The Effects of Perimenopause, Stress and Inflammation on Skin Health

The hormonal upheaval, and then waning estrogen levels of perimenopause and menopause intertwine with inflammation and stress, creating a perfect storm that dramatically affects skin health. 
Here’s how these factors combine to alter your skin and what you can do about it.

The Role of Estrogen in Skin Health

I once heard this apt analogy:  estrogen is to skin what Wi-Fi is to a smart home—crucial, invisible, and sorely missed when it starts to fade. During perimenopause/menopause, estrogen levels drop, and with it, the production of collagen and elastin—the proteins responsible for skin elasticity and firmness.

  • Diminished Collagen Production: Studies show that within the first five years after menopause, collagen levels can drop by as much as 30%. By the time we’re in our 70’s, we have just 25% of the collagen we had when we were young.  This loss leads to thinner, less firm, and less elastic skin.
  • Increased Collagen Break Down: With lower estrogen, enzymes called matrix metalloproteinases (MMPs) become more active, breaking down collagen more quickly.

Elastin, the protein that allows skin to snap back after stretching, also takes a hit.

  • Reduced Elastin Quality and Quantity: The production of elastin diminishes, and existing fibers become fragmented, causing skin to lose its resilience.
  • Structural Integrity: The skin becomes not only thinner but also less capable of recovering from stretching, leading to more pronounced sagging and wrinkles.

Estrogen also supports the body’s production of hyaluronic acid, which holds moisture in the skin. Levels decrease (suprise!) after our 20’s. 

Inflammation’s Role:

Chronic inflammation is another culprit in the skin aging process, often exacerbated during perimenopause.

  • Inflammatory Cytokines: Elevated levels of inflammatory messengers like IL-1, IL-6, and TNF-α increase MMP activity, further degrading collagen.
  • Oxidative Stress: Chronic inflammation leads to the production of reactive oxygen species (ROS), which directly damage collagen fibers, reducing skin’s strength and elasticity.
  • Fibroblast Dysfunction: Inflammatory conditions impair fibroblasts, the cells responsible for collagen synthesis, resulting in decreased collagen production and poor tissue repair.

Stress and the Skin:

When the body’s stress system is activated, the skin suffers in a few ways.  

  • Blood flow to the skin is impaired, which means that it receives less oxygen and fewer nutrients, heals more slowly, and produces more sebum (which can contribute to acne).  
  • Cortisol: Elevated cortisol levels inhibit collagen synthesis, increase MMP activity, and reduce the expression of collagen genes. Cortisol also raises blood sugar levels, promoting glycation, which stiffens collagen fibers and accelerates aging.
  • Telomere Shortening: Stress has been linked to the shortening of telomeres in fibroblasts, leading to cellular aging and a reduced ability for cells to regenerate.

A Perfect Storm

When stress and inflammation collide during perimenopause, their combined effects can significantly worsen collagen degradation. The interplay between inflammatory cytokines and stress hormones creates a vicious cycle, accelerating collagen breakdown, impairing synthesis, and compromising tissue repair.

Visible Changes and Practical Strategies

The result of these complex interactions is visible on the skin. Thinner, less elastic, and drier, the skin shows more pronounced wrinkles and sagging, especially in sun-exposed areas. In perimenopause, when hormone levels are characterized by erratic highs and lows, skin appearance can really be all over the place–inflamed with rosacea, broken out like a teenager, glowing, or suddenly dry and crepey.  

These changes not only affect appearance, but also increase vulnerability to injuries and slow wound healing.

Supporting skin health during perimenopause involves a holistic approach:

Diet: Consuming an anti-inflammatory diet rich in protein, healthy fats, and antioxidant flavonoids can support collagen synthesis, balance blood sugar and combat oxidative stress.

Topicals: Plant-based retinol-alternatives, Vitamin A-rich oils and botanical antioxidants can help mitigate some of the effects of decreased collagen and elastin, nourish skin, and improve its appearance.  

Hormone Replacement Therapy (HRT) and/or Plant-based Hormonal Support:  Talk with your ND, MD, DO or NP about HRT, which can dramatically improve skin elasticity and increase collagen content.  If you’re not a candidate for HRT, or just not interested, there are many botanicals traditionally used to support skin during hormonal transition, such as shatavari, schisandra, goji, gotu kola, calendula, vitex, maca and rose hips

Sleep Help:  Beauty sleep is a real thing.  Sleep is one of our best anti-inflammatories, and helps us manage our stressors better.  Adaptogens to reset circadian rhythms, nervines, sleep herbs and nutrients like magnesium, tryptophan and GABA can all be helpful.  

Supplements that REALLY WORK for glowing skin and healthy collagen:

  • Fatty Acids:  Fish oil (or algae oil, if you’re vegan or allergic to fish), Sea Buckthorn oil (especially for vaginal, eye and mouth dryness) and C:15, a newly discovered fatty acid that helps to stabilize cell membranes and make skin more resilient.
  • Biosil:  This bioavailable form of the mineral silica is an old school supplement that is still around because it works.  It supports the body’s production of collagen in all tissues, including skin, hair, nails, bones and joints.  24 week studies show decrease in fine lines and wrinkles, and increased hair growth.  
  • Hyaluronic Acid (HA):  HA holds 1000 its weight in water, and helps skin stay hydrated and plump. Studies have shown that HA supplementation improves skin tone, hydration and thickness. It also supports eye, joint and muscle health, and is extremely safe. 
  • Vitamin C:  An important antioxidant for the skin that protects and supports collagen. It’s best to take smaller amounts of C (250-500 mg) more frequently, rather than large doses at once, so that our bodies absorb it more readily.
  • Plant-based flavonoids, antioxidants and anti-inflammatories:  Yes, dark chocolate IS good for your skin–along with pigments in berries (including schisandra and goji), green tea, and turmeric, to name just a few. See our Summer Inflammation Guide for skin and collagen-friendly recipes.  
  • Marine or Bovine Collagen:  see our article on the benefits of collagen supplementation for improved connective tissue and skin health.  
  • Hydration with electrolytes:  Do you drink water all day but still find yourself thirsty and peeing all the time?  Try adding electrolytes to your water to support proper fluid balance throughout your body.  Many people report better energy levels, more hydrated skin, and less frequent urination with electrolyte use.  

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