Skin & Hair in Midlife: Your Practical Guide

Perhaps you know this moment in front of the mirror: You actually feel full of energy, yet your face suddenly looks tired. Your skin feels tight even though you just applied cream. Fine lines seem to have deepened overnight, and your hair, once easy to manage, suddenly feels dry, much thinner, or brittle.

If these changes irritate you, take a deep breath: It is not a sign of neglect, and you are not doing anything wrong. It is biology. During menopause, the rules of your body change – and that is why your care routine may change as well. To truly make your skin and hair glow in this phase of life, your old moisturizer is no longer enough. We need to look deeper.

Before we move on to solutions, it is important to understand why what worked at 30 is no longer sufficient today. Your body is undergoing a hormonal restructuring that directly affects your outer appearance.

Estrogen is your most important hormone for plump skin. It stimulates the production of collagen and hyaluronic acid and ensures that moisture is bound in the cells. As estrogen levels decline, the skin loses up to 30% of its collagen within the first five years after menopause. The result: Cell regeneration slows down, the skin becomes measurably thinner, more sensitive, and loses elasticity. The natural protective barrier – your acid mantle – also weakens, which is why moisture evaporates more quickly and pollutants can penetrate more easily.

Not only the density but also the structure changes; hair often becomes frizzy, dull, or unruly. As estrogen declines, the body’s own male hormones (androgens) become relatively more dominant. This can weaken the hair root and shorten the lifespan of each individual hair. In addition, the sebaceous glands on the scalp now produce fewer oils – the natural “conditioner” that once kept your hair supple is missing. The hair’s cuticle layer becomes roughened.

Changes do not only occur on the surface. To counteract them meaningfully, one must understand the three-dimensional nature of the face. When women say they suddenly look “tired” or “sunken,” it is usually due to the following factors:

• Bone Loss: Your facial bones begin to recede by your mid-40s at the latest. Similar to the onset of osteoporosis, the body loses bone mass. The bony eye sockets widen, and the jawline measurably loses height and width. The internal framework for your skin provides less support.

• Loss of Fat Compartments: The face has around 11 separate fat pads that create a soft, plump appearance. With declining hormones and chronic stress (cortisol has a fat-reducing effect above the neck!), these pads atrophy (shrink). As volume is lost, the skin begins to “sag.” The internal retaining ligaments become visible as deep grooves (e.g., under the eyes or as nasolabial folds).

The Gender Gap: While male skin and bones age relatively linearly, women often experience rapid breakdown in the lower half of the face after 50. Hormone replacement therapy (HRT) can not only relieve hot flashes but also significantly slow bone and structural loss in the face. Since your foundation has changed, we now need routines that actively force your cells to work.

Forget overly complicated routines. Science shows that you only need a few highly effective steps.

• Gentle Cleansing: For mature, dry skin in the morning, less is more! Lukewarm water is usually sufficient, as care products have been absorbed overnight. A cleanser in the morning would often destroy the carefully rebuilt barrier. Exception: If your skin is still sticky from evening “slugging” (rich care) or if you want to wash off active retinoid residues. In that case, use only mild, glycerin-based cleansers that do not foam.

• Antioxidants (Vitamin C): Apply a high-quality vitamin C serum (ideally L-ascorbic acid). It protects against free radicals, promotes collagen synthesis, and regulates pigmentation disorders. CAUTION: If you have sensitive skin, acclimate slowly and start with lower percentages to avoid irritation.

• Mineral Sunscreen (SPF 30–50+): Your most important anti-aging step. UV radiation destroys collagen faster than anything else. Prefer mineral filters (zinc oxide/titanium dioxide). Chemical filters are sometimes suspected of having hormonal effects, although this has not been conclusively proven in the EU. Modern mineral filters are now easy to apply and no longer leave a white cast.

• Double Cleansing: To remove daytime care, sunscreen, and makeup without harsh rubbing.

