Think you know menopausal skin? A clinical facialist just shared 6 things that may surprise you

Menopausal skin can be very unpredictable. As hormone levels fluctuate and decline during perimenopause and menopause, you might find yourself dealing with dryness and itching one week, and breakouts or increased sensitivity the next.

These changes are incredibly common. In a Newson Health survey of 5,744 perimenopausal and menopausal women, 64% reported experiencing dry skin, 56% itching and 30% spots or acne, while 22% experienced formication (the uncomfortable sensation of something crawling on or beneath the skin).

There are changes happening beneath the surface, too, with research suggesting that as much as 30% of skin collagen can be lost during the first five years after menopause.

All of which means the skincare routine that served you well in your 20s and 30s may suddenly stop delivering the same results. But knowing how to adapt it isn't always straightforward. We asked clinical facialist Kate Kerr to share 6 things she wants every woman to know about menopausal skin, from how to tackle hormonal breakouts to when facial redness could be rosacea rather than a hot flush.

Kate Kerr's menopausal skincare essentials

1. Menopausal acne isn't teenage acne

Knowing how to treat menopausal acne can be tricky, particularly when your skin may be feeling drier or more sensitive than it once did. “The mistake I see is women assuming they must either go back to the harsh, drying routine they used as teenagers or, because their skin now feels drier, avoid stronger active ingredients altogether,” says Kerr. “Menopausal breakouts often appear deeper in the skin and around the jawline and lower face.

“But that doesn't mean we need to wrap menopausal skin in cotton wool. Retinoids, exfoliating acids (like AHA vs BHA) and other medical-grade actives are often exactly what the skin needs. They simply need to be selected and introduced correctly for the individual skin.”

2. A hot flush and rosacea aren't the same thing

“A menopausal hot flush usually feels like a sudden wave of heat that spreads across the face, neck and chest, is often accompanied by sweating and settles within a few minutes,” explains Kerr. “A rosacea flush is more concentrated across the cheeks, nose, chin and central face, and can leave lingering redness, visible vessels or rosacea spots.”

Kerr regularly sees women who have assumed their redness is simply part of menopause, meaning rosacea can go unrecognised. “Notice whether the redness disappears completely once the flush has passed. If it remains, becomes more frequent or is accompanied by sensitivity, bumps or visible capillaries, it is worth having the skin properly assessed.”

3. HRT can change your skin, too

“Hormone replacement therapy (HRT) can have positive effects on the skin and some women find that their skin feels less dry,” says Kerr. “However, certain types of HRT can increase oil production or trigger breakouts, particularly when testosterone is introduced.”

That doesn't mean you should stop or alter prescribed medication yourself – speak to your prescriber if you've noticed changes. “From a skincare perspective, the important thing is to treat the skin you have now rather than continuing with a routine designed for how it behaved six months ago.”

4. Adapt your skincare routine, don't abandon it

“Perimenopause can start in your late 30s or early 40s and last for up to ten years, so it's worth adapting your routine early rather than waiting for your periods to stop,” says Kerr. Her mantra? “Adapt it, don't abandon it.”

While your skincare routine in your 50s may look quite different to the one you followed a decade earlier, Kerr says the answer isn't necessarily to strip everything back. “The instinct is often to switch to gentle, soothing products, but that tends to leave the skin under-stimulated rather than healthier.”

Instead, she recommends thinking about your routine in two halves. “The morning is about protection and prevention: cleanse, then apply a strong antioxidant, a functional hydrator and a broad-spectrum SPF every day. The evening is about correction and stimulation, which is where exfoliating acids and retinol do their work.”

5. Pigmentation can appear out of nowhere

One change women may not associate with menopause is pigmentation. “Oestrogen helps regulate the melanocytes, the cells that produce pigment, so as it falls, they can become erratic, leading to sun spots and irregular discolouration, even in women who've never had a pigment concern before,” explains Kerr.

“Thinner skin is also more sensitive to the sun, and years of past sun damage can start to show. Daily SPF and antioxidants matter more now, not less, alongside ingredients such as niacinamide, azelaic acid and vitamin C.”

6. Menopausal skin changes aren't identical across all skin tones

Menopause won't necessarily affect every skin tone in the same way. “Black skin is generally oilier, so the hormonal shift can bring more oil, breakouts and inflammation, and those breakouts increase the risk of post-inflammatory hyperpigmentation, which skin of colour is already more prone to,” says Kerr.

“Rosacea can also be missed, because redness isn't always the obvious sign. Instead, look for larger-looking pores, more oil and increased sensitivity across the cheeks. Slower cell turnover can make darker skin tones look dull, and erratic melanocyte activity can make tone more uneven. It's why every routine should be tailored to the individual skin, its tone and its history.”