Perimenopause most often begins in the early to mid-40s, with hormonal fluctuations that can last four to eight years.¹ Menopause follows, bringing a more sustained period of hormonal change.² These transitions directly influence skin health.
We spoke with Dr. Mary Christina Simpson, board-certified Obstetrician and Gynecologist, CEO, and Medical Director of SeaMist Medical & Wellness Spa to learn more about how these hormonal changes impact our skin performance and appearance.
Managing Hormonal Changes
What are the most important ways women can support their skin health through hormonal changes?
"Our hormones are constantly communicating with our skin; it's one of the most visible mirrors of internal health. For women, in your 20s and 30s, estrogen and progesterone help keep the skin hydrated, supple, and luminous. As these hormones fluctuate during the menstrual cycle, pregnancy, postpartum, or perimenopause, we often see shifts in oil production, breakouts, or dryness. In perimenopause and menopause, the natural decline in estrogen can lead to thinner skin, increased sensitivity, and more visible fine lines. At home, focus on supporting your skin barrier as hormones shift. Use gentle, non-stripping cleansers, hydrating serums with hyaluronic acid and peptides, retinols and always protect against UV damage with a high-quality SPF.
Nutrition also matters, foods rich in omega-3s, antioxidants, and phytoestrogens (like flax and soy) help your body maintain hormonal equilibrium from within. Do not underestimate sleep, stress management, and hydration; these directly influence cortisol levels, which in turn affect inflammation and breakouts.
In clinic, I recommend treatments that work with your body's regenerative potential - such as microneedling, LED therapy, collagen-inducing treatments like biostimulating drugs as well as medical grade exfoliation/peels. When hormones are fluctuating, your skin can be more reactive, so timing procedures around your cycle or after hormone stabilization can make a huge difference. Hormonal treatments may be appropriate depending on the life stage and changes that are occurring. Ultimately, skin health during hormonal transitions is about harmony, synchronizing your skincare, self-care, and hormonal rhythm together. Supporting your skin through hormonal changes means pairing smart skincare with internal balance not just chasing one or the other. Consistency is key!"
Declines in estrogen and progesterone affect every layer of the skin, contributing to visible changes in hydration, pigmentation, radiance, texture, and vascular balance.³⁻⁴ Declining skin elasticity in perimenopausal and post menopausal women is possibly age and estrogen-related.⁵ For many women, these shifts are among the most noticeable and distressing signs of midlife. While hormones are primary drivers, they are not the only factor. Nutrient pathways that support repair and renewal, particularly Vitamin D activity in the skin, also becomes increasingly important during this stage of life.
The Role of Vitamin D in Skin
Vitamin D plays an essential role in skin health, far beyond its systematic benefits. In the skin, Vitamin D regulates epidermal differentiation, lipid production, barrier recovery, and collagen synthesis. When insufficient or deficient, the skin is more prone to dryness, slower repair, inflammation, uneven tone, and diminished radiance.⁶⁻⁸ These combined effects of hormonal decline and Vitamin D insufficiency create patient concerns that often present in the treatment room. People often experience dry, tight, itchy, flaky skin, dullness, textural changes, or prolonged redness after procedures or environmental stress.
How do you see Vitamin D status influencing skin function during these transitions, particularly around inflammation, healing, and collagen integrity?
"Vitamin D is both a hormone and nutrient which is why it plays such a powerful role in skin, bone, and mental health. It helps regulate cell turnover, immune response, and inflammation, all of which are essential for maintaining clear, resilient skin. When Vitamin D is low, which is incredibly common, due to reduced time outside, limited exposure to the sun or living in low-sunlight areas, we see slower wound healing, more inflammation, and even worsened acne or eczema flares.
In terms of collagen integrity, Vitamin D supports the fibroblast cells that build collagen and elastin, helping the skin remain firm and youthful. It also has a role in modulating estrogen receptor activity, meaning it indirectly supports balanced hormone function. I encourage women to check their Vitamin D levels yearly, especially during perimenopause and menopause when absorption and synthesis naturally decline. Whether you replenish through sunlight, fortified foods, or supplementation, optimizing Vitamin D is one of the simplest yet most impactful steps you can take for hormonal, mood, and skin health."
Hormonal decline and Vitamin D insufficiency converge to create visible, patient-driven concerns that often present in the treatment room. While experiences vary, five categories consistently stand out as the most clinically relevant to skin health and appearance. Understanding these concerns in both perimenopause and menopause, and how Vitamin D deficiency amplifies them, provides a framework for effective patient care.
The visible changes that occur in skin during perimenopause or menopause fall into five primary categories. Each reflects the combined influence of fluctuating hormones and insufficient Vitamin D activity, and each can present uniquely depending on the stage of transition. Together, they form the foundation for understanding patient concerns and guiding effective treatment strategies.
Delivering Comprehensive Support
From your experience, how does optimizing hormonal balance, whether naturally or through medical therapy, affect the skin's ability to heal, regenerate, and respond to professional treatments?
"The connection between hormones and skin regeneration is profound. When your hormones are balanced, your skin is stronger, more elastic, and heals beautifully. You begin to glow from the inside out when your body is balanced. Estrogen promotes collagen production, increases skin thickness, and enhances hydration, so when levels decline, we often see dullness, sagging, and slower recovery after procedures. Restoring balance whether through bioidentical hormone therapy, traditional menopause hormone medications, lifestyle optimization, or nutritional support helps restore that youthful glow and improves how the skin responds to treatments like lasers, microneedling, biostimulating procedures or injectables.
Progesterone supports repair and calmness in the skin, while testosterone and DHEA influence oil production and structure. Too little testosterone can make the skin thin and fragile; too much can trigger breakouts. The goal is balance - not suppression. When we bring hormones, nutrition, and skincare into alignment, it creates a synergistic effect. Women often tell me that their skin "starts to cooperate again" breakouts resolve, tone improves, and their skin simply looks more alive. At the end of the day, skin vitality reflects hormonal harmony. When we treat the inside and outside together, we get sustainable, radiant results.
Hormones don't just influence mood or energy they sculpt how our skin behaves and ages. Whether you're in your 20s navigating monthly fluctuations or your 50s embracing menopause, supporting hormonal health through nutrition, balanced lifestyle, and medical guidance is one of the most powerful beauty secrets you can invest in."