Menopause and the Skin: Recognizing Changes Beyond Aging

Hormonal fluctuations during perimenopause and menopause can bring a range of cutaneous changes, from increasing dryness and sensitivity to loss of firmness and even the unexpected return of acne. For dermatologists, recognizing these changes—and separating them from the effects of intrinsic aging and cumulative photodamage—can help guide more individualized skin care recommendations for patients navigating this transition.

Jacqueline Watchmaker, MD, a board-certified dermatologist in Scottsdale, Arizona, whose practice focuses primarily on aesthetic dermatology, spoke with Dermatology Times during Menopause Awareness Month about the skin concerns she commonly hears from patients and how clinicians can approach skin care during perimenopause and menopause.

Dryness and Sensitivity Often Bring Patients In

Among the most common concerns Watchmaker encounters are increasing dryness and changes in skin texture.

“The most common thing I hear is dryness and kind of that loss of that vibrant, kind of bouncy, youthful texture to the skin,” Watchmaker said.

For some patients, the change is particularly noticeable because products they have tolerated for years may suddenly become irritating or no longer provide adequate hydration.

“I commonly have patients say things like, ‘Products I've been using for years that never irritated me are now starting to irritate me,’ or things like, ‘I've been using this one moisturizer forever, and it used to be great, and now I feel like it's not enough,’” she said.

Along with dryness and irritation, Watchmaker noted that patients may report loss of glow, elasticity, and firmness during the menopausal transition.

These complaints can present an opportunity for dermatologists to reassess a patient's existing regimen rather than simply adding more products to address each new concern.

When More Skin Care Is Not Necessarily Better

The increasingly crowded skin care market can make that adjustment difficult. Patients may arrive with complicated routines incorporating numerous active ingredients, particularly when they are trying to address several age-related concerns simultaneously.

Watchmaker cautioned against a “kitchen sink” approach, especially when skin has become more sensitive.

“There are so many different skincare products out there, and I wish more patients would be selective in what they're using and not just kind of throw the kitchen sink at their skin,” she said.

Instead, she recommends emphasizing hydration, considering gentler active ingredients, and introducing changes individually.

“I do think, especially given the increased sensitivity in a lot of these patients, sometimes less is more,” Watchmaker said. “I wish they knew to just kind of increase hydration, focus on slightly maybe more gentle active ingredients, and kind of take one thing at a time.”

For clinicians, simplifying a patient's regimen may also make it easier to identify which products are providing benefit and which could be contributing to irritation.

Acne Can Reappear During Perimenopause

Dryness is not the only concern Watchmaker sees in this population. Hormonal fluctuations can also coincide with acne in patients who thought breakouts were long behind them.

“I have a lot of patients in their late 40s and 50s, and they're like, ‘I haven't had acne in years. What's going on?’” Watchmaker said.

In these cases, she noted that the onset of acne is often associated with hormonal fluctuations occurring around perimenopause.

The coexistence of acne with dryness or increased sensitivity can further complicate skin care. A patient may be tempted to reach for aggressive acne treatments while simultaneously experiencing reduced tolerance to products, reinforcing the importance of tailoring treatment to the patient's current skin rather than relying on routines that worked earlier in adulthood.

Menopause or Aging? The Answer May Be Both

One of the challenges for dermatologists is determining how much of a patient's changing skin can be attributed specifically to menopause.

Many of the concerns associated with perimenopause and menopause—including loss of firmness, changes in texture, and sensitivity—also occur with intrinsic aging and accumulated sun exposure.

“A lot of the signs of perimenopause can be normal signs of, you know, sun damage and aging,” Watchmaker said.

Rather than attributing an isolated skin finding to hormonal changes, she recommended considering the patient's broader clinical picture.

“You kind of have to look at the patient as a whole and ask them other questions about missed periods and other kind of systemic symptoms to kind of correlate certain changes they're seeing in their skin that might be due to these hormonal fluctuations rather than just age,” she said.

Even then, the distinction is not always clear-cut.

“Honestly, most patients, it's kind of somewhat of an overlap,” Watchmaker added.

That overlap may be one of the most important considerations for dermatologists counseling patients during this stage of life. Menopause does not occur independently of chronological aging or years of environmental exposure. Instead, hormonal changes may contribute another layer to an already evolving cutaneous landscape.

For clinicians, recognizing that complexity can help shift the conversation away from assigning every change to a single cause and toward developing a regimen that responds to the patient's skin as it is now: potentially drier, more sensitive, less firm, and, in some cases, unexpectedly acne-prone.

Hormonal fluctuations during perimenopause and menopause can bring a range of cutaneous changes, from increasing dryness and sensitivity to loss of firmness and even the unexpected return of acne. For dermatologists, recognizing these changes—and separating them from the effects of intrinsic aging and cumulative photodamage—can help guide more individualized skin care recommendations for patients navigating this transition.

