Healthy Skin After 40: Naturopathic Tips for Perimenopause

Your skin in perimenopause

Skin is vital to both physical and psychological health. In the perimenopause transition, shifting levels of hormones and age-related skin changes can come together to exacerbate existing skin conditions or trigger new skin issues. Although up to 64% of women report skin issues in perimenopause, it often gets less attention than it deserves, and, as anyone who has had problems with skin health will know, there is a considerable impact on your quality of life, mental and emotional wellbeing (1).

 

This article examines the impact on perimenopausal skin and skin conditions, and offers practical considerations for topical skin care, nutrients, and herbal medicines that can support healthy skin. The focus is not so much on “turning back the clock” to regain youthful skin but supporting healthy skin in perimenopause and beyond.

 

What drives perimenopause skin changes?

The shift in hormones, particularly estrogen, is the driver of many of the skin changes in perimenopause. During the transition to menopause, your ovaries produce less estrogen. This lower estrogen state has an impact on many areas of the body and its functions; however, it specifically affects the skin in the following ways.

 

How does low estrogen impact the skin?

 

• Decline in collagen. During the first 5 years of menopause, the body’s collagen production decreases by approximately 30%. This also affects tendons and ligaments, which can leave women more prone to joint aches, pains, and injuries (1). Another skin protein, elastin, also decreases, and when combined with the lower collagen, this results in sagging skin, wrinkles, and skin thinning.
• The decrease in glycosaminoglycans (GAGs), such as hyaluronic acid and chondroitin sulfate, impacts the skin, ligament/tendon structure, hydration, and tissue repair.
• Lower levels of skin lipids, such as sebum and ceramides, impact skin hydration, barrier function, sensitivity, and microbiome profile (2).
• Low estrogen alters thermoregulation/temperature sensitivity and drives “flushing” and night sweats.
• Low estrogen alters how inflammation is regulated, which can exacerbate skin conditions where inflammation is a primary driver, such as eczema and psoriasis.

 

Other hormonal impacts on perimenopausal skin

 

Relative increase in androgens

• Often in perimenopause, the levels of androgens don’t change, but with declining estrogen and progesterone, they are “relatively high”, which can drive perimenopause acne and seborrheic dermatitis.

 

Increased cortisol

• As estrogen levels decrease, the body’s ability to regulate cortisol becomes impaired, potentially leading to higher baseline cortisol levels and a prolonged stress response. Menopausal sleep disturbances and mood swings can further exacerbate this.
• High cortisol levels have adverse effects on the dermal barrier, contributing to dryness, inflammation, and poor wound healing (1).
• Dryness, inflammation, and wrinkles

 

Vitamin D metabolism

Vitamin D has multiple roles in skin health, aiding in skin repair, wound healing, protecting against UV damage and reducing inflammation. Not just a nutrient, Vitamin D is also a hormone, and perimenopause impacts its metabolism and function(3).

• Alterations to the skin barrier reduce the ability to make Vitamin D from sunlight.
• Lowered estrogen alters the “activation” of vitamin D in the kidney.

 

What are the effects of perimenopause on skin?

General

• Development of wrinkles and skin sagging
• Thinner skin, more prone to injury
• Dryness and itching
• Pigmentation
• Poor wound healing
• Sensitivity and increased allergic response

 

Skin conditions in perimenopause

 

Not everyone will get these, but due to the hormonal changes in perimenopause, you might get a new onset or exacerbation of certain skin conditions, including:

Female adult-onset acne

 

This often presents as cystic, painful lesions on the chin and mouth and is caused by a combination of factors, including relative androgen excess and higher cortisol levels (4).

 

Dermatitis

Caused by perimenopausal alterations to the skin barrier, making it more sensitive to airborne allergens, along with lowered skin immune function and increased tendency to inflammation.

 

Rosacea

Rosacea can be triggered or exacerbated by the hot flushes of perimenopause.

 

Psoriasis

There is no consensus in the research around the effects of perimenopause and psoriasis. Some studies have shown that reduced estrogen alters the immune pathways that drive this condition. In contrast, other observational studies report no significant difference between the disease state before and after menopause (5).

Hidradenitis suppurativa

Like psoriasis, the jury is still out on whether menopause impacts hidradenitis suppurativa (HS). A recent study reported that 39.5% of women with HS reported disease flares, while 44.2% reported stabilisation with perimenopause. There are also anecdotal reports that HRT causes exacerbation of HS symptoms (5).

