9 Things Perimenopause Does to Your Hair and Skin

You're a woman in your early-to-mid 40s. Your moisturiser suddenly feels like it's doing nothing. You're finding more hair in the drain. You've noticed eye bags or developed a bit of a turkey neck. And something is happening to your vagina.

According to a growing body of peer-reviewed research, what you're experiencing may be the dermatological effects of perimenopause.

Why Hormones Matter So Much for Skin

The skin is not a passive barrier. It is an active endocrine organ, studded with receptors for oestrogen, progesterone, and androgens. A landmark 2013 review published in Dermato-Endocrinology by Dr. M.J. Thornton confirmed that oestrogen receptors are found directly on fibroblasts, keratinocytes, and sebaceous glands — the cells responsible for collagen production, skin renewal, and oil regulation respectively. When oestrogen fluctuates and declines, the impact is felt across all of these systems simultaneously.

A 2025 review in the European Medical Journal noted that "the declining oestrogen and progesterone levels in perimenopause and menopause have a profound effect on the skin, hair, and vulval tissue" and that these symptoms are "not often recognised as part of the menopausal transition." (DeGiovanni, EMJ Dermatology, 2025)

1. Collagen Loss: The Foundational Change

The most extensively researched effect of perimenopause on skin is the rapid loss of collagen. Collagen, produced by fibroblasts in the dermis, gives skin its structure, firmness, and resilience.

Peer-reviewed dermatology research has established that skin collagen content correlates more closely with menopausal age than chronological age, meaning that where a woman is in her hormonal transition matters more for her skin than her actual birthday.

Studies are consistent on the numbers: approximately 30% of skin collagen is lost in the first five years after menopause onset, after which collagen continues to decline at roughly 2.1% per year for the following 15 years. (Brincat et al., cited in Viscomi et al., Journal of Cosmetic Dermatology, 2025)

A 2025 review in the Journal of Cosmetic Dermatology summarised the mechanism: "The perimenopausal years are marked by an accelerated decline in skin quality, largely due to declining estrogen levels, which impair collagen production and the integrity of the extracellular matrix." (Sattler et al., Journal of Cosmetic Dermatology, 2025; reported in Physicians Weekly)

A consensus roundtable published in 2025 confirmed the multi-hormone picture: oestrogen supports collagen production and dermal blood supply, progesterone promotes extracellular matrix formation and dermal water retention, and declining testosterone further impacts cutaneous blood supply. (Consensus Roundtable, PMC/NCBI, 2025)

2. Skin Dryness and Barrier Impairment

As oestrogen declines, the skin loses two key hydrating components: hyaluronic acid and glycosaminoglycans. Both are hydrophilic molecules that bind water within the dermis. A 2025 review in the Journal of Cosmetic Dermatology described the process: "Loss of elastin, hydrophilic glycosaminoglycans, and sebum production results in dryness, reduced moisture retention, and increased skin rigidity, leading to wrinkling. Reduced vascularity impairs wound healing and weakens the skin barrier." (Viscomi et al., Journal of Cosmetic Dermatology, 2025)

A 2023 observational study published in Skin Research and Technology measured transepidermal water loss (TEWL), a standard marker of skin barrier function, in both perimenopausal and postmenopausal women. It confirmed that barrier dysfunction is measurable and significant in both groups. (Flament et al., Skin Research and Technology, 2023)

A Springer chapter reviewing climacteric skin changes found that perimenopause is associated with "a decline in functional properties of various tissues including viscoelasticity of the dermal connective tissue" and depletion of versican and hyaluronic acid in the dermis. (Piérard et al., Springer, 2015)

3. Adult-Onset Acne

Perhaps unexpectedly, some women experience more breakouts during perimenopause, not fewer. The reason lies in the relative shift in hormone balance.

During the reproductive years, oestrogen keeps androgens partially in check and promotes lighter, more fluid sebum secretion. As oestrogen drops in perimenopause, the relative androgenic activity increases. Androgens stimulate the sebaceous glands to produce a thicker sebum while simultaneously making pores smaller, a combination that can cause blockages and breakouts.

The European Medical Journal clinical review reported that acne affects approximately 25% of women during perimenopause, with causes including "relative androgen excess, increased inflammation, defective skin barrier function, and possible changes to the skin microbiome." The review noted that perimenopausal acne typically clusters along the jawline and chin, distinguishing it from the forehead-and-nose pattern typical of teenage acne. (DeGiovanni, EMJ Dermatology, 2025)

A 2024 review published in MDPI Cosmetics confirmed that "increased androgenic activity during menopause is a well-documented driver of excess oil production and adult breakouts." (Cited in AGEIST, 2024)

4. Impaired Wound Healing

One of the less-discussed but clinically important consequences of oestrogen decline is its effect on the skin's ability to heal. A review in the European Medical Journal noted that "in wound healing, oestrogen enhances the migration of dermal fibroblasts" - the cells that repair damaged tissue. Without adequate oestrogen signalling, this repair process slows. (DeGiovanni, EMJ Dermatology, 2025)

Research published in Nature Medicine (Ashcroft et al., 1997) and the Journal of Clinical Investigation (Ashcroft et al., 2003) demonstrated that oestrogen accelerates cutaneous wound healing, partly through upregulation of TGF-β1, a key repair signal. The 2024 review in GREM Journal summarised this literature, noting that "wound healing involves inflammatory, tissue proliferative and remodeling phases" - all of which are modulated by oestrogen. (Mejia-Gomez et al., GREM Journal, 2024)

5. Hyperpigmentation and Melasma

Changes in skin pigmentation are another well-documented perimenopausal phenomenon. Oestrogen and progesterone influence the activity of melanocytes, the cells that produce melanin, the pigment that gives skin its colour.

