Sometimes it can be the little things that make us feel a duller version of ourselves when experiencing the perimenopause and menopause.
The quality of your skin, fingernails and hair can change significantly when hormone levels fall and for some women, these changes may lead to a more negative self-image and a drop in confidence.
Topping up your declining levels of estrogen by taking HRT often improves the quality of your skin, the strength of your nails, and the look and feel of your hair.
The following information explains some of these changes in more detail and outlines practical tips that can be tried in addition to taking HRT.
Skin changes
Dry skin
Estrogen helps the skin produce ceramides, hyaluronic acid and sebum – the natural hydration mechanisms in the skin. Without these, skin loses water at a greater rate causing it to become dehydrated. When skin lacks moisture it will look dry and can feel rough and itchy. Over time, it may lead to more lines and wrinkles appearing.
What to do:
Soap dries the skin, especially soaps and gels that form a lather. Use a non-foaming cleanser or emulsifying ointment to clean your skin, or you can even use a moisturiser instead of hand soap and shower gel.
Take a short warm shower to cleanse. Avoid really hot showers as this will remove oil from the skin.
Use a good quality moisturiser twice a day, especially after a bath or shower. This helps your skin hold onto water and prevents it drying out. Use a lighter moisturiser in the day and a thicker creamier one at night if needed.
Many women find that their requirement for a moisturiser varies throughout the year. Cold and windy weather combined with central heating use in the winter causes the skin to dry whereas in summer, a lighter moisturiser can often be used.
In general terms, lotions are lighter than creams which in turn are lighter than ointments – you may need to try several to find one that suits you best.
Itchy skin
Your skin might be itchy because it is dry, and the above tips will help restore moisture. There are other causes of itchy skin also worth considering. Itching can be related to the release of histamine in the skin.
When the nerves in the skin get irritated, it can give the sensation of insects creeping on the skin known as ‘formication’.
Other causes of itching could be iron deficiency, abnormal liver function or thyroid disturbance, so consult your doctor if itchy skin becomes a persistent problem.
Scratching the skin can lead to a breakdown of the skin’s protective barrier and can lead to inflammation and infection. Your doctor may recommend an antibiotic to clear infection or a steroid cream to settle the inflammation. These should be used as prescribed by your doctor.
Tips for itchy skin:
- avoid hot or long baths and showers, go for lukewarm water instead
- in a bath, avoid bubble bath or bath bombs
- avoid perfumed soaps, shower gels, moisturisers and deodorants
- dab and pat the skin dry rather than rubbing
- use a mild, non-biological laundry detergent and avoid fabric conditioner
- avoid tight-fitting clothing and fabrics that irritate your skin
- use a cold compress/flannel when experiencing an itchy flare up
- avoid spicy foods, caffeine and alcohol
- wear cotton gloves at night if you think you’re scratching in your sleep
Redness and rosacea
Blood vessels in the skin can become very reactive during the menopause. It might lead to flushing, (when the face goes red suddenly) and often coincides with a sensation of heat and burning. Or you may be affected by rosacea, a common inflammatory skin condition that particularly affects women aged 35-50 years.
With rosacea, the redness and flushing are usually intermittent at first but then become more permanently visible. The redness (and sometimes spots) appears on the nose and cheeks initially and as it progresses, the forehead and chin too. The eyes may also be affected. Rosacea often has a burning, itchy sensation.
What to do:
Redness and rosacea can improve with lifestyle changes such as avoiding sun exposure and UV light, cutting down on alcohol and caffeine and avoiding spicy foods. Use a stripped back skincare routine including a non-foaming cleanser and a light moisturiser containing ceramides.
If Rosacea is becoming a problem, see your GP about trying other agents containing active ingredients such as azelaic acid, metronidazole and ivermectin.
Spots and acne
Some women have flare ups of spots and acne around the menopause, especially if they experienced this as a teenager. Acne can be differentiated from rosacea by the appearance of blackheads or other types of comedone.
What to do:
Check that any product you put on your skin is not going to aggravate the acne by blocking your pores (known as a non-comedogenic product), and use a cleanser that contains salicylic acid to help unblock pores.
