How does the perimenopause—or “second puberty”, as it’s often known amongst experts—affect the skin? Turns out in myriad ways because hormone equilibrium is disrupted, which can also impact mood, energy levels and metabolism. “During the perimenopause period, which often starts in mid-40s (note: everyone’s genetics are different, so that can vary) oestrogen starts to decline, and what that means is male-dominated hormones—testosterone and androgens—become more dominant during that time,” explains Dr Jo Mennie, a plastic surgery registrar doctor, who also has a PhD in women’s health. “It shifts the balance and then you can start to see things like acne or sensitivity in the skin.”
Already a time of great change in body and mind, having your skin play up right before your very eyes can feel insulting to say the least, so understanding how to effectively approach looking after it can be hugely beneficial for both mental wellbeing and the skin itself. “Women who have had absolutely fine skin up until the start of perimenopause can experience these breakouts, due to increased oil gland activity from testosterone being more dominant, red patches and dryness,” explains Dr Mennie.
“Then, as women slowly move more into the menopause years, and there’s a constant oestrogen-deficit state. What that means is that unfortunately and unfairly the ageing process is accelerated, because oestrogen is actually crucial for the stimulation of collagen and elastin.” The strong elastin, otherwise known as the scaffolding structure of the skin, and the collagen that sits in between that scaffolding, essentially start to disintegrate—and that’s where sagging, wrinkles and a lack of plumpness and firmness come in.
So, how to approach your skin? Below, what Vogue learned from Dr Mennie.
Do: Get on board with medical-grade skincare
In the years leading up to the menopause, oestrogen drops and collagen and elastin starts to “curl and coil”, reducing skin’s thickness and plumpness. After this point, collagen production reduces by about one per cent a year. Whatever the skin symptom, it’s key to address it using a targeted approach.
“If, for example, someone is suffering acne due to increased oil gland production, we have to treat what’s going on—we want to minimise the p.acnes bacteria and make sure we’re exfoliating,” she says. “But similarly menopausal skin, which is complicated, is also often quite dry alongside being oily and acneic, and most products targeted to acne are super drying.” The key, she says, is to find products that are formulated with both hydrating ingredients and those that help manage the excess oil on the skin.
Medical-grade brands, such as Obagi and Cosmedix, are useful because a doctor can prescribe a higher level of skincare product for you. “With brands like these, the money goes on the formulation, rather than the marketing,” says Dr Mennie.
Don’t: Use anything drying
“The skin metabolism is reduced as you get into menopause,” says Dr Mennie. “One of the skin’s functions is to act as a barrier to the environment and keep water in—that stops working, which is why women experience dryness, and also why the ageing process can accelerate because you’re more exposed to things like the sun and pollution.” The key is to ensure that the barrier is replenished and protected and that hydration is a key part of your skincare routine.
Not only does that mean utilising ingredients, such as hyaluronic acid, glycerin and ceramides, but it also means that you should avoid anything that foams, is perfumed or that will strip the skin. “Over-exfoliation can lead to a lot of irritation because of the skin barrier, and avoid chopping and changing products all the time,” advises Dr Mennie. “Step it back a bit.”
Do: Use retinol
Retinol is the best ingredient to increase collagen and effectively “reverse some of the ageing process”, which makes it a no brainer to add into your skincare routine. “I’d also recommend using a high-strength vitamin C,” she says. “They are two key ingredients that are established in science and research that will actually increase your collagen levels.” From increasing skin thickness to reducing fine lines, retinol newbies should start at a low dose and build up gradually to using stronger formulations. You should also always use an SPF as menopausal skin is more vulnerable to external aggressors, plus as we all know, it will help ward off further signs of ageing in the near future.
Do: See a professional
Seeing a dermatologist or skincare expert at this pivotal moment in your life is key to keeping skin as healthy as possible as you get older, and to prevent inevitable overwhelm from occurring. Yes, you might be thinking, “I’ve got this far without seeing anyone, why do I need to see a professional now?”, but Dr Mennie says it’s an important time to ensure that what you’re doing in your skincare routine and beyond is actually working for you.
“It’s not just about grabbing any old product, but more about thinking about your skincare routine in a global manner, in terms of how you’re layering it and how your products are working together,” she says. “Understanding your skincare routine doesn’t need to be complex and eight steps long, it’s about breaking it down to the basic and ensure each step is actually doing something different, that you’re using good quality ingredients at the right strength to actually work.”
It doesn’t have to be as much of a faff as you think, either. Online platform GetHarley has some of the UK’s best-respected experts (over 500 of them) at the other end of a video call. With a new menopause category, take an in-depth consultation from the comfort of your own home, in which the expert you’re matched with will recommend a course of action, as well as a bespoke skincare plan using medical-grade products, that are then delivered directly to you. Genius, and all for a consultation fee of £40 or approximately S$67.
Don’t: Shun in-clinic treatments
Having noticed that a lot of women complain about signs of skin ageing “snowballing” within a short couple of years, Dr Mennie also advocates considering in-clinic treatments, which can pay huge dividends for how skin looks and feels. “Profhilo is my first go-to because it boosts collagen and it’s a simple treatment—you have two treatments, where hyaluronic acid is injected into the skin, one month apart. There is very little downtime and it’s also affordable in terms of what it does.”
Her second favourite is Morpheus8, which combines microneedling with radiofrequency to stimulate collagen, elastin and generally improve skin quality. “You get a tightening and lifting effect around the jaw area—it’s a bit more expensive but it’s a next-level effective treatment for this age group.” She also often uses Botox to help with wrinkles in the upper third of the face and “take some tension off”, but to really reverse the impact of ageing, it’s all about the Morpheus8 and Profhilo.
This story originally appeared in British Vogue.