Your skin can reveal a lot about what’s happening inside your body. Produced by the endocrine glands, hormones are chemical messengers that impact how your skin looks and feels. 

​As women go through different life stages like puberty, menstruation, pregnancy, perimenopause and post-menopause, hormone levels rise and fall, often bringing noticeable changes to the skin. In addition, conditions like polycystic ovary syndrome (PCOS) and endometriosis can throw hormones off balance, leading to issues like acne, dryness, or pigmentation.

​The Relation Between Hormone Imbalances And Skin Health

If you have wondered why your skin goes through stages of dewy radiance to sudden breakouts, hormones are likely responsible. While a few pimples or occasional dullness might not be a big deal, some hormonal imbalances can cause more stubborn skin problems.

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Estrogen

The skin is made up of a foundation called the extracellular matrix (ECM), which contains molecules like collagen, elastin, and hyaluronic acid. All these substances have estrogen receptors on them, which means they are influenced by the estrogen levels in your body. [1]

​When estrogen production declines during menopause, your skin starts to change in noticeable ways.

• ​Wrinkles and Volume Loss – Produced by cells called fibroblasts, collagen keeps the skin plump and youthful. When estrogen levels fall, collagen production slows down, leading to fine lines, wrinkles, and sagging. According to studies, women lose about 30% of collagen during the first five years of menopause. [2]

• ​Sagging – Elastin makes your skin bouncy, flexible, and taut. A lack of estrogen causes the elastin fibers to become thicker and clump together. So your skin becomes less firm and more prone to sagging.

Figure 1:  In aged skin, decreased estrogen levels lead to reduced collagen and elastin production. (Image Source: Health Matters

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• Dryness and Itching– Glycosaminoglycans (GAGs) such as hyaluronic acid are natural components in the skin that help retain water, keeping the skin hydrated and plump. Low estrogen levels decrease GAG production, leading to dry, dehydrated skin. This decline in GAGs also weakens the skin's elasticity, leading to increased dryness, itchiness, and sensitivity, making the skin more prone to irritation.

• Uneven Skin Tone (Melasma) – Estrogen plays a key role in regulating melanocyte function, which is responsible for maintaining an even skin tone. As estrogen levels drop, melanocyte activity may decrease, leading to uneven pigmentation, blotchiness, or a duller complexion, especially in areas exposed to the sun. Women of color are found to be more prone to developing hyperpigmentation during menopause. A cross-sectional analysis of the All of Us database found Hispanic and Asian individuals to exhibit a threefold higher prevalence compared to White and Black populations, with the highest occurrence among those aged 41–55. [3]

• Thinning – A fall in estrogen levels decreases blood flow to the dermal vascular system, thereby inhibiting the formation of new blood vessels. Lack of nourishment makes the skin thinner, so it bruises more easily. The veins and bony landmarks also become easily visible on thin skin.

• Longer Healing Time –Estrogen levels also influence repair enzymes and growth factors such as epidermal growth factor (EGF) and vascular endothelial growth factor (VEGF), which play key roles in skin cell regeneration and wound healing. A decrease in estrogen can lead to reduced activity of these factors, making the skin more fragile and impairing its ability to heal wounds effectively.

• Flushing – Declining estrogen levels disrupt your body's temperature regulation system, leading to hot flashes. It is characterized by sudden sensations of heat, sweating, and a rapid heartbeat, with each episode lasting anywhere from 2 to 30 minutes. The clinical evidence indicates that approximately 75% to 80% of menopausal women in the U.S. experience hot flashes. [4]

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Progesterone

Progesterone stimulates the sebaceous glands on your skin to produce sebum or oil and keeps your skin supple. Changes in progesterone levels can cause:

• ​Acne – Progesterone levels rise during the second half of the menstrual cycle, often leading to oily skin, clogged pores, and acne, especially around the jawline.

• Puffiness and Swelling – Progesterone helps retain moisture by improving the skin barrier function, making your skin plump and hydrated. However, rising hormone levels can lead to water retention, leading to puffiness and swelling. [5]

• Drying and Dullness – When the production of progesterone drops during menopause, the skin may become dry, rough, and less radiant. [6]

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Testosterone

Though testosterone is usually associated with men, women produce small amounts of this hormone. [7] Testosterone has a mechanism similar to that of progesterone–it stimulates the sebaceous glands to produce oil.

Just like progesterone, when testosterone production increases after ovulation [8] or in conditions like PCOS and endometriosis, it can result in excessive sebum production and clog pores, creating an ideal environment for acne-causing bacteria to thrive, leading to breakouts, especially in the T-zone (forehead, nose, and chin). Conversely, a drop in testosterone levels during menopause can lead to skin dryness.

