Beyond the Surface: Rethinking Skin Health in Perimenopause and Postmenopause

By Chiza Westcarr

The aesthetics industry is uniquely positioned to serve women in midlife—yet our standard skin health protocols rarely reflect the complex hormonal shifts these clients and patients are experiencing. Every day, skin therapists, nurses, and aesthetic practitioners work with women dealing with challenges that include chronic skin dryness, hyperpigmentation concerns, an increase in lines and wrinkles and sagging skin. But are we truly addressing the root causes?

Menopause is more than the end of reproductive capacity. It is a profound biopsychosocial transition that alters skin, hair, metabolism, mood, and cardiovascular health. By 2030, over 1 billion women globally will be postmenopausal. For many, aesthetic treatments are their first point of contact for discussing visible changes linked to these hormonal shifts.

Why Menopause Impacts the Skin

Oestrogen plays a key role in skin hydration, collagen production, wound healing, fat distribution, and muscle maintenance. During perimenopause and postmenopause, oestrogen drops while folliclestimulating hormone (FSH) and luteinising hormone (LH) rise.

FSH stimulates the ovaries to produce oestrogen and mature eggs, while LH triggers ovulation and supports progesterone production. As ovarian function declines, the pituitary gland releases more of these hormones in an attempt to compensate, but the feedback loop breaks down—resulting in the aforementioned elevated FSH and LH alongside declining oestrogen.

Cytokines such as interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-α) increase, contributing to systemic inflammation. Growth factors like insulin-like growth factor-1 (IGF-1) decline, affecting muscle mass and skin regeneration.

This biochemical cascade accelerates collagen loss—up to 30% within five years post-menopause—leading to visible sagging, thinning skin, and volume loss. At the same time, hormonal changes contribute to both visible and internal shifts. For the skin, this may mean loss of elasticity, hydration, and firmness. The systemic shifts, including central adiposity and low-grade inflammation, not only impact overall health but also underscore the link between skin and metabolic function during midlife.

The Hormonal Influence on Outcomes

Body identical Menopausal Hormone Therapy (MHT) and bioidentical hormones are used to address the broad physiological consequences of oestrogen deficiency that occur during menopause. Oestrogen receptors exist throughout the entire body— including the brain, skin, bones, cardiovascular system, urogenital tract, and gastrointestinal system. As oestrogen declines, multiple systems are affected, leading to a wide range of symptoms and functional changes.

From a dermatological and aesthetic standpoint, oestrogen plays a critical role in maintaining skin hydration, collagen density, elasticity, vascularity, and wound healing.

Hormonal therapies may help reverse or slow some of these changes by supporting the skin’s structural and regenerative capacity. Clinically, this means that skin may respond differently to treatments depending on a client’s hormonal status. For example, some practitioners report that neuromodulators may wear off more quickly in women with marked oestrogen deficiency, possibly due to changes in dermal thickness or muscle responsiveness—though this remains anecdotal and unconfirmed in large-scale studies.

Oestrogen-deficient skin often requires more lipid-rich support and carefully calibrated collagen stimulation. Staying informed about hormonal therapies enables practitioners to tailor treatment expectations and offer guidance while remaining within scope of practice.

Addressing Midlife Skin Needs with Targeted Support

As hormonal and systemic changes accelerate skin ageing, a more deliberate approach to topical care and clinical treatment becomes essential. Standard protocols may no longer be appropriate for menopausal skin, which often presents with increased sensitivity, compromised barrier function, and slower regeneration.

By adapting both home care routines and in-clinic treatments to meet the unique needs of this life stage, practitioners can restore resilience, improve outcomes, and empower clients through education and support.

Home Care and In-Clinic Treatment Must-Haves for Menopausal Skin

Home Care Recommendations:

A menopause-aware home care routine should focus on protecting the skin barrier, restoring hydration, and promoting collagen synthesis, with gentle, skin supportive formulations:

• Cleanser: Non-stripping creamy or oil-based formulations are best for skin that is drier and often dehydrated. These help cleanse without disrupting already fragile barrier function.