 

Genitourinary symptoms of menopause (GSM)

The vulval and vaginal areas are particularly rich in estrogen receptors, and the low estrogen of perimenopause creates a possible constellation of symptoms related to changes in the vulval, vaginal and bladder tissues. These include vaginal dryness and itching, causing irritation and discomfort with everyday activities, as well as pain with intercourse and sexual dysfunction. The effect of perimenopause on the bladder mucosa can cause urinary urgency, increased frequency and light bladder leakage.   Changes to the microbiome can lead to an increased incidence of urinary tract infections (6).

 

Other skin conditions in the genitourinary area, which may be triggered by perimenopause in susceptible individuals, include lichen sclerosis and lichen planus. A qualified health professional should always investigate these to rule out any vulval cancer, which can present with similar symptoms (7).

 

Supporting healthy skin in perimenopause and menopause

 

While many of the above conditions can benefit from various types of either topical or oral hormone replacement therapy (HRT) or menopause hormone therapy (MHT), as it is now referred to, some women aren’t candidates for MHT or don’t wish to take it. Many of the diet and lifestyle options discussed below are helpful for all women regardless of the use of hormone therapy.

 

Sun protection

UV rays contribute to oxidative stress and increase the risk of skin cancers, so ongoing safe sun practices are essential and include protective clothing, a hat, sunglasses, and a good-quality sunscreen.

 

Skin care

• Regular use of an appropriate moisturiser for the face and body
• Limit the use of body washes and soap, as this can alter the skin pH
• Limit the use of antibacterial handwashes and hand sanitisers. Unless you’re in healthcare settings most of the time, washing with water will suffice.
• Limit long, hot showers as these contribute to dry skin
• Avoid products containing benzoyl peroxide to treat acne breakouts as it impairs the skin barrier, upsets the balance of the microbiome and increases skin dryness.

 

Lifestyle

• Quitting smoking or vaping. The free radicals and toxins in the smoke are damaging to the skin.
• Limit alcohol consumption. Current Australian Guidelines for alcohol consumption in healthy adults
• Regular exercise where you break a sweat. Exercise benefits skin on multiple levels. It supports overall metabolic health, stimulates circulation and tissue repair, reduces inflammation and cortisol levels, and promotes healthy lymphatic circulation and immune function.
• Aim to get adequate, refreshing sleep. Deep, slow-wave sleep is where the body’s repair work is done. It’s also helpful to keep cortisol in balance.

 

Diet

A healthy, nutritious diet is essential for skin health. In menopause, focus on these areas:

Protein

• Aim for at between 1-1.2g of protein per kg of body weight. Protein is essential for skin repair and wound healing.

Dietary polyphenols

These are plant chemicals found in fruits and vegetables, serving as a source of antioxidants that promote a healthy gut and skin microbiome. These include berries (of all kinds), green and black tea, apples, grapes, broccoli, spinach, red onions, dark chocolate, legumes, lentils, and cold-pressed extra-virgin olive oil.

 

Healthy fats

• Omega 3 fats from oily fish (salmon, tuna, sardines, anchovies, mackerel), flaxseed, hemp seed and chia seeds.
• Monounsaturated fats from extra virgin olive oil, avocado and nuts and seeds

 

Phytoestrogen foods

These foods help support postmenopausal estrogen levels and include soy products (such as tofu, tempeh, and edamame), legumes, lentils, sprouts, and flaxseed.

Find out more about phytoestrogen foods and their benefits.

 

Supplements to support perimenopausal skin

 

Collagen

Bioactive bovine collagen peptides (BCP) at a dose of 2.5grams/day have been shown in research in women aged between 35 and 55 years old to significantly reduce wrinkles, increase skin elasticity and improve hydration after 8 weeks. Dermal biopsies showed increased production of Type I collagen, elastin and proteoglycans (8). A small study also showed the benefit of BCP for genitourinary symptoms of menopause (9).

 

Immunobiotics

Lactobacillus plantarum 137 has been shown to increase the production of hyaluronic acid and regulate the immune responses in skin. It can be beneficial if dermatitis is present (10).

 

Omega-3 fatty acids

Supplementing with a good-quality fish oil can be helpful if you don’t consume around 3 serves oily fish a week. The docosahexaenoic acid (DHA) in fish oil can help increase filaggrin expression (which is implicated in atopic dermatitis), reduce skin inflammation and improve skin cell differentiation (11).

