Menopause, Hormones & Skin: Oestrogen Left the Chat…

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Let’s be honest — menopause doesn’t exactly send a calendar invite before it arrives. One minute you’re fine, the next your skin’s gone from dewy to desert-dry and you’re wondering “why does my moisturiser hate me?” In this candid and brilliantly relatable piece, Dr Janine Olivier gets real about what happens when oestrogen ghosts your collagen — and how skincare, aesthetic medicine, devices and a little humour can help navigate perimenopausal and menopausal skin.  

Let’s get real for a second – not as your aesthetic doctor, but as someone who’s also on a perimenopause rollercoaster and just found a fine line where I swear there was smooth skin yesterday. If you’ve been looking in the mirror lately, wondering, “Why is my skin dry, saggy, and suddenly allergic to joy?”, I feel you. I really do. As oestrogen gracefully exits stage left, your skin doesn’t just age – it throws a full-blown tantrum. 

So, let’s unpack what’s going on beneath the surface – what science says about your options, and how we (yes, we) can navigate this hormonal chaos with a blend of skincare, injectables, lasers, and just a pinch of humour. 

As oestrogen dips (thanks, perimenopause), skin loses collagen, hydration tanks, and barrier dysfunction sets in. Trans-epidermal water loss – alias moisture escaping like it’s late for a flight – leaves skin dull, thin, and prone to irritation. It’s not “ageing badly”; it’s physiology. What helps? Evidence-backed allies like peptides (collagen’s hype crew), ceramides, niacinamide, and SPF 50 (always). Radiofrequency and PRP microneedling (professionally performed) stimulate dermal remodelling, and lifestyle checks (less stress, more sleep, fewer margaritas) matter more than your 12-step skincare routine. 

Women are ditching the war on ageing for a smarter, bio-respecting approach – not anti-ageing, but pro-skin longevity. It’s skin science meets self-awareness: supporting hormonal health, eating for the microbiome, and knowing when to stop over-exfoliating. 

The shift isn’t about surrender – it’s about strategy. Because ageing isn’t a flaw to fight; it’s a process to navigate – brilliantly, boldly, biologically. With moisturiser. And SPF. Lots of SPF. 

When Oestrogen Leaves, Chaos Ensues 

Oestrogen has long been the unsung hero of your skin – boosting collagen, hydrating like a champ, keeping things firm, glowing, and (relatively) obedient. But once perimenopause or menopause rolls in, oestrogen starts ghosting us. And that’s when our skin starts giving us the cold, crepey shoulder. 

Here’s what the science says happens during this hormonal plot twist: 

• Collagen drops by up to 30% in the first five years after menopause. That’s not just a decline – that’s facial infrastructure collapse. 

• Skin thins (both the dermis and epidermis), which is why everything suddenly feels more fragile. I now find the simple act of makeup removal resembles the curating of ancient papyrus – no, really. 

• Sebum and sweat production decrease, leading to dryness (aka “my moisturiser used to work and now it just… sits there”). 

• Slower cell turnover makes skin look duller and more uneven. Remember that glow we used to wake up with? Neither do I. 

• Pigmentation shifts, thanks to erratic melanocyte activity, create blotchiness, dark spots, and that uneven “menopausal mosaic” look. 

• The microbiome changes, too. Ageing skin has more microbial diversity, which sounds cool… until your chin suddenly breaks out like it’s 2003. 

All of this is before you even factor in sun damage (SPF 15 tanning oil in the ’90s didn’t really cut it, did it?). 

Hormone Therapy: Skin Saviour or Overhyped? 

Now, I get asked this a lot: “Should I do hormone replacement therapy to save my skin?” 

Short answer: It helps, but it’s not magic – and it’s not for everyone. 

Oestrogen therapy has been reported to: 

• Increase collagen content 

• Improve skin thickness and elasticity 

• Boost hydration 

• Speed up wound healing 

Studies have even shown that long-term hormone users had fewer wrinkles and more elastic skin than those who skipped HRT. Sounds great, right? But other studies (including the massive Women’s Health Initiative) found no dramatic difference in wrinkles or sagging between groups using HRT and those not using it, as well as no great difference in skin prior to HRT initiation and some months in. 

