Symptom Guide: Dry Skin

May 12, 2022
Medically reviewed by: 
Dr. Leah Millheiser, MD

What is dry skin?

As you go through perimenopause and menopause, you might notice your skin becoming dry, flaky, and more prone to irritation. These changes can be uncomfortable and undesirable, but they are completely normal and can be addressed with a number of medical and non-medical treatments as well as lifestyle changes. 

What causes dry skin?

Declining estrogen levels often begin during the 40’s, even before perimenopause, and these decreases in hormones cause changes in the body that lead skin to become drier, thinner, and less firm. As a result, the skin becomes more sensitive and prone to irritation and sagging. A simultaneous decline in testosterone levels can exacerbate dryness.

What’s happening inside your body?

The loss of estrogen during menopause causes a number of changes in the body that contribute to skin dryness. Estrogen promotes water retention in skin cells, so when it starts to decline, so does the capacity of cells to hold water, causing a reduction in volume that makes the skin dry and appear less full. The drop in estrogen also causes the top layers of skin, known as the epidermis, to become thinner, increasing dryness and sensitivity. 

The broader aging process also causes atrophy of the cells in the epidermis, the dermis layer below it, and the layer of fat under the skin, which contributes to thinning skin. At the same time, skin cell turnover slows with aging, so skin can appear dull.

These changes coincide with decreases in elasticity and the production of collagen, a protein that provides tissues with structure. Without this support, the skin begins to lose volume and appears less full. 

It can be hard to experience sudden changes to your appearance, but remember that they are part of a natural aging process where beauty exists at every stage. 

Furthermore, the loss of testosterone during menopause is linked to decreased activity of the skin’s sebaceous glands, which produce oil. This too can make your skin drier and more sensitive. 

How is dry and changing skin addressed?

Dry skin can be uncomfortable, but it can be managed by staying hydrated, using appropriate moisturizers and cleansers, using medical treatments if necessary, and avoiding triggers that may cause flare-ups of irritation, such as sun exposure. 

What are some non-medical treatments?

Most treatments for dry skin during menopause are non-medical. They largely aim to provide support to your skin as it changes.

  • Moisturizers: As the skin loses its ability to retain water, locking in moisture becomes especially important. Moisturizing products for the face can include creamy cleansers, heavier night creams, and substances that help the skin hold onto water, like hyaluronic acid or ceramides. Avoid products that are drying, like foaming products and those containing alcohol, alpha-hydroxy acids, or salicylic acids. For the body, use a cream rather than a lotion, and look for products designed for sensitive skin.
  • Retinols: Derived from vitamin A, retinols are over-the-counter substances that are applied topically to reduce dryness and signs of aging. They penetrate through the epidermis to the middle layer of the skin, called the dermis, and help reduce fine lines and wrinkles and promote collagen production. Retinols are related to but milder than retinoids, which require a prescription. 
  • Avoiding hot showers and baths: Bathing in hot water can strip skin of oils that keep it moist and supple. Opting for warm water and moisturizing immediately after bathing can lock in moisture.
  • Always use SPF: Thinning, dry skin is more vulnerable to harmful damage from UV rays, which can also cause spots and discoloration. Regularly using broad-spectrum sunscreen of at least SPF 30 can help protect it from further damage and irritation. Dr. Leah Millheiser, Chief Medical Officer of Evernow, recommends brands like CeraVe, Neutrogena, Supergoop, Elta MD, Black Girl Sunscreen, and La Roche-Posay Antithelios.
  • Cover up: Dark spots like freckles and age spots can be worsened by the sun, so covering exposed skin by wearing UV-protective clothing, a hat, or driving gloves can add another layer of protection.

What are effective medical treatments?

  • Hormone therapy: If skin issues related to menopause become especially difficult to manage, a dermatologist or medical professional may recommend hormone therapy. This treatment comes in the form of a prescription that restores dropping estrogen levels, alleviating the root cause of skin dryness or thinning. Research suggests that hormone replacement therapy (HRT) can improve skin hydration, elasticity, and thickness; boost collagen production; and reduce wrinkling. 
  • Prescription retinoids: Closely related to retinols but much stronger, these substances reduce dryness and signs of aging through a number of mechanisms. Applied topically, they encourage cellular turnover in the skin, allowing newer and brighter layers of skin cells to surface. They also promote cell proliferation, which makes skin thicker and less prone to wrinkles and fine lines, and the production of hyaluronic acid, a substance that helps retain water. Available via prescription, retinoids such as the drug Retin-A (tretinoin) are potent and can be drying, so use them sparingly and in combination with sunscreen and moisturizing products. Usually, results appear after three to six months and complete effects can take up to a year.
  • Lasers: Laser treatments can be effective for brightening dull skin and addressing melasma, which is discoloration caused by hormonal changes, and other types of hyperpigmentation.

What to do next

Talk to a dermatologist or other medical professional who specializes in menopause about skin changes: A professional can help you assess your skin changes and recommend the best treatment options, prescribing drugs if appropriate. The American Academy of Dermatologists has great resources and referrals on its site, and you can always ask an Evernow provider for insight.

And remember: Be kind to yourself. It can be hard to experience sudden changes to your appearance, but remember that they are part of a natural aging process where beauty exists at every stage. 

Learn more

Disclaimer: This information isn’t a substitute for professional medical advice, diagnosis, or treatment. You should never rely on this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.

Reviewed by Dr. Leah Millheiser, MD