Itching & Skin Changes

Written by Andrea Mazzocchi, PhD | Medically reviewed by Mandy Armitage, MD

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If you're suddenly dealing with unexplained itchy skin, crawling sensations, or dry patches that no amount of moisturizer seems to fix, you're experiencing one of perimenopause's most frustrating and under-recognized symptoms. Research reveals that up to 36% of women report significant skin changes during perimenopause, with itching being one of the most common complaints (1).

Studies show that pruritus (medical term for itching) affects between 8-38% of menopausal women depending on the population studied, with many experiencing it as one of their most bothersome symptoms (2). These sensations range from mild, dry skin and occasional itching to intense crawling sensations or feeling like something is prickling under the skin. Understanding the science behind these changes transforms them from mysterious annoyances into predictable, manageable symptoms with clear biological origins.

How common is itchy skin during perimenopause or menopause?

The prevalence of skin-related symptoms during perimenopause is both significant and measurable, yet rarely discussed in clinical settings. Large-scale studies indicate that dermatological changes affect the majority of women during perimenopause, with 64% reporting at least one significant skin symptom and itching ranking among the top five most frequent complaints (3).

What makes this particularly challenging is that itchy skin in perimenopause often gets misattributed to allergies, stress, or aging rather than hormonal changes. The medical literature confirms that pruritus without visible skin lesions - meaning itching without rash - is a recognized menopausal symptom that can affect any part of the body, but commonly impacts the face, neck, chest, back, and limbs (4). By identifying these symptoms as hormone-related rather than random skin issues, targeted interventions that address the root cause rather than just treating surface symptoms can potentially be used.

How do hormone changes in perimenopause cause itchiness and skin changes?

The mechanisms driving perimenopausal skin changes reveal a direct relationship between declining hormone levels and skin function. During early perimenopause, fluctuating estrogen levels can trigger the first noticeable changes - increased dryness, occasional itching, or changes in skin sensitivity. As the transition progresses, research demonstrates that these symptoms intensify, with the most significant changes occurring in the late perimenopausal and early postmenopausal periods (5).

The science is clear and quantifiable. Estrogen receptors are present throughout the skin, including in keratinocytes, fibroblasts, blood vessels, and hair follicles - meaning estrogen directly influences virtually every aspect of skin health (6). When estrogen levels decline, multiple measurable changes occur: collagen production decreases by approximately 2% per year in the first five years post-menopause, skin thickness reduces by 1.1% annually, and sebum production drops by up to 35% (7). These aren't just numbers - they translate directly into the symptoms women experience.

Declining estrogen impacts the skin barrier function, reducing its ability to retain moisture. Studies have shown skin water loss increases by 10-15% during menopause (8). This compromised barrier function triggers inflammatory responses that manifest as itching, even without visible irritation. Hormonal shifts also affect skin pH, microbiome composition, and immune responses. Research indicates that skin pH increases from an average of 5.5 to 6.0 during menopause, creating an environment more prone to irritation and bacterial imbalance (9).

The relationship between other vasomotor symptoms, such as hot flashes and night sweats, reveals another layer of complexity. Research shows that women experiencing those symptoms report significantly higher rates of skin complaints, with studies showing a clear correlation between hot flash frequency and dermatological symptoms (10). The mechanism is multifaceted: each hot flash triggers rapid vasodilation followed by sweating and evaporative cooling, a cycle that strips natural oils and disrupts the skin's protective barrier. Night sweats compound this effect. Studies indicate that evening itchiness is a common complaint during menopause, with worsening symptoms correlating with night sweat episodes (11). The heat itself lowers the itch threshold, while the subsequent rapid cooling and salt residue from dried sweat create an environment primed for irritation (12). This creates a trackable sequence: hot flash onset, peak sweating, rapid cooling, and increased itching within 30-60 minutes. Understanding this connection transforms seemingly separate symptoms into an interconnected pattern, enabling targeted interventions that address both the vasomotor and dermatological aspects at the same time.

Understanding these mechanisms as measurable, hormone-driven changes rather than random skin problems enables a data-first approach to treatment. With proper tracking of symptoms alongside hormone levels, we can identify individual patterns, predict progression, and implement targeted interventions ranging from hormone support to specific skincare ingredients that address the underlying biological changes.

Tracking your symptoms and hormones with Play Health can help you make sense of the symptoms you’re experiencing during perimenopause.

• References

  1. Lephart ED. A review of the role of estrogen in dermal aging and facial attractiveness in women. J Cosmet Dermatol. 2018;17(3):282-288. doi:10.1111/jocd.12508. PMCID: PMC6047276

  2. Szepietowski JC, Reich A. Pruritus in the menopause: A frequent problem rarely treated. Prz Menopauzalny. 2021;20(4):174-177. doi:10.5114/pm.2021.110953. PMCID: PMC8764960

  3. Monteleone P, Mascagni G, Giannini A, Genazzani AR, Simoncini T. Symptoms of menopause - global prevalence, physiology and implications. Nat Rev Endocrinol. 2018;14(4):199-215. doi:10.1038/nrendo.2017.180

  4. Reich A, Ständer S, Szepietowski JC. Pruritus in the elderly. Clin Dermatol. 2011;29(1):15-23. doi:10.1016/j.clindermatol.2010.07.002

  5. Zouboulis CC, Blume-Peytavi U, Kosmadaki M, et al. Skin, hair and beyond: the impact of menopause. Climacteric. 2022;25(5):434-442. doi:10.1080/13697137.2022.2050206

  6. Thornton MJ. Estrogens and aging skin. Dermatoendocrinol. 2013;5(2):264-270. doi:10.4161/derm.23872. PMCID: PMC3772914

  7. Rzepecki AK, Murase JE, Juran R, Fabi SG, McLellan BN. Estrogen-deficient skin: The role of topical therapy. Int J Womens Dermatol. 2019;5(2):85-90. doi:10.1016/j.ijwd.2019.01.001. PMCID: PMC6451761

  8. Luebberding S, Krueger N, Kerscher M. Age-related changes in skin barrier function - quantitative evaluation of 150 female subjects. Int J Cosmet Sci. 2013;35(2):183-190. doi:10.1111/ics.12024

  9. Man MQ, Xin SJ, Song SP, et al. Variation of skin surface pH, sebum content and stratum corneum hydration with age and gender in a large Chinese population. Skin Pharmacol Physiol. 2009;22(4):190-199. doi:10.1159/000231524. PMCID: PMC2836847

  10. Kronenberg F. Hot flashes: Epidemiology and physiology. Ann N Y Acad Sci. 1990;592:52-86. doi:10.1111/j.1749-6632.1990.tb30316.x

  11. Palacios S, Henderson VW, Siseles N, Tan D, Villaseca P. Age of menopause and impact of climacteric symptoms by geographical region. Climacteric. 2010;13(5):419-428. doi:10.3109/13697137.2010.507886