What Happens to Collagen, Elastin, and Blood Flow When Estrogen Declines?
Quick Read
During menopause, your skin may lose collagen and elastin, and experience diminished blood flow, due to a decline in estrogen. Understanding what's happening biologically allows you to stop blaming yourself and start addressing the root cause with strategies that can help.
The skin changes you experience during menopause aren't just about aging. They're specifically about what's happening to your hormones. Estrogen receptors are everywhere in your body, and as estrogen levels drop, your skin loses its ability to retain moisture, produce collagen, maintain elastin, and deliver blood flow.
Dr. Karen Koffler, Clinical Chair of Women's Health and Integrative Medicine at LifeMD, explains the biology behind these changes and why understanding them helps you stop blaming yourself and start addressing them strategically.
Why Does Collagen Production Drop During Menopause?
Dr. Koffler: Because estrogen receptors are all over the body, the skin is not immune to the changes we see once estrogen levels begin to decline. Estrogen has an impact on collagen production specifically, which can decrease over 30% in the first five years of menopause. That's a significant drop in a relatively short window, and it shows up as wrinkles, loss of skin firmness, and what women often describe as a "crepey" appearance to the skin due to lack of collagen production and reduced repair.
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A licensed provider can help you understand your symptoms and determine if hormone replacement therapy is the right next step.
How Do Collagen and Elastin Loss Affect Your Skin's Texture and Firmness?
Dr. Koffler: Collagen and elastin are what keep your skin firm and able to bounce back. When both decline, your skin texture changes and it feels less resilient and loses firmness. You'll also notice changes in your facial contours because of both the loss of these proteins and changes in bone density. Your skin essentially loses the structural support it had before, and that shows up as changes in how your skin looks and feels.
How Does Estrogen Affect the Skin's Ability to Stay Hydrated?
Dr. Koffler: Estrogen has an impact on the skin's ability to retain moisture and its ceramide production, which is the glue that holds the skin together and keeps it from drying. When estrogen declines, your skin can't hold onto water the way it used to. This is why so many women experience sudden dryness during menopause. Your skin is literally losing its ability to retain moisture.
Does Blood Flow to the Skin Change?
Dr. Koffler: Yes. Estrogen has an impact on blood flow to the skin. When estrogen declines, you get reduced blood flow, which means less oxygen and fewer nutrients reaching your skin cells. Your skin becomes duller, loses its natural glow, and heals more slowly from irritation or damage.
What are the Visible Skin Changes Women Typically See During Menopause?
Dr. Koffler: Women will complain of drier, thinner, more sensitive skin, of being more prone to irritation. They'll often notice crepey-ness, which is due to reduced collagen production. They may notice crow's feet that begin to morph into more obvious wrinkles. There's often a loss of facial fullness. Many women begin to notice age spots, and some notice acne begin to appear again. There's a lot of changes that we might see. That said, there are some women who have the good fortune, often due to their genes, reduced sun exposure, a healthy diet, and more, that do not experience many dramatic effects.
Can HRT Reverse Skin Changes?
Dr. Koffler: Estrogen itself is considered to be an anti-inflammatory compound, so by taking hormones like estrogen, you're actually protecting yourself from the damaging effects of inflammation. But estrogen has also been shown to improve collagen synthesis, to improve the thickness of skin, to improve elastin, to improve blood flow, and all of those have a direct impact on skin health. You can take it systemically, for instance, through a patch, or more directly, you can apply it topically as a skin cream to your face.
How Can You Address Skin Changes During Menopause?
Dr. Koffler: This is where you would want to have a conversation with your doctor about the things you're most concerned about, and to assess all of your health, all of your risk factors to figure out what is the most strategic approach to address your overall health – bone health, heart health, brain health, as well as skin health. It may include, for instance, an estradiol patch, and it may also include some topical products like tretinoin and topical estrogen, both of which have been shown to improve skin health. So there are options by which we can help your skin as you age.
How Can LifeMD Help With Skin Changes During Menopause?
The LifeMD Women's Health Program connects you with licensed menopause providers who understand how hormones affect your skin. Treatment is personalized to your needs, delivered online, and supported through ongoing follow-up to make sure your skin, as well as overall health, improves.
Take the free assessment to see if you qualify.
Want to hear more? To learn more about Dr. Karen Koffler's full conversation, listen to this podcast episode.