 

Vitamin D

Vitamin D plays multiple roles in skin health, including enhancing skin immunity, supporting a healthy barrier, and reducing the impact of UV damage and skin cancer risk. The ability to synthesise Vitamin D from sunlight decreases with age and is also impacted by liver and kidney function. Even if you get regular sunlight exposure, you might not be making as much as you were in your 20s. Testing Vitamin D status can guide you on the dosages needed.

 

Support for GSM

 

Topical use of fennel oil and sea buckthorn oil has been shown to have benefits in reducing vaginal dryness and vulval irritation (12,13). Water-based lubricants should be considered for sexual activity to protect the vaginal and vulval skin.

 

In summary

 

Menopause brings many changes to the skin, but with proper care, natural skincare, targeted nutrients, and lifestyle tweaks, healthy skin is achievable. Embrace this new phase with confidence by supporting your skin from the inside out. If menopausal skin changes are impacting you, don’t hesitate to reach out for personalised advice and holistic support tailored just for you. I offer one-on-one consultations from my Brisbane clinic or via telehealth Australia-wide.

 

 

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References:

1. Zouboulis CC, Blume-Peytavi U, Kosmadaki M, Roó E, Vexiau-Robert D, Kerob D, et al. Skin, hair and beyond: the impact of menopause. Climacteric. 2022 Sept 3;25(5):434–42.
2. Kendall AC, Pilkington SM, Wray JR, Newton VL, Griffiths CEM, Bell M, et al. Menopause induces changes to the stratum corneum ceramide profile, which are prevented by hormone replacement therapy. Sci Rep. 2022 Dec 15;12(1):21715.
3. Bocheva G, Slominski RM, Slominski AT. The Impact of Vitamin D on Skin Aging. Int J Mol Sci. 2021 Jan;22(16):9097.
4. Dias da Rocha MA, Saint Aroman M, Mengeaud V, Carballido F, Doat G, Coutinho A, et al. Unveiling the Nuances of Adult Female Acne: A Comprehensive Exploration of Epidemiology, Treatment Modalities, Dermocosmetics, and the Menopausal Influence. Int J Womens Health. 2024 Dec 31;16:663–78.
5. Kamp E, Ashraf M, Musbahi E, DeGiovanni C. Menopause, skin and common dermatoses. Part 2: skin disorders. Clin Exp Dermatol. 2022 Dec 1;47(12):2117–22.
6. Gimenez C, Alperin M, De Vita R. The Effect of Menopause on Vaginal Tissue Mechanics: A Brief Review. J Biomech Eng [Internet]. 2024 Mar 20 [cited 2025 Oct 4];146(060903). Available from: https://doi.org/10.1115/1.4063101
7. Pagac MP, Stalder M, Campiche R. Menopause and facial skin microbiomes: a pilot study revealing novel insights into their relationship. Front Aging [Internet]. 2024 Mar 21 [cited 2025 Oct 4];5. Available from: https://www.frontiersin.org/journals/aging/articles/10.3389/fragi.2024.1353082/full
8. Proksch E, Zdzieblik D, Oesser S. The Oral Intake of Specific Bovine-Derived Bioactive Collagen Peptides Has a Stimulatory Effect on Dermal Matrix Synthesis and Improves Various Clinical Skin Parameters. Cosmetics. 2025 Apr;12(2):79.
9. Tafuri A, Panunzio A, Tricarico M, Tricarico EM, Mazzarella CR. Oral Collagen Peptides and Vulvovaginal Radiofrequency Therapy for Genitourinary Syndrome of Menopause: A Pilot Randomized Study. J Clin Med. 2025 May 23;14(11):3656.
10. Nakai H, Hirose Y, Murosaki S, Yoshikai Y. Lactobacillus plantarum L-137 upregulates hyaluronic acid production in epidermal cells and fibroblasts in mice. Microbiol Immunol. 2019;63(9):367–78.
11. Balić A, Vlašić D, Žužul K, Marinović B, Bukvić Mokos Z. Omega-3 Versus Omega-6 Polyunsaturated Fatty Acids in the Prevention and Treatment of Inflammatory Skin Diseases. Int J Mol Sci. 2020 Jan;21(3):741.
12. Abedi P, Najafian M, Yaralizadeh M, Namjoyan F. Effect of fennel vaginal cream on sexual function in postmenopausal women: A double blind randomized controlled trial. J Med Life. 2018;11(1):24–8.
13. Chan LP, Yen TW, Tseng YP, Yuen T, Yuen M, Yuen H, et al. The impact of oral sea-buckthorn oil on skin, blood markers, ocular, and vaginal health: A randomized control trial. J Funct Foods. 2024 Jan 1;112:105973.