Avoid excessive exfoliation which can aggravate the skin.
Retinol and niacinamide are also useful ingredients to look for to help prevent flare ups but it can take 6-8 weeks for improvements to appear so give any changes to your skincare routine time to work.
Signs of sun damage
Signs of sun damage are irregular dull skin tone, flat brown marks known as sunspots, thread veins, and lines and wrinkles.
What to do:
Avoid spending prolonged periods in the sun with your skin exposed, and when you do, use factor 50 sun cream and reapply every 2 hours. A wide-brimmed hat and covering your neck and chest area will help. If you are worried about any dark sunspots or changing moles, see your doctor.
Other facial signs of ageing
The facial bones lose their strength and become smaller which may alter your appearance by leading to jowls appearing and a less prominent jaw line.
A loss of collagen is also more pronounced at menopause (collagen normally keeps the skin strong, firm and plump) and can lead to fine lines and wrinkles appearing.
What to do:
The best ways to look after your skin as you get older is to protect it from sun damage, have a healthy lifestyle with minimal caffeine and alcohol, don’t smoke, and use skincare products that contain vitamin C, vitamin A and retinols to slow down the loss of collagen.
Looking after your nails
Your fingernails and toenails are made of a protein called keratin. This is what makes them hard and strong. The hormone estrogen helps to produce keratin so when levels decline, your nails may become more brittle, soft, or crack and split more easily.
What to do:
- use a cuticle oil 1-2x a day
- try and ensure your diet contains plenty of Omega 3 fatty acids, the essential B vitamin Biotin, and keratin (these could be taken as a supplement)
- moisturise your hands and skin around the nails daily
- drink plenty of water
- use rubber gloves when doing housework or any activities that involve strong chemicals
- use a soft nail file and acetone free nail varnish remover in your nail-care routine
Hair loss
It is very common to notice more prominent hair loss around the time of the menopause. For most women, it will be a general loss over the whole scalp, for some women it is mainly at the front and temple area.
Causes of hair loss
The cause of hair loss at menopause are multiple and are thought to be down to a combination of hair ageing and shrinking hair follicles. Our hair ages like the rest of the body does. Estrogen is thought to support hair growth and hair follicles shrink at a faster rate at menopause, which leads to finer hair.
Female pattern hair loss is a specific condition where the follicles shrink to the extent that the very fine hair produced does not provide any coverage. It is often hereditary but not always.
There can be more hair shedding if the hair cycle becomes imbalanced and this may be due to severe stress, illness, extreme dieting, thyroid imbalance or an iron deficiency.
Medications that can sometimes lead to increased hair loss are antidepressants and blood pressure treatments, some painkillers, or treatments used after breast cancer such as tamoxifen or aromatase inhibitors.
Some skin and other conditions that affect the scalp can cause hair loss such as alopecia or lupus. Women who notice hair loss affecting the hairline at the front of the scalp should seek a medical opinion to exclude Frontal Fibrosing Alopecia, a condition which occurs mostly in postmenopausal women and which benefits from early medical treatment.
With less estrogen circulating and a loss of hair from the scalp, it can mean that the more ‘male’ hormones become more prominent in women and may lead to increased growth of hair on the upper lip, chin and jaw line.
What to do about hair loss in addition to taking HRT:
- use a gentle shampoo and a good quality conditioner
- avoid tightly pulled hair styles to reduce the strain on the follicles
- avoid intense hair drying as this can damage hair shafts and make them more prone to splitting
- protect the scalp and hair from UV damage by wearing a hat
- when dieting, restrict your calorie intake gradually
- ensure you have adequate iron levels
- take steps to reduce your levels of stress.
(Colouring your hair does not usually exacerbate hair loss.)
If hair loss is causing you distress, there are several treatments available that can be tried once your specific cause of hair loss has been identified. See a specialist in hair loss for further advice and discussion about treatments.
Useful links for skin changes:
British Association of Dermatologists
Last updated June 2023
Last updated: June 2026
