Perimenopause and Your Skin: When You Don’t Quite Look Like Yourself
There is a phrase I hear increasingly from women in my clinic: “I just don’t look like myself anymore.”
It is interesting because, very often, they can’t tell me exactly what has changed.
There hasn’t necessarily been one dramatic change, and it certainly hasn’t happened overnight. You’ve looked at the same face in the mirror every day for decades, while countless tiny changes have been taking place almost imperceptibly. Then one day – perhaps in a photograph, under particularly unforgiving lighting or simply when putting on your makeup – you notice them.
Your skin looks different. Your face doesn’t seem quite as defined. Something that has always worked for you suddenly isn’t giving you quite the same result.
And you think: when did that happen?
For many women, this moment arrives around the same time as another period of change: perimenopause.
You may still feel completely like yourself. Or, between disrupted sleep, changes in mood, brain fog, fluctuating energy and everything else life is throwing at you, perhaps you don’t feel entirely like yourself either.
Then the face looking back at you starts to feel unfamiliar too.
I think we need to talk about that.
Not because perimenopause suddenly makes you old, and certainly not because every woman reaching her 40s needs aesthetic treatment, but because hormonal changes can affect the skin and understanding what is changing, can help us make much better decisions about how we look after it.
So, what actually changes?
Oestrogen has an important relationship with the skin, influencing collagen, elasticity, hydration, skin thickness and barrier function. As hormone levels fluctuate and eventually decline, some women notice greater dryness or sensitivity, changes in texture or pigmentation and a gradual loss of firmness and elasticity.
But hormones aren’t working in isolation.
Natural facial ageing is happening alongside them. Genetics, UV exposure, lifestyle and weight changes all contribute, while the deeper structures supporting the face continue to change too.
This is why “my face has changed” isn’t a diagnosis.
Is the skin drier or less resilient? Has there been a loss of firmness? Is pigmentation making the complexion look different? Has facial volume or structural support changed? Or, as is so often the case, are several small changes happening at once?
This distinction matters because I wouldn’t treat all of those things in the same way.
And it is also why I don’t think women need to panic about some of the statistics they see online. The often-repeated claim that women lose around 30% of their collagen relates to the first five years following menopause; it does not mean that entering perimenopause suddenly causes 30% of your collagen to disappear.
We should be able to talk about the realities of ageing skin without frightening women into treating it.
What worked at 35 may not be what you need at 45
This is perhaps the most important part of the conversation for me.
I have patients I have treated for many years. I know their faces. I know what we have done previously, what they like and, equally importantly, what they don’t like.
And sometimes a patient comes back asking for “the usual”, but the usual isn’t necessarily what I would recommend anymore.
The patient hasn’t changed what she wants. She still wants to look like herself. What may have changed is how we achieve it.
A little treatment in one area may have been enough five years ago. Today, her skin may need more support, or we may need to address something completely different.
That might mean doing a little more.
It might mean treating somewhere different.
It might mean introducing a treatment focused on skin quality or collagen stimulation.
And sometimes it means doing less, or deciding that the treatment she thinks she needs isn’t actually the treatment I would recommend.
Aesthetic medicine shouldn’t be a process of endlessly adding more as we get older.
The treatment plan should evolve because the face evolves.
A different approach doesn’t always mean more treatment
This is where aesthetic medicine has changed considerably.
We now have many more ways to support ageing skin without simply adding volume. If the primary concern is declining skin quality, for example, we might look at treatments that support collagen production, hydration or regeneration. If it is laxity, we may consider an energy-based treatment. If there has been genuine structural volume loss, carefully placed dermal filler or a treatment such as Profhilo Structura may still be entirely appropriate.
Treatments including Sofwave, Sylfirm X, Polynucleotides and Profhilo, alongside other skin boosters and collagen-stimulating approaches, all work differently and address different concerns. None is automatically “better” because it is newer or marketed as regenerative.
And importantly, moving away from filler doesn’t necessarily mean moving towards something else.
Sometimes I think we need to do a better job in aesthetics of saying: you don’t need a replacement treatment simply because you no longer want the treatment you used to have.
The aim is to identify what has changed and then decide whether there is anything we actually need – or want – to do about it.
Your skincare might need to change too
The same applies to the products you use at home.
Skin that previously tolerated a very active routine may become drier or more sensitive. Products that once worked beautifully may no longer feel quite right.
At the same time, we are seeing a growing number of products marketed specifically for “menopause skin”.
I would approach these in exactly the same way as any other skincare product: what is in it, what evidence supports it and does this particular skin actually need it?
The word menopause on the packaging doesn’t automatically make something better for menopausal skin.
Sometimes the most appropriate change isn’t another aesthetic treatment at all. It may simply be reassessing your skincare and giving the skin more of the support it needs now.
And sometimes, it is about feeling looked after
There is another part of this conversation that I don’t think we should dismiss simply because it is harder to measure.
Perimenopause can coincide with an incredibly busy and sometimes emotionally turbulent stage of life. You may feel completely yourself, or changes to sleep, mood, energy, body and confidence may mean that you don’t.
Aesthetic medicine cannot treat perimenopause, and I would never suggest that it can.
But we can listen. We can support our patients within our role. And we can give them a little time and space to focus on themselves.
For me, this is where long-term relationships with patients become particularly valuable. I have treated some of my patients for many years. I know their faces, how we have approached them previously, the results they like and, importantly, what they mean when they say they want to look like themselves.
Sometimes we will adapt the treatment plan. Sometimes we might introduce something different. Sometimes the answer is better skincare. And sometimes I will say: I don’t think you need anything today.
There is no single “best aesthetic treatment for perimenopause”, because there is no single way that perimenopause affects every woman’s face or skin.
And perhaps that’s the most important message.
Perimenopause isn’t something we need to aesthetically correct. Ageing isn’t either.
But when you look in the mirror and feel that something has changed, understanding what has changed can be enormously helpful. From there, we can decide together whether your treatment plan needs to evolve, whether your skin simply needs different support – or whether nothing needs doing at all.
For some women, having a treatment and looking a little fresher can provide a welcome lift during a time when plenty else feels as though it is changing. For others, simply understanding what is happening and feeling listened to can be just as valuable.
The goal isn’t to make you look like the woman you were ten years ago. It is to help you continue to look – and feel – like yourself now.
Written by Dr Preema Vig, Medical Director at Dr Preema London Clinc