A 2025 review published in PMC/NCBI described melasma as a "commonly acquired hyperpigmentation disorder" whose causes involve "a multifactorial interplay of genetic predisposition, ultraviolet radiation exposure, and hormonal factors." The review confirmed that "estrogen and progesterone regulate melanocyte activity via genomic and non-genomic signalling pathways, impacting key enzymes and transcription factors critical to pigment synthesis." (PMC Review on Hormonal Crosstalk in Melasma, 2025)

As oestrogen levels fluctuate erratically during perimenopause, melanocytes receive inconsistent hormonal signals that can trigger excessive melanin production, leading to melasma, age spots, and post-inflammatory hyperpigmentation that is more persistent than younger skin would typically produce. Research suggests that up to 70% of perimenopausal women experience some form of hyperpigmentation, with melasma, age spots, and post-inflammatory hyperpigmentation being the most common presentations. (Genova Skincare, citing dermatological literature, 2025)

6. Skin Oxidative Stress

Oestrogen has a lesser-known but important anti-oxidant function. Its molecular structure (the A-ring phenol) allows it to directly neutralise reactive oxygen species, which are unstable molecules that damage DNA, proteins, and lipids, and accelerate ageing.

The European Medical Journal clinical review explained: "Reactive oxygen species are major contributors to skin ageing... and oestrogen deficiency leaves the skin more susceptible to this oxidative damage." (DeGiovanni, EMJ Dermatology, 2025)

This means that as oestrogen declines, the skin loses a layer of molecular protection that was working quietly and continuously throughout the reproductive years, leaving it more vulnerable to both environmental stressors and intrinsic ageing processes.

7. Hair Loss and Thinning

Hair changes during perimenopause are common and distressing, but frequently minimised or misattributed. Some research suggests that up to two in three people will experience hair thinning and increased shedding during menopause. (GoodRx, citing Grymowicz et al., International Journal of Molecular Sciences, 2020)

There are 3 main types:

• Female Pattern Hair Loss (Androgenetic Alopecia): The most common form. Unlike male-pattern baldness, women typically experience diffuse thinning at the crown and widening of the part line, rather than a receding hairline. The prevalence of FPHL climbs steadily through midlife, peaking around and after menopause. (Fabbrocini et al., 2018; Mysore et al., 2022, cited in Haver, 2025)

  • A study of nearly 200 postmenopausal women published in the journal Menopause, conducted by researchers at Chulalongkorn University in Bangkok, found that 52.2% had female pattern hair loss (FPHL), and that low self-esteem was present in 60% of those affected, increasing with severity of hair loss. (Chaikittisilpa et al., Menopause)

• Telogen Effluvium: A second distinct pattern, where large numbers of hairs shift from the active growth (anagen) phase to the resting (telogen) phase simultaneously — a response to physiological stress, including hormonal change. This can cause up to 70% of hairs to enter the resting Hair changes during perimenopause are common and distressing, but frequently minimised or misattributed.

• Frontal Fibrosing Alopecia (FFA): Less common but more serious, FFA is a form of permanent scarring hair loss that can occur around and after menopause. A 2025 ScienceDirect review noted it "can cause permanent hair loss" and requires early diagnosis to prevent irreversible follicle destruction. (Menopause and Hair Loss in Women, ScienceDirect, 2025)phase at once, with affected women losing more than 200 hairs per day. Unlike FPHL, telogen effluvium is typically temporary, with hair regrowth occurring over six to nine months. (Hims & Hers, citing clinical literature)

A 2025 study published in ScienceDirect confirmed that "female-pattern hair loss and telogen effluvium are common in post-menopausal women," and described the mechanism: "hormonal changes, including the relative increase in androgens and the cessation of ovarian estrogen production, directly impacts the hair follicle, which is an estrogen-sensitive tissue." (Menopause and Hair Loss in Women: Exploring the Hormonal Transition, ScienceDirect, 2025)

8. Changes in Hair Texture and Sebum

Beyond volume and density, the character of both scalp and body hair changes during perimenopause. Declining oestrogen and testosterone affect sebum production in the scalp ie. the natural oils that keep hair supple and shiny.

A consensus of dermatological experts in 2025 noted that decreased testosterone "impacts cutaneous blood supply and sebum production," affecting both skin and scalp health. (Consensus Roundtable, PMC/NCBI, 2025)

Conversely, facial hair, particularly on the chin and upper lip, may increase, again due to the relative increase in androgenic activity as oestrogen declines.