• Actives: Introduce actives slowly and with consideration for sensitivity. Low- dose retinoids, peptides, and exosomes can support skin renewal. Gentle pigment correctors, enzyme-based exfoliants, and low-percentage, suitable acid formulations may aid cell turnover, while antioxidants such as esterified vitamin C and niacinamide may help defend against oxidative stress.

• Oils and Serums: Products containing squalane, shea butter, or other nourishing emollients can boost hydration and improve suppleness. These are particularly helpful for skin experiencing increased trans epidermal water loss.

• Moisturiser: Choose lipid-rich moisturisers fortified with ceramides and essential fatty acids. These reinforce barrier function, support resilience, and provide long-lasting hydration.

• Sun Protection: A broad-spectrum SPF 30+ should be used daily, even on cloudy days. Postmenopausal skin is more vulnerable to UV-related damage, including pigmentation and collagen breakdown.

In-Clinic Treatment Options:

Clinical interventions should prioritise barrier integrity, inflammation control, and gradual stimulation of collagen production:

• Barrier Repair: Begin with restorative treatments using lipid-rich, hydrating products to recondition the skin and reduce reactivity.

• Soothing and Calming: Incorporate calming actives to reduce inflammation and support skin recovery, especially for those with a history of sensitivity or hormonal flushing.

• Gentle Exfoliation: Enzymatic exfoliants or mild acids at low concentrations help remove dull skin cells without compromising barrier function.

• Collagen Stimulation: Treatments such as microneedling, plateletrich plasma (PRP), and ultrasound-based therapies can be used conservatively to improve dermal density and elasticity.

• LED Light Therapy: Red or near-infrared LED treatments may reduce inflammation and support healing while improving overall skin tone and texture.

• Injectables: Neuromodulators and dermal fillers can be used thoughtfully to address volume loss, while remaining mindful of the increased risk of puffiness in oestrogen-deficient skin.

The Cardiometabolic Connection

While aesthetics traditionally focuses on visible changes, perimenopause also introduces deeper systemic concerns. Hormonal decline, particularly the reduction in oestrogen, contributes to a chronic low-grade inflammatory state that increases the risk of metabolic syndrome, type 2 diabetes, metabolic dysfunctionassociated fatty liver disease (MAFLD), and cardiovascular disease (CVD).

Research shows that inflammatory markers such as high-sensitivity C-reactive protein (hs-CRP), ferritin, and interleukin-6 (IL-6) are commonly elevated in postmenopausal women. These markers provide valuable insight into the body’s internal state:

Key Markers and Their Functions:

• hs-CRP (high-sensitivity C-reactive protein): A protein produced by the liver in response to inflammation; widely used as a clinical marker for cardiovascular risk.

• Ferritin: A marker of iron storage that can also rise during systemic inflammation, making it useful for detecting chronic inflammatory states.

• Interleukin-6 (IL-6): A cytokine involved in immune system signalling; known to increase during inflammation and metabolic dysfunction, contributing to tissue breakdown and delayed healing.

Increased central adiposity and elevated inflammatory markers are often observed in midlife women as oestrogen declines. These changes reflect shifting metabolic health and may increase cardiometabolic risk, independent of chronological ageing.

Recognising these patterns allows practitioners to take a more informed and holistic approach. Understanding the connection between hormonal transition and metabolic health enables better education, timely referral, and broader support strategies for women navigating midlife.

Clinic Considerations: Evolving Best Practice

Supporting menopausal clients requires thoughtful consultation and treatment adjustment.

A holistic consultation should include:

• Medical history: Menopausal Hormone Therapy (MHT) use, medications, cardiovascular risks

• Skin health markers: hydration, elasticity, pigmentation

• Lifestyle factors: nutrition, sleep, exercise, stress

• Psychosocial context: confidence, body image, expectations

Integrating Wellness: The Bigger Picture

Aesthetic practitioners increasingly appreciate the need for a wholeperson approach. Menopausal skin health improves when nutrition, stress management, and exercise are optimised.