Plus, not everyone is a candidate for HRT. It comes with real risks that should be weighed up against your individual genetic profile, risk assessment, and general health condition – in accordance with your GP and/or gynaecologist. 

So, while it can certainly be a helpful part of a skin-health strategy, think of it as a supporting actor – not the lead. 

Topical Skincare: Your Daily Defence Regimen 

Now, onto things we can control without a prescription pad or blood tests. If your current skincare lineup still looks like your premenopausal self picked it out, it’s time for an upgrade. 

Here’s what works: 

• Retinoids (like Tretinoin): Gold standard. They stimulate collagen, speed up cell turnover, and help skin behave like it’s still in its 30s. Start slow – two to three nights a week – and titrate up if tolerated to a sustainable routine, while preserving hydration like it’s your day job. 

• Hyaluronic acid, ceramides, glycerine: These help to decrease moisture loss and repair the barrier function. Think of them as emotional support for stressed-out skin. 

• Vitamin C and Niacinamide: Antioxidants brighten, even skin tone, and help with pigment regulation. Plus, they make you feel like you’re doing science on your face. 

• Peptides, exosomes and growth factors: The jury’s still out on just how effective they are, but many of my patients (and my own reflection) see firmer, bouncier results – especially when needled in professionally at just the right depth and interval. 

Injectables & Devices: The Tools I Trust (and Personally Use) 

Listen, I love skincare, but at a certain point, no cream is going to lift a jowl. That’s where aesthetic medicine steps in (and yes, I’ve had most of these treatments myself). 

• Fillers: Restore lost volume (especially in the cheeks and temples), smooth lines, and make you look refreshed instead of resigned. 

• Neuromodulators (the tried and trusted toxins): Soften expression lines, prevent new ones, and stop your resting face from becoming a full-time frown. 

• Energy-based devices (RF microneedling, ultrasound, lasers): Stimulate collagen remodelling deep down, firm up skin, and improve texture. I personally swear by them in this phase of life. 

• Microneedling + PRP: Stimulate healing, boost collagen – and yes, it sounds scary, but it works. Think “tiny, professionally controlled injuries; major glow-up.” 

Lifestyle Still Matters – Unfortunately 

No, you can’t laser your way out of chronic stress or skip sleep and expect to glow (believe me, I’ve tried). 

• Eat real food. Your skin loves antioxidants, omega-3s, and protein. Wine and cheese count only emotionally. 

• Hydrate. And I mean water – not just oat milk lattes. 

• Move your body. Exercise boosts circulation, detoxifies, and enhances that elusive “natural healthy glow.” 

• Sleep. This is when your skin repairs itself. Less Netflix, more melatonin. 

• Manage stress. Cortisol eats collagen for breakfast. Get a hobby. Go outside. Meditate. Or rage-clean your pantry – whatever works. 

• Daily SPF at least 50 (100 if available) so that reapplication time is decreased. Yes, even when it’s cloudy. Yes, even indoors (windows and blue light exist). Don’t fight me on this. 

Final Word: Oestrogen Left, but You Don’t Have to Look Like It 

Menopause is not the end of beauty – it’s just a plot twist in your skincare story. Yes, the hormonal shift is real, but so is modern science. Whether you’re going the skincare route, medical aesthetics, hormone therapy, or a mix of all three, your face is still very much in the game. 

So: embrace the retinoids, book that microneedling, wear your SPF like armour, and for the love of the glow, seal that moisturiser in like your collagen depends on it – because frankly, it kind of does. 

If you’re feeling like your face is ageing in dog years, trust me, you’re not alone. Menopause is the wilderness. One minute you’re glowing (OK, flushing maybe), the next you’re Googling, “Why am I getting a muffin top and why does my chin look like crepe paper with zits?” 

But here’s the truth: we have options. Between skincare, treatments, lifestyle, and smart support (hormonal or otherwise), you can absolutely reclaim your radiance. I say this as your aesthetic doctor and as a woman walking the same path – tube of retinoid in one hand, cooling fan in the other, reluctantly on my way to the gym. 

So no, oestrogen may have left the chat… but we have not.