It’s Not Just Aging — Perimenopause Is Changing Your Skin (Clear Plan I Give Patients) | Dr. Idriss

If you're over 40 and you feel like your skin has suddenly changed overnight, you're not imagining it. I went to bed, I woke up, I don't recognize myself. I didn't change my skincare routine, I didn't change my lifestyle. But all of a sudden my skin and my face is unfamiliar to me. It's not necessarily worse, but it's different. Follow along as I explain why this happens, what's actually going on biologically, and most importantly, how to respond with a clear, calming plan instead of panic, chaos, trend chasing and over treatment. Welcome to Pillow Talk Germ. We do this thing every Saturday morning at 10am and today we are going to talk about aging in your early 40s and how your skin is more impacted by perimenopause than you think. What exactly then is perimenopause? Because this is a word you guys are hearing a lot about. Perimenopause is the hormonal transition leading up to menopause. But it can begin up to 10 years before you even hit menopause. So it's a long, undefined period. There's no single age, there's no single presentation. And that's why it's important for you guys to get to know your skin. And some people even start noticing changes in their late 30s, others in their mid-40s. There is no hardcore line. But what defines perimenopause is hormonal instability. And not just hormone loss. Because your skin relies so, so heavily on hormonal signaling for hydration, barrier function, collagen production and inflammation control, this instability can show up very clearly on your face. Your skin often shows you the signs of perimenopause before the classic symptoms, like missed periods, hot flashes, temperaments flaring or not, dryness, pigment changes, breakouts, redness, all of these can show up early, but they often also show up all together. And that's why it suddenly feels so, so sudden. It's not a slow linear decline. Perimenopause is defined by chaos, ouch, fluctuation. Your skin normally thrives on consistency. So when the internal consistency disappears and is out of whack, your skin is going to react accordingly. It's not skin care failure on your end, it's your internal biology that's taking place. So how does hormonal changes in perimenopause impact your skin and show up on your skin? I want to walk through the major hormonal shifts and what they actually do to your skin, keeping in mind that your skin is a hormone respondent organ and it's not just estrogen, but we're going to start. I said that weird, but we're going to start with estrogen fluctuation. Estrogen regulates your hydration, the barrier lipids, your collagen production and your blood vessel function. So during this stage of life, when estrogen is going up and down and spike, spikes and dips unpredictably, this inconsistency is going to lead to dryness and dehydration, increased pigment reactivity, hello, melasma flare ups or sunspots appearing worse and more flushing and overall redness. And that is why sunscreen tolerance changes, why pigment feels harder to control, why skin suddenly feels like really tight but also reactive and you just don't know what to do with yourself. And number two, progesterone declines, but this is much more steady and it starts earlier than the estrogen fluctuation because progesterone provides a calming anti inflammatory balance. So when it drops, you're going to notice increased inflammation, redness, puffiness and heightened sensitivity. And that's also why products that you used before that never bothered you can suddenly start causing an issue and burning and causing itching and stinging for you. Number three is your relative androgen, AKA testosterone influence. Your androgens don't always increase, but their relative influence when estrogen and progesterone decline appears stronger. And so this often will show up on your face as adult acne, especially along the jawline and the chin, oiliness in some areas that used to be dry. Like I'm experiencing more oiliness in my T zone. I don't fully know if I am in perimenopause. I am working under the assumption that I am. And yes, you can be breaking out and dry at the same time. And number four, cortisol, the stress hormone of life. Perimenopause itself is a physiologic stress state. Sleep disruption, life stress, caregiving, career pressure, all of this cortisol goes up the roof. High cortisol leads to your skin barrier breakdown, slower healing, worsening redness and pigmentation all over lying, the fact that our cell turnover tends to be slower in our 40s, your skin becomes less resilient overall. And number five, insulin is not just for diabetes, but insulin sensitivity shifts affect our skin. These hormonal changes affect how our body handles glucose. And on the skin that means increased inflammation, darkening of pigmentation and slower recovery after irritation or procedures. And that's why drinking, for example, shows up more the next day. Or if you eat a lot of sugar, you see it more on your face. That's not to say don't drink and don't eat sugar, but everything in moderation. We definitely need to talk about what not to do before we talk about what to do. And I think it's important that we do so. So we're all on the same page. Casual use of topical estrogen creams on the face. I'll tell you honestly, I tried it a year and a half ago before I was even fully in the zone that I'm in now. I didn't see a difference because I wasn't