Jacqueline Watchmaker, MD, a board-certified dermatologist in Scottsdale, Arizona, whose practice focuses primarily on aesthetic dermatology, spoke with Dermatology Times during Menopause Awareness Month about the skin concerns she commonly hears from patients and how clinicians can approach skin care during perimenopause and menopause.

Dryness and Sensitivity Often Bring Patients In

Among the most common concerns Watchmaker encounters are increasing dryness and changes in skin texture.

“The most common thing I hear is dryness and kind of that loss of that vibrant, kind of bouncy, youthful texture to the skin,” Watchmaker said.

For some patients, the change is particularly noticeable because products they have tolerated for years may suddenly become irritating or no longer provide adequate hydration.

“I commonly have patients say things like, ‘Products I've been using for years that never irritated me are now starting to irritate me,’ or things like, ‘I've been using this one moisturizer forever, and it used to be great, and now I feel like it's not enough,’” she said.

Along with dryness and irritation, Watchmaker noted that patients may report loss of glow, elasticity, and firmness during the menopausal transition.

These complaints can present an opportunity for dermatologists to reassess a patient's existing regimen rather than simply adding more products to address each new concern.

When More Skin Care Is Not Necessarily Better

The increasingly crowded skin care market can make that adjustment difficult. Patients may arrive with complicated routines incorporating numerous active ingredients, particularly when they are trying to address several age-related concerns simultaneously.

Watchmaker cautioned against a “kitchen sink” approach, especially when skin has become more sensitive.

“There are so many different skincare products out there, and I wish more patients would be selective in what they're using and not just kind of throw the kitchen sink at their skin,” she said.

Instead, she recommends emphasizing hydration, considering gentler active ingredients, and introducing changes individually.

“I do think, especially given the increased sensitivity in a lot of these patients, sometimes less is more,” Watchmaker said. “I wish they knew to just kind of increase hydration, focus on slightly maybe more gentle active ingredients, and kind of take one thing at a time.”

For clinicians, simplifying a patient's regimen may also make it easier to identify which products are providing benefit and which could be contributing to irritation.

Acne Can Reappear During Perimenopause

Dryness is not the only concern Watchmaker sees in this population. Hormonal fluctuations can also coincide with acne in patients who thought breakouts were long behind them.

“I have a lot of patients in their late 40s and 50s, and they're like, ‘I haven't had acne in years. What's going on?’” Watchmaker said.

In these cases, she noted that the onset of acne is often associated with hormonal fluctuations occurring around perimenopause.

The coexistence of acne with dryness or increased sensitivity can further complicate skin care. A patient may be tempted to reach for aggressive acne treatments while simultaneously experiencing reduced tolerance to products, reinforcing the importance of tailoring treatment to the patient's current skin rather than relying on routines that worked earlier in adulthood.

Menopause or Aging? The Answer May Be Both

One of the challenges for dermatologists is determining how much of a patient's changing skin can be attributed specifically to menopause.

Many of the concerns associated with perimenopause and menopause—including loss of firmness, changes in texture, and sensitivity—also occur with intrinsic aging and accumulated sun exposure.

“A lot of the signs of perimenopause can be normal signs of, you know, sun damage and aging,” Watchmaker said.

Rather than attributing an isolated skin finding to hormonal changes, she recommended considering the patient's broader clinical picture.

“You kind of have to look at the patient as a whole and ask them other questions about missed periods and other kind of systemic symptoms to kind of correlate certain changes they're seeing in their skin that might be due to these hormonal fluctuations rather than just age,” she said.

Even then, the distinction is not always clear-cut.

“Honestly, most patients, it's kind of somewhat of an overlap,” Watchmaker added.

That overlap may be one of the most important considerations for dermatologists counseling patients during this stage of life. Menopause does not occur independently of chronological aging or years of environmental exposure. Instead, hormonal changes may contribute another layer to an already evolving cutaneous landscape.

For clinicians, recognizing that complexity can help shift the conversation away from assigning every change to a single cause and toward developing a regimen that responds to the patient's skin as it is now: potentially drier, more sensitive, less firm, and, in some cases, unexpectedly acne-prone.

References

1. Wentworth A. Menopause and skin. Menopause. 2026;33(9):1031-1033. doi:10.1097/GME.0000000000002889 PubMed
2. Viscomi B, Muniz M, Sattler S. Managing menopausal skin changes: a narrative review of skin quality changes, their aesthetic impact, and the actual role of hormone replacement therapy in improvement. J Cosmet Dermatol. 2025;24(suppl 4):e70393. doi:10.1111/jocd.70393 PubMed
3. Kamp E, Ashraf M, Musbahi E, DeGiovanni C. Menopause, skin and common dermatoses. Part 2: skin disorders. Clin Exp Dermatol. 2022;47(12):2117-2122. doi:10.1111/ced.15308 PubMed