. It found no clear effect on dryness. [38] In two larger randomised trials, HRT made no measurable difference to facial wrinkles, or to skin firmness where it was measured, compared with placebo: one in 485 women about five years after menopause, and one that followed women in early menopause for four years. [39, 40] A change measured in a skin sample does not necessarily mean a visible difference.
A decision about HRT should be based on your symptoms, health and preferences, in discussion with a GP or menopause specialist. It is not a cosmetic treatment, and wanting to change how your skin looks is not, by itself, a reason to start it. Do not apply HRT or other prescribed hormone products to your face, and do not change how you take a prescribed treatment without advice.
"Bioidentical" and compounded hormones. Compounded hormones are made up to an individual recipe. The NHS does not recommend them, and the British Menopause Society says they are not evidence-based for effectiveness or safety. Repeated blood or saliva hormone tests to guide treatment are not supported by evidence either. [36, 41]
Juvenology does not diagnose menopause or prescribe HRT. For menopause care, speak to your GP. NICE recommends referral to a healthcare professional with expertise in menopause if treatments are not helping or the best option is unclear. [6]
Where aesthetic treatments fit
Aesthetic treatments do not treat menopause, balance hormones or replace medical care. Being in perimenopause does not mean you need one. If a specific, visible concern such as fine lines, crepey texture or a loss of skin quality matters to you, a treatment may be worth discussing once your skin is comfortable and any medical concern has been assessed. Good skincare, sun protection, waiting, or doing nothing are always reasonable choices.
These treatments do not appear to have been tested specifically in perimenopausal women, so the evidence comes from general adult groups.
Microneedling may soften fine lines and improve texture over a course of sessions. Most studies are small, and redness for a day or two afterwards is usual. It is not suitable over active acne, rashes or infection. See the guide to microneedling.
Profhilo is an injectable hyaluronic acid product intended to improve hydration and skin quality. It does not add volume or lift. The evidence comes mainly from small, manufacturer-funded studies. See the guide to Profhilo.
Polynucleotides are injectable DNA fragments from fish, used to try to improve skin quality. The evidence is limited and product-specific. Injected polynucleotides are a different treatment from polynucleotide products applied during microneedling. See the guide to polynucleotides.
None of these is suitable on inflamed, broken or infected skin, or for an undiagnosed rash. Changes in facial shape, such as a softer jawline, are caused by deeper tissues and need a different assessment; the guide to early jowls explains this. A consultation should cover the evidence for the specific product and area, the risks and recovery, the cost, and the option of not having treatment. For how each treatment is offered at Juvenology, see the pages on microneedling in Kent, Profhilo in Kent and polynucleotides in Kent.
When to see a GP
Many skin changes around perimenopause can be managed with simple care. Some need their own assessment, and a few need urgent help.
If you notice | What to do |
Itching that is all over your body, severe, affecting daily life, or not improving with self-care | See a GP. Itching can occasionally be a sign of thyroid, liver or kidney problems [16] |
Spots that are deep, painful, widespread or leaving scars, or acne affecting your mental health | See a GP [18] |
Redness that is there most of the time, or redness with eye pain, blurred vision or a gritty, red eye | See a GP; ask for an urgent appointment or call 111 for the eye symptoms [20] |
A new or existing mole that changes in size, shape or colour | See a GP [42] |
New thick, dark hair growing suddenly on the face or body, or a deepening voice | Ask for an urgent GP appointment [19] |
Vaginal dryness for a few weeks that is not improving with your own measures | See a GP [23] |
Any vaginal bleeding after 12 months without a period, or periods that become heavier rather than lighter | See a GP [1, 43] |
Symptoms of perimenopause that you want help with, including palpitations | See a GP [1] |
Mention any new medicines when you see a doctor, because some can cause itching, rashes or spots.
Frequently asked questions
Can perimenopause cause dry, itchy skin?
Yes. Dry and itchy skin are recognised symptoms of perimenopause and menopause, and itching is common after menopause. [1, 16] Itching can also come from hot showers, soap, eczema, an allergy or a medicine, and occasionally from a thyroid, liver or kidney problem. See a GP if it is all over your body, severe, or not improving with self-care. [16]
Can perimenopause cause acne?
It can be linked with hormone changes, including around menopause. [18] New spots in midlife can also have other causes, including skincare products, medicines and conditions such as rosacea that can look similar. If spots are painful, widespread or scarring, see a GP rather than relying on cosmetic treatment.
Why does my usual skincare suddenly sting?
Drier skin can make products that were comfortable before feel uncomfortable. But stinging can also come from irritation, an allergy or a reformulated product. Pause anything new or active, go back to a simple routine, and seek advice if the stinging persists or you see a rash.
Will my skin go back to how it was?
Some symptoms, such as dryness, may settle or become easier to manage, but there is no fixed course for any one person. Daily sun protection and a routine your skin tolerates help in the long term, whatever stage you are at.
Do I need a hormone test to know if my skin changes are hormonal?
No. Hormone levels fluctuate during perimenopause, and a single test cannot explain a skin change. [5] For people aged 45 or over with symptoms, NICE recommends identifying perimenopause without tests. [6] A GP can advise if you are younger or your symptoms are unusual.
Should I use "menopause" skincare products?
Not necessarily. A label does not mean a product suits your skin or works better than a simple, well-tolerated moisturiser and sunscreen. Look at what a product contains and how your skin responds.
Can I still get pregnant?
Yes. Contraception is still needed until two years after your last period if you are under 50, or one year after it if you are over 50, and HRT is not a form of contraception. [31] This also matters for skincare, because some active ingredients should be avoided in pregnancy.
Talking it through at Juvenology in Maidstone
If you would like to talk about a skin concern once any medical questions have been looked at, a skin consultation at Juvenology Clinic in Maidstone gives you time to do that. We will look at your skin, ask about your health, medicines and the products you use, and help you decide whether skincare changes, a GP appointment, a treatment, or nothing at all is the most useful next step. You do not need to choose a treatment before booking, and there is no obligation to go ahead.
The in-person consultation is listed at £50 for 30 minutes. If you would rather talk first, you can request a free discovery call on WhatsApp. The discovery call helps you choose the next step, but it is not a clinical assessment.
About the author
Marina Kostadinova-Yankova is the founder of Juvenology Clinic in Maidstone, Kent. She is a registered nurse with the Nursing and Midwifery Council (NMC) and has more than 25 years of nursing experience. She is listed with the Joint Council for Cosmetic Practitioners (JCCP), is a member of the Royal College of Nursing, and has trained in aesthetic injectables with ACE Group and Derma Medical. Read more about Marina.
This article is general information and does not replace individual medical advice. For menopause symptoms and treatment, speak to your GP. Information was checked in October 2026.
References
NHS. Symptoms of menopause and perimenopause. Last reviewed 19 May 2026.
NHS. What are menopause and perimenopause? Last reviewed 19 May 2026.
British Association of Dermatologists. Melasma: patient information leaflet. Updated June 2024.
NHS. Types of hormone replacement therapy (HRT). Last reviewed 9 March 2023.
NHS. Benefits and risks of hormone replacement therapy (HRT). Last reviewed 8 February 2023.
British Menopause Society. Bioidentical HRT: consensus statement. Reviewed April 2026.
NHS. Symptoms of melanoma skin cancer. Last reviewed 15 July 2026.
NHS. Postmenopausal bleeding. Last reviewed 24 September 2026.