9. Genitourinary Syndrome of Menopause (GSM)

The same hormonal processes that alter the skin on your face and scalp are simultaneously reshaping the tissues of the vulva, vagina, bladder, and urethra. This is the domain of Genitourinary Syndrome of Menopause (GSM), a term introduced in 2014 by a consensus panel of the North American Menopause Society (now The Menopause Society) and the International Society for the Study of Women's Sexual Health, replacing the older and less comprehensive label of "vulvovaginal atrophy."

The name change was deliberate and important. As the 2025 AUA/SUFU/AUGS clinical guideline explains, GSM "describes the spectrum of symptoms and physical changes resulting from declining estrogen and androgen concentrations in the genitourinary tract during perimenopause and after menopause." (AUA/SUFU/AUGS Guideline on GSM, 2025)

The connection to the skin changes described throughout this article is direct: the genitalia and lower urinary tract share the same embryological origin as external skin, and the same oestrogen receptor systems. When oestrogen declines, all of these tissues are affected.

How Common Is GSM?

Research consistently shows that GSM is widespread but dramatically underreported. A StatPearls/NCBI review updated in 2024 reported that GSM affects 27% to 84% of postmenopausal women, with roughly 40% to 54% of postmenopausal individuals reporting bothersome symptoms.

Critically, approximately 15% of women begin experiencing GSM symptoms before menopause. (StatPearls/NCBI, 2024)

Despite this prevalence, the research highlights a significant gap between incidence and care-seeking. Only around 25% of women with GSM consult a healthcare provider about it, and a recent study found that only 4% of affected women were able to correctly attribute their vulvovaginal symptoms to GSM. (American Journal of Obstetrics & Gynecology, 2016; StatPearls/NCBI, 2024) Stigma, embarrassment, and lack of clinician awareness all contribute to this gap.

What Happens to the Tissue

The tissue changes in GSM are a direct parallel to what happens to facial skin but in a more specialised and sensitive environment. A 2025 review in Sexual Medicine Reviews described GSM as encompassing "anatomical and functional changes in the urogenital tissues (the labia majora/minora, clitoris, vestibule/introitus, vagina, urethra, and bladder) mainly related to the hypoestrogenic (deficiency of estrogen) state." (ICSM 2024 Recommendations, Sexual Medicine Reviews, 2025)

When estrogen drops, the vaginal lining becomes thinner and sheds fewer mature cells. The mature cells are the source of glycogen that fuels the "good" Lactobacillus bacteria, which keeps the vagina healthy by creating lactic acid. When the vagina is less acidic. The area is vulnerable to dryness, discomfort, or infections (AUA/SUFU/AUGS Guideline, 2025)

The 2025 AUA guideline catalogued the clinical signs: vulvar, vestibular, and vaginal dryness; irritation; discomfort and burning; introital narrowing (which causes pain during intercourse); spontaneous bleeding; and tissue fissuring. In the urinary tract symptoms include: urinary urgency, recurrent urinary tract infections, and incontinence. (AUA/SUFU/AUGS Guideline, 2025; ScienceDirect Overview, 2025)

A 2024 pilot study using non-invasive diffuse reflectance spectroscopy to measure vulvar tissue composition confirmed that measurable tissue changes are underway during perimenopause, before menopause is formally established. (PMC/NCBI Pilot Study, 2024)

The Link to the Broader Skin Picture

GSM is progressive and does not resolve on its own without intervention. A MDPI case-based review published in 2026 described it as "a chronic, progressive hypoestrogenic condition affecting vulvovaginal, urinary and sexual health in women," noting that it remains "underdiagnosed and undertreated, thereby negatively impacting women's quality of life." (MDPI Case-Based Perspectives on GSM, 2026)

The evidence base for treatment is well-developed: localised oestrogen therapy (vaginal oestradiol or oestriol), vaginal DHEA (prasterone), and the selective oestrogen receptor modulator ospemifene all have strong evidence of efficacy.

Non-hormonal options including vaginal moisturisers, pelvic floor therapy, and emerging energy-based treatments (laser, radiofrequency) are also supported by clinical trial data. (ICSM 2024 Recommendations, Sexual Medicine Reviews, 2025; AUA/SUFU/AUGS Guideline, 2025)

What the Research Tells Us

The peer-reviewed literature is clear: perimenopause is a period of accelerated and multifaceted change for the skin, hair, and genitourinary tissues. These are not simply cosmetic concerns. Impaired wound healing, weakened barrier function, increased oxidative stress, significant hair loss, and the progressive tissue changes of GSM all carry real quality-of-life implications.

If you are experiencing skin or hair changes in your 40s, they are worth taking seriously and worth discussing with a doctor who understands the hormonal landscape of perimenopause.

If you would like to get advice about how to approach this topic with your doctor, book a free discovery call with me. https://www.menopauser.com/free-call

This article summarises peer-reviewed research and is intended for informational purposes only. It does not constitute medical advice. Please consult a qualified healthcare provider for personalised guidance.