Perimenopause, the stage of reproductive change for cisgender women that occurs in the years leading up to full menopause, can show up even earlier than expected and, as we now know, in plenty of surprising, confusing ways.
Most women are well aware that they’ll someday have to wrestle with hot flashes, night sweats, and weight gain as their bodies estrogen production declines, but the real shock comes when perimenopausal women, often only in their 30s or early 40s, see these symptoms accompanied by thinning hair and sagging skin before they hit the big 5-0.
If you’re already noticing other perimenopausal changes, like an out-of-whack menstrual cycle, difficulties in falling or staying asleep, or extreme fatigue after a normal day, your mirror might provide further evidence that your body is starting the co-called “change.”
Hair Changes
Scalp and hair are often the first to take a hit in perimenopausal women. Hair loss is the most talked about, but there are several underlying reasons and multiple symptoms you’ve probably never heard of – at least not before middle age, anyhow.
Differences in Hair Texture
During perimenopause, you’ll begin to see harbingers of how your hair texture will change as you age into menopause and your senior years.
Older ladies aren’t running around with wispy, frizzy, or frazzled-looking hair because they can’t be bothered to style it. Those short-haired, aging babes with angel hair-thin strands are just working with what Mother Nature doles out as the clock ticks on.
As the body’s estrogen declines, many women see a complete turnaround in hair texture. Women have often described their ‘new,’ aging hair as feeling dry and straw-like, or quite the opposite, with new hair growth appearing thin, light, and wispy. Others have noticed their formerly straight hair now grows in curly, or vice versa.
Significant Hair Loss
Except for the lucky-duck winners of the aging genetic lottery, lots of women also experience significant to severe hair loss in menopause, and this hair loss often starts in the perimenopausal stage. Women as young as 36 – or even younger! – have been vocal about their hair loss struggles and solutions, both online and in hair salons, proving that you don’t need to be “old” to see your hair start to seriously thin.
Female Pattern Hair Loss is a common diagnosis for perimenopausal women, and the loss of hair is often due to the overproduction of the androgen DHT.
Other types of hair loss can also occur during this time, such as Telogen Effluvium, a type of hair loss related to stress or a major, jarring life event. While TE is usually temporary, Telogen Effluvium can sometimes “unmask” a woman’s predisposition for genetic hair loss, leading to hair loss that becomes permanent without treatment.
Depending on your predisposition for genetic hair loss, plus your body’s reaction to differing levels of testosterone, progesterone, and estrogen, you can expect to see different types of hair thinning and loss, such as diffuse loss, which effects hair thickness across the entire scalp; widening of the part, where loss is mainly noticed where you part your hair; or a receding hairline, with the temples seeing the worst of the loss.
Miniaturization of Hair Follicles
In addition to seeing more hair fall out in the shower and when brushing, you might also see your hair grow back thinner. This is called miniaturization, and it occurs when hair follicles shrink, causing less hair to grow out of each follicle and individual hairs to grow back thinner than before.
Miniaturization is a symptom of Female Pattern Baldness and, unfortunately, will assist in both the loss of more of your hair on a daily basis and a change in texture over time as hair thickness decreases due to the smaller follicles.
Skin Changes
You already know you’ll eventually wind up with wrinkles, but perimenopause can trigger plenty of other skin changes you may have assumed were relegated to your senior years. Hormonal fluctuations in the years leading up to menopause can cause your skin texture, moisture levels, and elasticity to change seemingly overnight.
‘Crepey’ Skin
Remember looking at your grandmother’s skin and noticing how paper-thin it seemed, almost like a roll of crepe paper party decorations?
These small, usually horizontal, saggy lines in the skin can appear anywhere on your entire body, and though we usually associate this type of skin texture with women over the age of 60, so-called ‘crepey’ skin can begin to show up as soon as perimenopause begins.
The loss of estrogen also results in a loss of collagen and elastin in the skin, which takes away that lush, moisturized, and ‘bouncy’ feeling you once had in your skin’s more youthful days. A lack of estrogen also makes it more difficult for your skin to hold moisture, which only highlights any ‘crepey’ texture you might have.
‘Turkey’ Neck
Many women notice the first appearance of ‘crepey’ skin on the front of their neck, often called ‘turkey neck’ by ladies in-the-know due to the way the skin begins to thin, sag, and take on an uneven, lined texture, like a turkey’s waddle.
As soon as your hormones start to weave towards the start of menopause, it’s possible to see your neck skin begin to change form. ‘Turkey neck’ is a common topic among women over 45, but such skin changes can happen even earlier, depending on when you become perimenopausal.
You might see your neck skin start to sag with or without any ‘crepey’ texture, which may look similar to the way skin appears after quick weight loss – kind of like a balloon that’s been blown up and then deflated, having lost it’s elasticity.
Enlarged Pores, Bumpy Skin Texture, and Acne
As if wrinkles and your skin turning into a kid’s party decoration weren’t enough, declining estrogen can turn your formerly smooth skin into an acne zone, topped off with enlarged pores and pock marks, tiny bumps, and other new, raised textures.
Skin smoothness is, indeed, due largely to estrogen, and without it, most of what women consider skin ‘flaws’ can either become more pronounced, like pores and scars, or seemingly develop overnight. Fluctuating hormones, just like in teenhood, can also lead to menopausal acne.
Facial Changes
Loss of Facial Muscle Tone, aka ‘Melting Face’ or Jowls
Due in part to decreased muscle tone, though also heavily influenced by loss of skin tightness, many women half-jokingly exclaim that their ‘face is melting into their neck.’
What’s actually happening is that you’re experiencing every woman’s favorite part of aging (and that’s sarcasm, of course): jowls, which refers to the saggy, excess skin that makes it appear as if your cheeks are melting straight down your face and into your neck.
Jowls aren’t harmful to your health, but we get it: it can be a confidence killer to go from a tight, pronounced jawline and cheeks to the type of sagging skin we usually only associate with seniors, especially when you’re scarcely near your 50s.
Severe Dry Skin and Thinning Lips
Loss of estrogen, collagen, and elastin can also ‘deflate’ your lips and dry out your skin, leaving you reaching for lip balm 24/7 and slathering on lotion to seemingly no avail.
Perimenopausal and menopausal women have often described their lips and newly wrinkled skin as beginning to resemble shriveled, dried-up raisins, with minimal benefit from increasing water intake. Skin dryness also leads to constantly itchy skin over the entire body, a common symptom for women entering menopause. (And oddly enough, one of the itchiest places for women in peri or menopause is inside the ears!)
Some women have seen improvement in skin plumpness and moisture retention while on Hormone Replacement Therapy or from using estrogen skin creams, though it seems these treatments don’t show results for everyone.
Our Conclusion?
Keep in Touch With Your Doctor to Maintain a Healthy Body and Mind Throughout Perimenopause
We know it sounds obvious, but when it comes to properly tracking the effects of aging and perimenopause for optimal health, you need an MD. Only medical doctors with a full understanding of how perimenopause and menopause can change a woman’s body and brain will be able to properly address your concerns through exams, blood tests and possibly scalp/skin biopsies, and the safest medication based on your medical background and genetics.
Common courses of action often include Hormone Replacement Therapy, or HRT, or regular hormonal birth control methods, like the pill or a hormonal IUD, to supplement the hormones that the body is no longer producing.
No one has to see a doctor or take medication during the stages of menopause, but if your symptoms are causing you to feel like your life is falling apart, a doctor with expertise in women’s health can help you find a solution.