Cortisol

The body’s primary stress hormone, cortisol, triggers oil production in the sebaceous gland. [9]

• Acne – During menopause, the cortisol level spikes, causing clogged pores, breakouts, or exacerbating existing acne. 

• Aging – High cortisol levels also accelerate skin aging (wrinkles, sagging, and dull complexion) by breaking down collagen fibers.

​Cortisol spikes can also worsen inflammatory skin conditions like psoriasis, eczema, or rosacea, leading to redness, flare-ups, and slower healing. [10] According to studies, chronic urticaria (hives) and psoriasis were found to be more prevalent in women with endometriosis than in women without the disease. [11] Lichen sclerosus is a chronic inflammatory skin condition primarily affecting postmenopausal women. It causes painful, patchy, discolored, and thin skin, particularly around the genital and anal areas. Additionally, it is also seen in women with endometriosis.

​To learn more about how chronic stress impacts your hormones, contributing to concerning health issues in mid-life women, stay tuned for our upcoming feature articles on these topics.

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Thyroid Hormones

Thyroxine (T3) and triiodothyronine (T4) play a vital role in regulating your body’s metabolism, skin cell turnover, and moisture retention, all of which impact skin health. [12] Any changes to thyroid hormone levels can trigger changes in the skin’s overall appearance.

• ​Dry, Rough, and Flaky Skin – Hypothyroidism is a common problem faced by women going through menopause. According to studies, nearly 12-20% of women over the age of 60 years are thought to have an underactive thyroid. [13] Since the thyroid gland regulates the activity of oil and sweat glands, dropping levels of thyroid hormones can lead to dryness, flakiness, and irritation. [14]

• Warm, Sweaty Skin – On the other hand, hyperthyroidism makes the skin oily, warm, and sometimes flushed. Due to increased cell turnover, the skin may also become thin, delicate, and more prone to bruising. [15]

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How To Keep Your Skin Healthy Amid Hormonal Changes?

While you must discuss any new skin changes with your doctor or dermatologist, there are some general lifestyle changes you can make to maintain your skin health through hormonal transitions.

• Consume a balanced diet rich in antioxidants, vitamins, and minerals to reduce oxidative stress and support collagen production.

• Avoid alcohol, caffeine, and spicy food, as they can trigger hot flashes and worsen skin issues, particularly during hormonal changes.

• Drink plenty of water to keep your skin hydrated and maintain its elasticity.

• Practice stress-relief techniques like yoga, meditation, etc., to reduce cortisol spikes that can contribute to acne and skin inflammation.

• Exercise regularly to improve blood flow to the skin.

• Aim for 7-9 hours of quality sleep every night to reduce dullness and promote skin repair.

• Avoid long, hot showers that dry out the skin.

• Apply a broad-spectrum sunscreen with a high SPF (above 30) every day to prevent hyperpigmentation and premature aging.

• Opt for gentle, non-soap based cleansers to avoid skin irritation and dryness and to lessen sensitive skin conditions.

• Moisturize your skin twice a day, ideally with a moisturizer containing hyaluronic acid or glycerin to maintain hydration and reduce fine lines.

• Incorporate skincare products containing ingredients like retinol or peptides, as they can stimulate collagen production in your skin, helping reduce wrinkles and improve skin texture.

While these measures can help manage skin changes, finding the right products can often be overwhelming. It’s best to consult a board-certified dermatologist, endocrinologist or gynecologist for a personalized treatment plan, which may include hormonal therapies, steroid creams, oral medications, or topical agents. Always consult your doctor for optimal efficacy and safety. 

• ​Hormone Therapy – Estrogen, progesterone, or a combination of both is prescribed to replace the hormones that your body produces less of. By bringing the hormone levels back to pre-perimenopause levels, hormone therapy has been found to increase dermal collagen levels and improve skin thickness and elasticity. [16]

• Topical Estrogens – Available as gels or creams, topical estrogen is used to treat moderate to severe symptoms of menopause, such as hot flashes, vaginal dryness and itching, etc.

• Selective Estrogen Receptor Modulators (SERMs) – These compounds act as estrogen agonists in the skin and show promise in improving skin health. In a 12-week clinical study, women applying topical equol twice daily experienced significant improvements in skin firmness and hydration. [17]

 If you have concerns about any skin issue, always consult with your family doctor or a licensed physician to get an accurate assessment, diagnosis and treatment plan that is right for you.