Perimenopause: What changes in a woman's health and skin!
To help us better understand what happens during this period and to answer the questions that so many women have, we spoke with Dr. Rita Maia , a General and Family Medicine physician with advanced training in menopause from the British Menopause Society and extensive experience in supporting women through this stage of life.
1. What exactly is perimenopause and when does it usually occur?Perimenopause is the transitional period preceding menopause, characterized by progressive changes in menstrual cycles, hormone levels, and various clinical aspects.
It usually appears between the ages of 40 and 50, lasting an average of four to eight years, although this can vary from woman to woman.
During this phase, ovulation becomes irregular and estradiol levels fluctuate unpredictably, with periods of excess and deficiency, but with a general tendency to decline as menopause approaches. At the same time, progesterone decreases due to more frequent anovulatory cycles, and follicle-stimulating hormone (FSH) tends to increase in an attempt by the body to compensate for the reduction in ovarian function.
2. What are the early signs that many women ignore?
The initial signs of perimenopause are often subtle and easily confused with the effects of stress, age, or lifestyle changes. These include irregular menstrual cycles, hot flashes, sleep disturbances, mood swings, and unexplained fatigue. Changes in the skin and hair may also go unnoticed, such as dryness, increased skin fragility, or thinning hair. Many women only recognize these signs when they become more persistent or begin to interfere with daily life.
3. What is happening hormonally in the body at this stage?
During perimenopause, hormonal balance undergoes significant changes. Estradiol levels become unpredictable, with peaks and troughs that affect the regulation of many bodily functions, including mood, sleep, and skin metabolism. Progesterone, which normally prepares the body for ovulation and maintains regular cycles, decreases due to non-ovulatory cycles. FSH increases to try to stimulate the ovaries, while LH also fluctuates. These hormonal changes explain many of the typical symptoms of perimenopause, from hot flashes to emotional and physical changes.
4. What impact does perimenopause have on the skin?
The decline in estrogen during perimenopause has several effects on the skin.
Estrogen directly influences collagen synthesis and skin hydration, as well as skin elasticity and thickness. With its decrease, a reduction in collagen, thinner dermis and epidermis, decreased elasticity, and water loss are observed, resulting in increased dryness, fragility, and the formation of wrinkles and sagging. Many women describe these changes as "sudden aging," when in fact they reflect a physiological adaptation of the body to the hormonal reduction.
5. Why do many women say they "suddenly aged"?
The sensation of sudden aging is due to a combination of several changes: in addition to thinner and less elastic skin, there are changes in hair strands, with thinning and decreased density, and alterations in body fat distribution. These effects, combined with hormonal fluctuations that influence sleep, mood, and energy, cause some women to perceive rapid changes in their appearance and well-being, giving the impression of accelerated aging compared to the gradual aging that occurs throughout adulthood.
6. Does perimenopause only affect the skin, or is it a phase of systemic transformation?
In fact, perimenopause is a phase of systemic transformation. Beyond the skin and hair, hormonal effects impact sleep, emotional balance, cognitive function, sexual health, metabolism, bone mass, and even cardiovascular health. Therefore, skin and hair changes are only a visible part of much broader changes occurring in the body.
7. Which habits really make a difference at this stage?
Maintaining healthy lifestyle habits is fundamental to minimizing symptoms and preserving health. Sleeping well, exercising regularly, eating a balanced diet, hydrating the skin, and managing stress are effective strategies. These practices do not replace clinical treatments when necessary, but they contribute significantly to overall well-being and help the body adapt to the hormonal changes of this phase.
8. What would you say to a woman who is starting to feel changes but doesn't know if it's "normal"?
I would say that most of the changes you begin to feel during perimenopause are completely normal, reflecting the hormonal transition that all women experience. However, this doesn't mean you have to tolerate bothersome symptoms. Seeking specialized medical advice helps you better understand what's happening and decide which interventions, whether lifestyle changes, specific skin care, or hormonal treatments when indicated, are appropriate.
9. What errors do you see most often?
The most common mistakes include attributing all symptoms solely to stress or age and not seeking medical evaluation, underestimating the emotional and physical impact of changes, and resorting to supplements or cosmetic products without a scientific basis. Ignoring persistent or debilitating symptoms can delay effective management strategies.
10. If you could give three fundamental pieces of advice for living better through perimenopause, what would they be?
First, get to know your own body well and be attentive to the changes you are feeling, to understand what is normal and what requires attention. Second, adopt lifestyle habits that support holistic well-being, including sleep, diet, exercise, skincare, and stress management. Finally, seek professional guidance whenever symptoms significantly affect your quality of life. Often, the combination of general care, pharmacological therapy when indicated, and regular medical follow-up allows you to live this phase in a healthy and balanced way, with preserved quality of life.