Perimenopause is a stage many people enter earlier than expected, and the shifts in skin, hair, and overall body rhythms can feel unexpected, frustrating, or confusing. These changes often appear gradually, making it difficult to understand why your body no longer behaves the way it once did. It’s common to question what is normal and how to best support yourself through this transition.
In this blog board certified dermatologist Dr. Kamrani reviews how perimenopausal skin and hair can be supported effectively, including at home strategies, lifestyle considerations, and in office treatments.
What is Perimenopause? When Does it Start?
Perimenopause is the transitional period leading up to menopause, marked by fluctuating estrogen and progesterone levels. These shifts typically begin in the early to mid- 40s, however some people can begin as early as the mid-30s.
Perimenopause typically lasts four to eight years. Menopause is defined as 12 months without a menstrual cycle. This typically occurs around age 51 in the U.S., but anything between 45–55 is average.
What are Early Signs of Perimenopause?
Early symptoms can be subtle, inconsistent, and easy to dismiss:
- Skin and hair changes (often the first noticeable sign)
- Irregular or changing menstrual cycles
- Increased PMS symptoms
- Night sweats or occasional hot flashes
- Sleep disruption
- Anxiety or feeling more easily overwhelmed
- Brain fog
Many patients are surprised to find that their sudden skin or hair changes are actually hormonally driven!
What Skin and Hair Changes are Most Common in Perimenopause?
Changes in estrogen levels affect nearly every layer of the skin and hair follicle! These changes are common but treatable. Here’s what’s happening beneath the surface:
Dry, Thinning, More Sensitive Skin
Estrogen supports hyaluronic acid production, which is key for hydration. As levels decline, skin becomes drier, more fragile, more sensitive to products, and prone to irritation and redness.
Collagen and Elasticity Loss
We start to lose ~1% of collagen annually starting in our 30s, but within the first five years after menopause, women can lose up to 30% of skin collagen. This leads to fine lines, deeper wrinkles, skin laxity, loss of jawline definition, “tired” appearance
Dull or Uneven Skin Tone
Slower skin cell turnover causes dead skin to accumulate on the surface, making the complexion look dull, rough, and less radiant. Sun exposure with hormonal changes can also worsen hyperpigmentation and dark spots.
Hair Thinning and Shedding
Hormonal shifts disrupt the growth cycle, especially around the part line and crown of the scalp in women. Hair changes you may notice include increased shedding, reduced hair density, changes in hair texture (more frizzy or brittle), and slower growth.
At-Home Tips for Common Perimenopause Concerns
- Strengthening and hydrating the skin barrier: Look for gentle, medical-grade skin care that has ceramides, hyaluronic acid, and is calming. Be mindful that your skin may get more sensitive, so products that you may have used previously may be too irritating.
- Introducing Retinoids: retinoids have been shown to increase collagen, improve skin texture, and minimize fine lines. Introducing this to your skin care slowly is important because overuse can cause skin irritation! I recommend that patients to start every 3 days for one week, then every day for two weeks, then if their skin tolerates it well, they can increase it to every night.
- Supporting your hair: avoid any tight hairstyles and reduce high-heat hair styling. Don’t ignore your nutrition! A diet rich in protein, omega-3, iron, and vitamin D can support both hair and skin health.
- Sun protection every day! The most important tip is protecting your skin from the sun! Thinner and more fragile skin will be more vulnerable to UV damage. Sun protection will reduce fine lines, hyperpigmentation, as well as reduce the risk of developing skin cancer.
In-Office Treatments to Consider During Perimenopause
Collagen-Stimulating Injectables
These treatments help rebuild the skin’s foundation from within. Sculptra or Radiesse stimulates your body’s own collagen production, improving skin firmness, fine lines and skin texture, cheek support, and provides natural results.
Collagen-Stimulating Lasers
Energy-based treatments help counteract the accelerated collagen loss that occurs during perimenopause. We have all options for various skin types and downtime: Fraxel (1550/1927 nm), RF Microneedling, Sofwave, Microneedling, Halo Pro, and my personal favorite: the CO2 laser for resurfacing.
Wrinkle Relaxers
Neuromodulators (such as Botox, Dysport, Daxxify, and Jeuveau) soften expression lines and prevent deeper creases from forming as skin changes during hormonal transitions. These treatments can lift the eyebrows, open and refresh the eye area, soften forehead lines, and provide a subtle lift effect of the lower face and neck.
Hyaluronic Acid Fillers
Perimenopause accelerates volume changes in the cheeks, temples, jawline, and around the mouth. Hyaluronic acid (HA) fillers can help restore facial structure and support.
Hair Loss Treatments
Treatments include a combination of either at home and/or in office procedures. Hormonal shifts often trigger increased shedding or reduced density. Treatment options include topicals, prescription oral medications such as low-dose minoxidil or spironolactone. In office procedures include platelet-rich plasma injections, which slow shedding, stimulate regrowth, and improve hair density. ScalpStim is an Aesthetic Solutions exclusive procedure that helps both hair density and hair quality.
Perimenopause can introduce changes that feel unfamiliar, but understanding what is happening makes this stage far easier to navigate. With the right combination of consistency, thoughtful lifestyle choices, and targeted in office treatments, many of these concerns can be managed effectively. A personalized approach ensures your skin and hair remain healthy, resilient, and well supported as your body moves through this transition.
If you are in the Raleigh, Durham, Chapel Hill area and have questions about your own experience, our team is here to help guide you. Contact our office to get started!
