Balanced Advice Q&A: Sorrowful Over Sagging Skin

sagging-skin_webAt age 40, I was diagnosed with premature menopause. One of the biggest changes I have seen has been in the appearance of my skin.  I have tested my hormones and my estrogen comes back low, despite my estrogen replacement treatments.  I am devastated at the changes in my skin.  I have noticed wrinkles, dry skin and fine lines that never used to be there.  Throughout my life I have always looked younger than my years.   But in that last three years since turning 40, my skin is looking worse and worse and to top it off I have gained weight!  I feel like I have morphed into a different person.  Is there anything I can do to improve my skin?

Sorrowful Over Sagging Skin

Dear Sorrowful Over Sagging Skin,

Skin changes in perimenopause and menopause are a normal accompaniment to the hormone decline that is common at this time of life. Hormones like estrogen, progesterone and testosterone are produced in much lower levels in menopause.  This decline can begin as early as your thirties  (See perimenopause blog post ) but is more likely to occur in the forties and fifties.  You  are on the early side of the curve.

The hormone that may have the most impact on skin health in menopause is estrogen,    though progesterone and testosterone play a role too. More important than any single hormone, however, is that the hormones must be balanced with each other in order for the skin to reap benefits.  We see trouble with hormone balance pop up in puberty as young people start to produce hormones in bursts and surges. We also see this during pregnancy, with certain hormone imbalance conditions such as PCOS, and again at perimenopause and menopause.

Here’s a quick primer on what role the hormones play on our skin:


  • Increases collagen- which maintains skin thickness
  • Maintains skin moisture
  • Reduces wrinkles by effecting the quality of elastic fibers and collagen in the skin
  • Decreases wound healing time


  • Plays a  role in collagen and skin elasticity
  • Increases secretions of sebaceous glands (oil producing cells on the skin)
  • Excess testosterone relative to estrogen causes acne in women at midlife


  • Increases elasticity and firmness of the skin
  • Maintains skin hydration
  • When balanced with estrogen levels, it can help estrogen function more effectively
  • Synthetic progestins can mimic androgens in the skin and cause or exacerbate acne

Hormonal changes are normal in perimenopause and menopause and hormone imbalance is part of the underlying cause. Other factors that play a role in skin health and should not be discounted are:

  • Genetics
  • Diet and nutrition
  • Water intake
  • Emotions and moods
  • Smoking
  • Sun exposure

For you  it will be important to address proper hormone balance.  You report that you are already taking estrogen, but your tested levels remain low. Talk with your provider about get the right dose and form of estrogen, and balancing it with bioidentical progesterone to find the skin health that you seek. Just taking estrogen is not enough. Finding balance is the key to health and vitality in midlife. Talk to your health care provider about how you might also find better hormone balance through improved nutrition and lifestyle choices.  Qualified bio identical hormone practitioners can be found on NUNM’s Provider Tool.

In health,
Elise Schroeder ND
Women In Balance Institute and Portland Oregon doctor