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Image of a woman holding a flower representing perimenopause

The perimenopause – how should my treatments change?

Written by
Chloë James

It’s not unusual and it’s not new, yet the conversation around the perimenopause seems to only just be getting started. Defined as the years leading up to menopause, for a long time it was a source of embarrassment for some and a total mystery to others. But more and more women are talking about how their bodies evolve as they age – and just as many are keen to prepare for these inevitable changes.

What makes it tricky is that it’s different for everyone. There’s no fixed starting point (although most women start in their 40s) and it can last for anywhere between six months and ten years. The only real consistency is that it’s marked by the ovaries producing less oestrogen. When they stop releasing eggs altogether – and 12 months pass without a period – it’s official: you’ve reached the menopause. But what happens in the meantime? And how can you ride out the hormonal changes while still feeling like you?

Find a clinic or practitioner near you and enjoy a risk-free booking process thanks to free in-clinic consultations and the option to pay in-clinic. Also, you can now split the cost of your treatment into four equal, interest-free instalments using Tabby.

What happens during perimenopause?

If menopause is the destination, the perimenopause is the hormonal rollercoaster that gets you there. Oestrogen drops, but irregularly. The erratic changes throw progesterone and androgens off balance, and it takes your body a while to get to grips with its new chemistry.

As it’s responsible for increasing your body’s collagen content, less oestrogen means less collagen. We start losing one per cent of our collagen annually from the age of 25, but the perimenopause speeds up the process. By the time it’s over, around 30 per cent of our supplies are gone for good.

How does this impact our body?

The first signs of the perimenopause aren’t always obvious. In some ways it’s like puberty. Menstrual cycles might get longer, shorter, or more or less frequent, and mood swings or irritability are also common. As for the visible changes, these are often gradual and vary across your body.


Our skin has an annoying habit of acting as a window into the current state of our hormones. During the perimenopause, it tends to lose both volume and elasticity. Looser and laxer than before, it becomes more prone to wrinkles and fine lines. Most obviously affected areas usually include the cheeks, jaw, décolletage, and hands.

Oil production and water retention is hugely impacted by the decrease in collagen. If you’re going to change skin types at any stage of your life, it’ll most likely be now when skin starts to feel drier. At the same time, you might find yourself sweating more, with your upset hormones affecting other hormones in charge of regulating your body temperature.

You may also see an increase in pigmentation – whether that’s freckles, dark spots, or dark patches of skin called melasma. And just like in puberty, this hormonal upheaval can also trigger acne breakouts.


Over the course of the perimenopause, the drop in progesterone changes the shape, position, and feel of our breasts. They become less hydrated and less firm and look like they’re sitting lower than they once did. With reduced collagen and elastin, the skin may also feel crepey.


A combination of confused hormones and increased insulin resistance make it easier to gain weight during the perimenopause. Your body starts storing fat differently and usually concentrates it around the stomach and waist, making the latter look less defined. Some people call this the ‘middle-age spread’.


Again, you can blame the dip in collagen and elastin for how the vagina changes as you leave your reproductive years. It loses both muscle tone and mass, it may feel thinner, drier, and less elastic, and the vulva can look crepey.

What treatments can help?

There’s a lot more to the perimenopause than how it impacts your appearance – and there’s a lot more to managing symptoms than treatments alone.

Small tweaks to your lifestyle can make a big difference. Incorporating more foods high in phytoestrogens into your diet – such as soy, wheat, and lentils – has been shown to mimic the effects of oestrogen, softening the blow of its plummeting natural production. Even just 30 minutes of gentle aerobic activity such as walking, cycling, or swimming can help with both the physical and emotional impact of the perimenopause.

And as your skin changes, be sure to adapt your skincare routine with it, embracing gentle, soothing moisturisers or serums containing humectants, antioxidants, or peptides to lock in water and keep skin calm.

However, if they can help you feel your best at a time of so much change, there’s no shame in also undergoing treatments too.


The VIP of treatments for signs of aging is, of course, Botox. By weakening the muscles that pull with each movement to create dynamic wrinkles, it can help smooth out the area into which it’s injected. It can also help any perimenopausal hot flashes by reducing how much your body sweats.

Browse clinics offering Botox.

LED light therapy

Depending on the colour involved, LED light therapy can provide a whole range of solutions for your skin – ideal during the perimenopause, when so many different concerns are involved. Blue kills the bacteria feeding acne, while red can boost collagen. Some studies suggest the latter may also help with any menopausal sleep issues.


Laser is beauty’s master of all trades, with the ability to fade hyperpigmentation, smooth fine lines and wrinkles, and encourage new collagen production. Creating micro-injuries to trigger the skin’s healing response, it’s most commonly used on the face but has uses all over the body. This includes the vagina, where it can strengthen and tighten the tissue.


The collagen-induced thinning of skin in your perimenopausal years can affect everything from your lips to your hands. Injected into the areas of concern, fillers can help restore some of this lost volume. As most formulas contain hyaluronic acid, they can also act as a magnet for water in the skin to prevent additional water loss.

Browse clinics offering fillers.


Packed with the highest concentration of hyaluronic acid you’ll find in a treatment, think of Profhilo as an injectable moisturiser. It’s not as thick as filler, so it can spread more freely and hydrate the entire face, not just one area.

Browse clinics offering Profhilo.


If you want to tackle dryness and a lack of elasticity, the nutrient-rich injections of mesotherapy can top up your depleted vitamins and minerals. Skin is left stronger and more hydrated – as well as more resistant to fine lines or wrinkles. It can also be used to break down small pockets of stubborn fat.

Browse clinics offering mesotherapy.


Cavitation – or, to call it by its full name, ultrasonic cavitation – is designed to break down excess fat from specific areas of the body with ultrasound waves. This turns the fat cells to liquid, which is naturally removed from the body within 12 weeks.

Serve yourself

With more people opening up about getting treatments, and the conversation around perimenopause becoming more mainstream, there is little shame in admitting that, along with the hot flashes or mood swings, how a woman feels about their appearance during this time is valid and important. Do what feels right for you and the process will feel a lot more manageable.

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