estrogen depleted. Your skin is an estrogen dependent organ, but the reality is there are different forms of estrogen and the long term safety data that exists currently exists for vaginal use, not for facial use. So there are no current strong studies proving it replaces core skin care products. And that's why estrogen cream is never going to ever replace retinoids, sunscreen or even in office procedures to a certain extent because that has a true and tried true and tried and true track record. Everything great was once you but not everything new is great. Would you consider topical estrogen then? In a very select few patients in perimenopause or post menopause who have significant thinning or creepiness or dryness and under medical supervision and never ever, ever as a first line treatment. You only jump to this once your core is really set. Core being products that we're going to talk about in a second. Number two, jumping straight to a facelift. Listen, I would be lying to all of you if I told you I'm not sometimes doing this. But the reality is a facelift is you chasing youth and you're not really talking about maintenance. And skin changes in perimenopause are rarely solved with surgery alone. So you need to figure out what is your maintenance plan and you need to figure out what is your skin care optimization, what is your barrier support, what are your strategic in office procedures? Because even after the facelift, guess what? Your hormones are going to be out of whack and you're going to have to figure out what is your maintenance plan. So I don't believe in fear based decisions or panic driven decisions either. Number three, over exfoliating to reset hormonal skin hormonal fluctuations already slows barrier recovery. If you are aggressively exfoliating, you're going to be increasing your inflammation, triggering rebound pigmentation and making everything worse. Exfoliation needs to change month to month sometimes in this phase and you have to be very attuned to your skin. But exfoliation is also a must because like I said a little bit earlier, our cellular turnover rate slows down. So we want to be getting rid of those dead skin cells in a smart, thoughtful fashion. Number four though is pushing through burning or stinging sensation. Like let's say you use a retinol and you're used to the burn, but you keep using it in perimenopause. Burning and tingling are signs of inflammation and not progress because inflammation is going to be the end of you and it's what's going to age you fastest. So listen to your skin. So this leads me to what actually helps in this situation and this part of your lives. Because it's not all created equal, but if you can create a stronger foundation off of which our skin can thrive, we're helping our own biology. So starting with number one, the increased dryness factor that comes into play. We are talking about the things that estrogen used to support. We want to have products that are fortified with ceramides, cholesterol and fatty acids so that it's helping to replace those barrier lipids that estrogen supported. We also want to add glycerin in for water retention because estrogen drives hydration. Let's add that hydration externally in and squalane is another one that can help to mimic your natural skin lipids without clogging your skin. When it comes to pigmentation and hyperpigmentation, you want to use pigmentation pigment regulating actives like alpha arbutin, Kojic acid and of course vitamin C. We also want to make sure we're using sunscreen every single day. It is a non negotiable because UV and as we get older amplifies any hormonally reactive pigment. And UV can amplify DNA damage in the form of regular sunspots, flushing, redness and inflammation. We want to look for things with colloidal oatmeal, panthenol and Centella asiatica. All of these to help soothe soothe inflammation and support our barrier repair. These are all essential if you want to have happy skin. Which leads me to four breakouts. We're looking for gentle anti inflammatory control and that is key things with azelaic acid that are going to regulate your oil production and improve your breakouts. Zinc PCA to balance your oil without over stripping your skin cell acid might have been a thing of the past, but it's not necessarily going to be a thing of two day. There's one thing that I want you to take away from today's video, it's that your skin is not betraying you. It's just responding to your internal chaos that is going on and to the internal change that is happening, happening on an erratic fashion. Perimenopause requires attention, adaptation, and definitely not aggression, because you will make things worse. And once you understand what's happening beneath the surface of your skin, you can better support your skin through this phase, calmly, confidently, and without chasing trends, the next best thing or surgery, especially not at 38, 39 or 40. And that is how we age intelligently, that is how we age to the best of our ability, and that is how we set ourselves up for success when we do want to get that surgery. Because now we know how to maintain our skin throughout the course of time. And if you don't want to get that surgery, great, you do you. And if you do you do you, it doesn't matter. But what matters is that you know how to maintain yourself. And with that, I hope you guys have a beautiful Saturday. Please, as always, leave your questions below and I will see you guys next week.