  • Step 1 (Oil-Based): A fragrance-free cleansing oil or balm melts away dirt and sunscreen like a magnet.

  • Step 2 (Water-Based): Follow with a mild, glycerin-based cleanser. Aggressive soaps destroy important barrier lipids and the skin microbiome (“bouncer bacteria”).

• Retinoids (Vitamin A): The undisputed gold standard. They stimulate collagen production and force the skin to shed old cells. Use one fingertip unit for the entire face – including the skin under the eyes!

Deep Dive Retinoids: The Right Choice

1. Tretinoin (retinoic acid): The gold standard for maximum effectiveness, but prescription-only. Usually starting at 0.025%.

2. Retinaldehyde: The best over-the-counter alternative. It requires only one conversion step to the active acid and is very effective with good tolerability (ideally start at 0.05%).

3. Retinol & Adapalene: For beginners or sensitive skin. Retinol (approx. 0.25%) is milder because it requires several conversion steps. Adapalene is considered particularly low-irritation.

4. Not recommended: Pure retinyl esters (e.g., retinyl palmitate), as they are usually too weak against photoaging.

Application & Combination

• Combinations: Hyaluronic acid plumps and reduces dryness from retinol. Niacinamide soothes the skin barrier. Vitamin C should be used at a different time (vitamin C in the morning, retinol in the evening).

• Rules: “Start low, go slow.” Begin with 1–3 applications per week.

• The Sandwich Method: Ideal for beginners to minimize irritation: Cleanse → thin layer of moisturizer → retinoid → second layer of moisturizer.

• Moisture & Hormones: Use occlusive care with ceramides or shea butter. Optionally, after medical consultation, a local estriol cream may be applied to directly promote skin thickness on site.

Hair loss or structural hair changes are often warning signals of perimenopause. Since the root is one of the most metabolically active tissues, it needs support from inside and outside.

• Minoxidil (5%): Considered highly effective for improving circulation and extending the growth phase. An initial “shedding effect” (temporary increased loss) is normal – new hair becomes visible after about four months.

• 🚨 Important Note for Pet Owners: Minoxidil is highly toxic to cats and dogs. Use it in a separate room, wash your hands thoroughly, let it dry for 2 hours, and do not let your pet lick your hair or sleep in your bed.

• Hormonal Balance & Building Blocks: Progesterone protects the follicle from inflammatory stress. In addition, the root needs iron, zinc, selenium, and amino acids (L-methionine, L-cysteine). L-arginine promotes microcirculation.

Burning eyes during menopause are often due to androgen deficiency (testosterone). The Meibomian glands on the eyelid need testosterone to produce the oily protective layer of the tear film. Without it, the water evaporates immediately.

• Natural Remedies: Euphrasia (eyebright) as drops (external) or globules (internal).

• Schüßler Salts: No. 8 (sodium chloride D6) as a basic remedy for dryness and No. 4 (potassium chloride D6) for inflammatory sensations or a “gritty” feeling.

Sudden deep, painful nodules (often on the chin) are usually hormonally triggered. Since scarring is a risk, creams are often not sufficient. Isotretinoin (oral retinoid) or photodynamic therapy are the treatments of choice.

An inflamed gut is reflected in the face. When the microbiome is out of balance, redness or couperose develops.

• Solution: Heal the skin from within with soluble fiber (acacia fiber) and fermented foods (sauerkraut, kimchi). Locally, ivermectin creams or vascular laser treatment at the dermatologist can help.

• Resurfacing: Non-ablative (e.g., IPL) stimulates collagen without downtime. Ablative (e.g., CO2 laser or TCA peels) removes the surface and offers dramatic improvements for deep wrinkles (7–10 days recovery time).

• Volume Restoration (Autologous Fat): An autologous fat transfer (autograft) is often more sustainable than hyaluronic acid fillers. “Nano-fat” from the flanks in particular is rich in stem cells and permanently rejuvenates skin quality.

Take this list to your next doctor’s appointment to achieve not just the “normal” range, but the optimum: