Menopausal skin was the subject of a recent FOX News interview with Amy Weschler, MD, PhD, who is board certified in dermatology and psychiatry. In the interview, Dr. Weschler addressed acne during menopause as well as the impact of stress and sleep on the skin. She included recommendations for stress management that can lead to skin improvements.
For a deeper dive into the skin effects of menopause and their pathogenesis, I interviewed Keira Barr, MD, FAAD, a double board-certified dermatologist, integrative somatic trauma therapy practitioner, and founder of the Center for Mind Skin Medicine.
What are some of the biggest misconceptions about menopausal skin?
One of the most limiting misconceptions is that menopausal skin changes are purely cosmetic, facial, or inevitable, and therefore best addressed with surface-level interventions alone. In reality, menopause affects the entire neuroimmunoendocrinecutaneous system, with visible expression on the face, skin, hair, scalp, vulva, and mucosa system-wide. Acne, rosacea, accelerated laxity, wrinkling, pruritus, hair thinning or loss, and paradoxical facial hirsutism often occur together, reflecting systemic dysregulation rather than isolated skin pathology.
Another misconception is that patients should simply “accept” these changes without acknowledging their psychosocial impact. For many women, menopausal skin changes intersect with identity, sexuality, self-trust, and belonging—especially in a culture that equates youthfulness with vitality, productivity, and even moral worth under the banner of “longevity.” When clinicians minimize this impact, patients often internalize shame and self-blame, which paradoxically amplifies stress and worsens inflammatory skin disease.
What’s the latest understanding of the impact of hormone shifts during menopause on the skin?
Menopause is best understood as a system-wide neuroendocrine transition, not simply estrogen deficiency. Declines in estrogen and progesterone alongside shifts in androgen signaling affect epidermal barrier integrity, collagen synthesis, immune modulation, vascular support, and wound healing. Progesterone loss is particularly under-recognized; its absence removes inhibitory control over 5-alpha reductase, contributing to relative androgen dominance even when absolute androgen levels decline. Clinically, this explains the common pattern of scalp hair thinning or loss alongside facial hair growth and hormonally patterned acne.
Importantly, estrogen also plays a central role in brain health and gut integrity. Changes in estrogen signaling and the estrobolome influence systemic inflammation and neuroimmune communication, helping explain why skin flares often co-occur with brain fog, anxiety, mood changes, or depressive symptoms. From this lens, menopausal skin is not “misbehaving,” it is responding appropriately to internal signals of physiologic and emotional stress.
What lifestyle factors also impact the skin during menopause?
Because of the intimate nervous system-skin connection, lifestyle factors during menopause are best understood as inputs into nervous system regulation rather than simple “choices.” Chronic stress, interpersonal conflict, unresolved attachment patterns, caregiving strain, workplace pressure, and cumulative emotional load all activate the HPA axis and influence immune and inflammatory signaling in the skin.
Sleep disruption is especially critical. Declines in estrogen and progesterone destabilize sleep architecture, while vasomotor symptoms fragment restorative sleep. This matters because sleep is when skin repair is supposed to occur: cortisol should be at its lowest, while melatonin and growth hormone peak to support antioxidant, anti-inflammatory, and regenerative processes. When sleep is impaired, this repair window is repeatedly missed.
Environmental stressors also deserve explicit attention. Air pollution, excessive or unprotected UV exposure, endocrine-disrupting contaminants in water and food, and occupational or geographic toxin exposure contribute to oxidative stress, barrier dysfunction, and immune dysregulation, often compounding hormonally driven vulnerability. Movement, nutrition, and alcohol use matter, but menopause amplifies the physiologic cost when these systems are already under strain.
Equally important, and often overlooked, is the role of positive resource cultivation: helping patients intentionally savor pleasure, laughter, creativity, social connection, and moments of meaning can expand nervous system capacity, improve stress resilience, and indirectly support skin healing by shifting physiology out of chronic threat and into states that support repair and restoration.
What’s unique about acne in menopausal skin? How does the pathogenesis impact treatment selection?
Menopausal acne reflects relative androgen dominance, barrier fragility, and heightened inflammatory sensitivity, rather than classic comedonal overload. Lesions often cluster along the jawline, chin, and neck and frequently coexist with xerosis, rosacea, or perioral dermatitis, making standard adolescent acne regimens poorly tolerated.
Treatment selection should be informed by this biology. Barrier-repair strategies, anti-inflammatory actives, and consideration of anti-androgen approaches (when clinically appropriate) are often more effective than escalating exfoliation or retinoid intensity. Just as importantly, clinicians should assess psychosocial stressors, sleep quality, and systemic inflammation, because persistent acne in menopause is often a signal of broader dysregulation, not a failure of compliance or skincare discipline.
In 2022, you published research on the role of hormone therapy in female aesthetic rejuvenation. What are some key takeaways?
One of the central takeaways from our work is that hormone therapy should be reframed from a fear-based, one-size-fits-all debate to an individualized, timing-aware, whole-person intervention. Early interpretations of the Women’s Health Initiative shaped decades of hesitation, but later analyses clarified important limitations related to age, formulation, route, and baseline risk.
From a dermatologic standpoint, the evidence consistently shows that menopausal hormone therapy can improve collagen content, elasticity, hydration, skin thickness, vascularity, wound healing, and wrinkle severity. Topical estrogen demonstrates localized skin benefits with lower systemic exposure, and emerging data on adjunctive hormones such as DHEA highlight the importance of addressing neuroendocrine balance, not just estrogen alone.
The key message is not that hormones are an aesthetic prescription, but that skin health is inseparable from systemic hormonal health.
How should a patient’s menopausal status impact a skin rejuvenation plan?
Menopausal status should meaningfully influence how we pace, sequence, and contextualize care. Skin in this phase is often more reactive, slower to heal, and more inflammation-prone, so aggressive stacking of actives or procedures can undermine outcomes.
Effective plans prioritize terrain restoration first: barrier repair, inflammation reduction, pigment regulation, and collagen support before layering devices or injectables. Expectations should be framed around longer timelines and gentler progression.
Equally important is integrating hormonal context and psychosocial load into treatment planning. When patients feel seen, not just treated, adherence improves, outcomes stabilize, and skin care becomes collaborative rather than corrective.
What else should dermatology clinicians know about menopausal skin?
First, mucosa matters. Beyond vulvovaginal tissue, menopause also affects the oral mucosa, where collagen decline and estrogen loss can contribute to dryness, burning mouth symptoms, altered sensation, periodontal vulnerability, and delayed healing. These symptoms are often overlooked yet fall squarely within dermatology’s scope of mucocutaneous care.
Second, genitourinary syndrome of menopause (GSM) is common, progressive, and under-discussed. Vulvovaginal atrophy contributes to irritation, fissuring, recurrent UTIs, and painful sex, directly impacting intimacy and relational safety. This loss of comfort and connection increases stress and anxiety, reinforcing a vicious neuroendocrine–inflammatory loop that can exacerbate skin disease elsewhere.
Finally, from a somatic and trauma-informed perspective, menopausal skin changes often reshape how women relate to their bodies. Recurrent flares, hair loss, mucosal pain, or sleep disruption can lead to hypervigilance, withdrawal from touch, and diminished self-trust. A validating clinical stance: “This makes sense, it’s biologic, and you’re not failing” is not ancillary to treatment; it is a therapeutic intervention that reduces shame, lowers stress physiology, and supports healing.
Menopause invites dermatology to practice integrative, compassionate, systems-aware skin care where evidence and empathy work together to improve outcomes.
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