Encouraging clients and patients to:

• Incorporate adequate amounts of protein, healthy fats, fibre, phytoestrogens, and water, focusing on whole foods as the foundation

• Provide alcohol replacement options as this worsens vasomotor and other menopausal symptoms

• Engage in both cardiovascular exercises, such as walking, and resistance training to support musculoskeletal, metabolic, and cardiovascular health

• Consider supplements like vitamin D, magnesium, omega-3s, and polyphenols as indicated

• Offer support around mental wellbeing and self-image by listening actively, validating client concerns, and referring to qualified professionals where needed

• Providing clients with menopause education resources— whether leaflets in clinic or webinars online—helps normalise the conversation and builds trust.

Referral Network

Importantly, skin professionals must recognise when to refer. Building partnerships with GPs familiar with menopause care, pelvic health experts, nutritionists/naturopaths, and psychologists strengthens client and patient outcomes.

Commitment to Professional Development

To stay ahead, clinics must invest in menopause-specific training. This ensures all staff understand how hormonal changes affect skin physiology, treatment outcomes, and client needs. Ethical practice also demands we avoid over-treating vulnerable skin and remain vigilant around mental health considerations.

By embedding menopause knowledge into daily clinic protocols, the aesthetics industry can better serve this growing client base. Menopause is not a niche issue. It is a mainstream, life-stage transition that deserves evidence-based, empathetic care.

Conclusion

Skin therapists and aesthetic professionals have an opportunity to expand their impact. By moving beyond surface-level treatment and embracing a multidisciplinary, menopause-aware approach, we can help clients and patients navigate midlife changes with confidence and clarity.

Menopause is not something to fix, it’s something to understand. We all need to support the woman, not just her skin.

References

1. Abildgaard, J., et al. (2020). Increased systemic inflammation and altered distribution of T cell subsets in postmenopausal women. PLOS ONE, 15(6), e0235174.

2. Kim, O.Y., et al. (2012). Effects of aging and menopause on serum interleukin 6 levels and peripheral blood mononuclear cell cytokine production in healthy non-obese women. Age, 34, 415–425. https://doi.org/10.1007/s11357-0119244-2

3. Lephart, E. D., & Naftolin, F. (2021). Menopause and the Skin: Old Favorites and New Innovations in Cosmeceuticals for Estrogen-Deficient Skin. Dermatology and Therapy, 11(4), 1323–1338. https://doi.org/10.1007/s13555020-00468-7

4. Vandermeeren, M., et al. (2021). A role for oestrogen in skin ageing and dermal biomechanics. Experimental Gerontology, 150, 111424.https://doi. org/10.1016/j.exger.2021.111424

5. Australasian Menopause Society. (2022). Global Consensus Position Statement on Menopausal Hormone Therapy. https://www.menopause.org.au/ hp/position-statements/revised-global-consensus-statement-on-menopausalhormone-therapy

About the Author

Chiza Westcarr is a university-qualified nutritionist, skin specialist, Health Coach, and Menopause Coach, with a career dedicated to skin health, gut health, and women’s wellness. Recognised for her expertise in the connection between gut health, skin health, and menopause, Chiza is a sought-after speaker and writer, contributing to industry publications and events both nationally and internationally.

In February 2025, Chiza hosted the medical aesthetics industry’s first-ever menopause symposium, Thriving Through Menopause, and founded the Menopause Skin Academy— an online community created to support clinicians seeking to expand their understanding of menopause and its impact on skin and overall health. Chiza holds international diploma qualifications (CIDESCO, ITEC Hons, CIBTAC), a Bachelor of Health Sciences (Clinical Dermal Therapies), a master’s degree in Human Nutrition, an Advanced Diploma in Nutritional Medicine, and a Graduate Certificate in Health Research Practice. She is currently undertaking a PhD focusing on cardiometabolic health in menopausal women. @chizawestcarr_