If your algorithm is anything like ours, you probably see a *lot* of skincare content — some of which is legit, and some of which is…less so. For those of us in the menopausal years, our skin does experience a ton of changes, which can make choosing the right skincare products and routine super difficult. We spoke with board-certified dermatologist Dr. Cybele Fishman to learn more about the key ingredients to healthy skin, including a sample anti-aging skincare routine.

How do hormones impact our skin?

To understand what the changes in hormones mean for our skin in perimenopause and menopause, we have to understand what estrogen and testosterone do in the skin and why their loss makes us feel like we aged 10 years in one.

Estrogen

Estrogen is the hormone that regulates the growth and physiology of our reproductive system. It also influences our nervous, endocrine (aka hormonal), skeletal, and cardiovascular systems. Because the skin has estrogen receptors, the hormone also has a direct effect on the health of our skin cells. It:

• Stimulates collagen production in the skin (the building block of our skin that helps it maintain thickness, produce natural oils, and retain moisture)
• Maintains skin moisture by increasing hyaluronic acid in the skin
• Helps with wound healing
• Provides skin elasticity and firmness

Not too shabby, huh? Of course, a reduction of estrogen in turn comes with several effects…

• Thinning of skin
• Decreased collagen and elastic tissue
• Increased prominence of wrinkles and fine lines
• Increased dryness
• Impaired wound healing

Now, while decreasing estrogen gets a lot of credit for symptoms of menopause, we can’t overlook the influence of decreasing testosterone…

Testosterone

Testosterone is a major driver of sebum production in the skin, which is responsible for oiliness. While in teen years, the overproduction of sebum can contribute to acne and oily skin (cue pang of sympathy for our 15-year-old selves), its reduction in menopause can result in dry skin.

What are your skincare non-negotiables as a dermatologist?

As our skin changes during perimenopause, we have to address three major components: hydration, collagen loss, and skin barrier health. This translates to prioritization of a few key elements:

Moisturizer

Lotion, creams, and oils all work well — it just depends on your preference and sometimes the time of year. For instance, you might prioritize a thicker cream in the winter or if you live in a very dry climate (or have an especially dry skin type), while a lightweight lotion might do the trick in the summertime.

Sunscreen

Gone are the days of baby oil-slicked bodies on the beach (at least I hope!). Many of us have traded in our tanning instruments for a bottle of sunscreen — thank goodness. Sun damage is associated not only with increased risks of skin cancer, but can also cause signs of aging like dark spots, hyperpigmentation, and of course — wrinkles.

There are two different types of sunscreen: mineral, and chemical. As a dermatologist, my favorite type is whichever a woman likes — and will wear religiously. Personally, I prefer the mineral sunscreens as they are less likely to cause allergies, and they provide both UVA and UVB protection. They also block UV rays, whereas chemical sunscreens absorb the sun’s rays so your skin doesn’t, which is why some people complain that they feel hotter when using chemical sunscreens — not so great for women experiencing hot flashes in perimenopause.

Retinoid

Retinol is one of those skin care things that can be super confusing and technical — so bear with me. “Retinoids” is a catch-all term for different types of Vitamin A used in skincare for the treatment of acne, sun spots, melasma, uneven skin tone, and fine lines…and they are very effective. Under the “retinoid” umbrella falls:

• Retinol: a lower concentration retinoid
• Tretinoin: a more concentrated form of retinol that is available only by prescription

For many of us, retinol alone will be effective, and may be a better option for sensitive skin since tretinoin can cause irritation. The upside to tretinoin is that you can get faster results. I recommend speaking with your dermatologist to decide whether retinol or tretinoin is best for you.

Sample morning routine

1. Wash face with a non-foaming cleanser as foaming face washes are very alkaline and can disrupt the moisture barrier, resulting in dryness and irritation.
2. Apply an antioxidant serum such as Vitamin C serum (L-ascorbic acid) — which prevents and repairs DNA damage to skin cells. You can think of antioxidants as your force-field against all the skin stressors out there, like pollution, car exhaust, second hand smoke, which create what are called in the skincare world “free radicals.” Antioxidant face serums have brightening effects on the skin, and can help lighten the appearance of dark under-eye circles.
3. Use a moisturizer with broad-spectrum SPF 30 or higher. I don’t recommend relying on foundations with SPF since you need to apply a ton to get adequate sun protection — which might not give you the makeup look you’re going for.

Sample evening routine

1. Wash your face with a gentle cleanser.
2. Apply your retinoid of choice.
3. Lather on the moisturizer.

Everyone is talking about peptides…should we be using those too?

Despite their being one of the most popular ingredients in skincare, I actually don’t recommend peptides. Why? At this time, there are few good studies demonstrating a real benefit. Plus, they don’t absorb well into the skin because they are too big. For people using other active ingredients like Vitamin C or retinoids — peptides can also react with these components, making them less effective.

What about exfoliation?

Exfoliation can be a good addition to our skincare routines, but shouldn’t be done more than once a week. There are also two different types of exfoliation:

• Chemical exfoliation uses acid or enzymes to remove dead skin cells, and can be done with glycolic acid, lactic acid, or mandelic acid.
• Mechanical exfoliation involves the use of friction to remove dead skin cells, and can be done with rice powder or sugar.

Are there any skincare developments you’re especially excited about?

Exosomes! The use of exosomes for skincare is fairly new in the field of dermatology, but shows real promise. Essentially, they are small, sac-like structures released by skin cells that support communication between cells — which is vital for body processes like immune system functioning and tissue healing. In the context of skincare, they may help improve skin health by boosting cell turnover and wound healing. For more information about exosome treatment, speak with your dermatologist!

READ MORE:

• Wait…You Can Put Estrogen Cream On Your Face?
• Elektra 101: The Science Behind Dry, Itchy Skin in Menopause

About Dr. Cybele Fishman

Dr. Cybele Fishman is a board-certified dermatologist and fellow of the American Academy of Dermatology with 25 years-experience in medical and cosmetic dermatology. She has been recognized as a leader in her field, honored as a Castle Connelly Top Doctor, SuperDoctor in New York, and Top Dermatologist in NY by expertise.com.