Menopause face and perimenopause skin changes: dry skin, rashes, redness and nails

You catch sight of yourself in the mirror and your face looks different. It's drier and duller. The lines are deeper, your cheeks feel less plump, and your jaw looks softer than it did. Some days your skin goes red or stings for no clear reason. Your nails might be splitting too.

Some people call this "menopause face". It isn't a medical term, but the changes behind it are real. Perimenopause skin changes are common. The NHS lists "skin changes, including dry and itchy skin" among the symptoms of perimenopause and menopause.

You're not imagining it, and you're not just "getting old overnight". But a few skin changes have nothing to do with menopause and need a doctor to look at them. So please read the box below first.

What is "menopause face"?

Most of what people mean by menopause face comes down to a few changes under the skin:

• less collagen, the protein that gives skin its strength and firmness
• weaker elastic fibres, so skin is less springy
• thinner, drier skin that holds on to less water

A 2022 review of menopause and skin problems says collagen in the skin falls quickly after menopause, with nearly a third lost in the first 5 years. It then keeps falling by about 2% a year for the next 15 years. The same review says the breakdown of elastic fibres shows up as slack skin and more wrinkles.

Why does menopause change your skin?

Oestrogen does a lot of quiet work in your skin. It helps keep it thick, firm and moist. As oestrogen falls and swings in perimenopause, that support drops away.

• Moisture. The Menopause Charity says a lack of oestrogen causes a drop in the skin's natural moisturising factors. So skin dries out more easily.
• A weaker barrier. The 2022 review explains that low oestrogen may mean skin loses more water. This makes it drier and quicker to get irritated.
• Thinner, more delicate skin. The National Eczema Society says that with less collagen, skin becomes thinner and more easily damaged by scratching or bumps. This can lead to inflammation and bruising.

Menopause dry skin

Dry skin is one of the most common changes. It can feel tight after washing, look flaky, and itch. The Menopause Charity says dry skin and itching are common, and can upset your sleep and cause real distress. It also says dry skin often gets worse in the colder months.

If itching is your main problem, our page on perimenopause itchy skin goes into it in more detail.

Is there such a thing as a menopause rash?

There isn't one single "menopause rash". But rashes and red patches do seem to be more common around this time. The usual suspects are:

• eczema or dermatitis: dry, itchy, sometimes cracked patches
• rosacea: redness and flushing across the middle of the face
• hives: an itchy, raised rash (see our itchy skin page)
• spots: some women get menopause acne just as the rest of their skin gets drier
• a reaction to an HRT patch or gel: the 2022 review lists skin reactions where the HRT goes on as a possible side effect

A perimenopause rash can have lots of other causes too, so if a rash is new, spreading or won't settle, get your GP or pharmacist to look at it.

Menopause and eczema

Eczema can turn up for the first time in midlife. The National Eczema Society says eczema can appear for the first time during perimenopause or menopause, and eczema you had as a child can come back. If you already have it, it may flare more often or more badly.

It gives two reasons. Falling oestrogen leaves skin drier, which weakens its protective barrier. And hot flushes and night sweats make you sweat more, and sweat can irritate eczema.

The 2022 review mentions a large study in which eczema-type rashes were the skin problem women around menopause reported most often.

On brown and black skin, eczema may not look red. The National Eczema Society says inflamed patches may look darker than the skin around them.

Menopause and rosacea

Rosacea is a long-term skin condition that mainly affects the face. The NHS says it often starts with redness or flushing across the nose, cheeks, forehead and chin that comes and goes. Over time, the redness can stay. You may also get small red bumps, tiny visible blood vessels, dry skin, and skin that stings or burns.

The NHS says the cause isn't known, and that it's more common in women. It isn't caused by poor hygiene and you can't catch it.

The link with menopause hasn't been studied much. But the 2022 review says menopausal flushing is known to make rosacea worse, or even start it off.

The NHS lists these common triggers:

• alcohol
• spicy food and hot drinks
• sunlight
• hot or cold weather
• hard exercise, such as running
• stress

The NHS also says the redness may be harder to see on brown or black skin.

Brittle nails and menopause nails

Nails that split or snap more easily can be another change you notice. The NHS says it's normal for nails to get thicker or more brittle as you get older.

The NHS says most nail problems are caused by:

• injuries, or biting or picking your nails
• having your hands in water or cleaning products a lot
• fungal nail infections

Less often, nail changes can be a sign of something else, such as psoriasis, low iron, thyroid problems or diabetes. See your GP if a nail has changed shape or colour, or fallen off, and you don't know why.

What you can do yourself

None of this will turn the clock back. But looking after your skin's barrier can make it more comfortable and less reactive.

Washing

• Swap soap, shower gel and bubble bath for a mild cleanser or an unscented emollient (a plain moisturiser you can wash with). The Menopause Charity says harsh soaps strip the skin's natural oils.
• Keep showers and baths short and lukewarm. Hot water can make itching and overheating worse (National Eczema Society).
• Pat your skin dry with a soft towel. Don't rub.

Moisturising

• Moisturise straight after washing and at least twice a day, as The Menopause Charity suggests.
• In winter, a heavier moisturiser at night may help.
• Keep your moisturiser in the fridge. The National Eczema Society says a cool emollient can feel soothing during hot flushes or night sweats.

Redness and flushing

• Notice what sets your redness off and avoid it where you can.
• Use gentle, unscented products made for sensitive skin.
• The NHS advises people with rosacea to use sunscreen of at least SPF 30 every day, and to cover the face in cold weather.

Keeping cool

• Keep your bedroom cool and use lighter bedding. Overheating and sweat can upset sensitive skin. Our article on night sweats has more ideas.

Nails

• Wear rubber gloves for washing up and cleaning.
• Rub hand cream into your nails and fingertips often (NHS).
• Try not to bite or pick at your nails or the skin around them.

What your GP can offer

Your GP can look at a rash or patch and tell you what it is. Depending on the cause, they may:

• prescribe a steroid cream for an eczema flare. The National Eczema Society says steroid creams are the first treatment for eczema at any age, and that standard eczema treatments are safe to use during menopause and alongside HRT
• prescribe creams, gels or a course of antibiotic tablets for rosacea (NHS)
• refer you to a skin specialist (dermatologist) if treatment isn't working

HRT. HRT replaces the oestrogen your body is making less of. The 2022 review says oestrogen HRT can raise skin collagen back towards its level before menopause, and that oestrogen put on the skin helps it hold on to water. The National Eczema Society says HRT often helps ease dry, itchy skin.

But HRT can have skin side effects too. The same review lists acne, extra hair growth and skin reactions, and says some women taking HRT have developed melasma (brown patches on the face). HRT isn't right for everyone. It's one to talk through with your GP, especially if you have other menopause symptoms as well.

When to see a GP about skin changes

See your GP if:

• anything in the box at the top of this page applies to you
• you think you have rosacea (the NHS says it can get worse without treatment)
• your skin is flaring and self-care isn't helping. The National Eczema Society says not to wait
• a rash is new, spreading, painful or keeps coming back
• a nail has changed shape or colour for no clear reason
• your skin is getting you down or affecting your sleep

Our symptoms checklist lets you tick off everything you've noticed and print a list for your GP.

Related

Skin changes often come with itchy skin, menopause acne and hair loss, and you can see them all in our list of perimenopause symptoms.

This page is general information, not medical advice. If you're worried about any symptom, please talk to your GP or pharmacist.

See all perimenopause symptoms