How Hormonal Changes Affect Skin and Treatment Planning

The Hormonal Influence on Skin

Hormones are among the most powerful regulators of skin health and appearance. Throughout life, fluctuations in key hormones — including oestrogen, progesterone, testosterone, cortisol, and thyroid hormones — directly influence skin thickness, oil production, hydration, elasticity, pigmentation, and healing capacity. For aesthetic practitioners and patients alike, understanding these hormonal influences is essential for optimising treatment timing, selection, and outcomes.

Key Hormones and Their Skin Effects

Oestrogen

Oestrogen is arguably the most important hormone for skin health. It influences:

• Collagen production: Oestrogen stimulates fibroblast activity and collagen synthesis. When oestrogen levels are high, skin is thicker, firmer, and more resilient
• Hydration: Oestrogen increases hyaluronic acid and glycosaminoglycan production, improving skin moisture retention
• Wound healing: Higher oestrogen levels correlate with faster, more efficient wound healing
• Elasticity: Oestrogen supports elastin fibre production and maintenance
• Sebum regulation: Oestrogen counterbalances testosterone’s stimulatory effect on sebaceous glands

Progesterone

• Sebum production: Progesterone increases sebaceous gland activity, which is why many women experience oilier skin and breakouts in the luteal phase of their menstrual cycle
• Water retention: Can cause facial puffiness and temporary swelling
• Inflammation: Higher progesterone levels may increase skin sensitivity and inflammatory responses

Testosterone and Androgens

• Sebum production: Androgens are the primary drivers of oil production, explaining why acne is often androgen-mediated
• Hair growth: Androgens stimulate facial hair growth while potentially contributing to scalp hair thinning
• Skin thickness: Testosterone contributes to thicker skin in men compared to women
• Collagen density: Men have approximately 20-25% more collagen than women, partly due to testosterone’s influence

Cortisol

• Collagen breakdown: Chronic elevated cortisol accelerates collagen degradation and inhibits new collagen synthesis
• Impaired healing: High cortisol levels slow wound healing and tissue repair
• Skin thinning: Prolonged cortisol elevation leads to skin atrophy
• Increased oil production: Stress-related cortisol spikes can trigger acne breakouts

Thyroid Hormones

• Hypothyroidism: Causes dry, coarse skin; hair thinning; slow wound healing; facial puffiness
• Hyperthyroidism: May cause warm, flushed skin; increased sweating; fine hair texture

Hormonal Life Stages and Treatment Implications

Puberty and Adolescence

The surge in androgens during puberty triggers increased sebum production and acne. Treatment considerations:

• LED blue light therapy and salicylic acid peels are safe and effective for adolescent acne
• Aesthetic injectable treatments are generally not recommended for patients under 18
• Focus on establishing good skincare habits: cleansing, SPF, and appropriate active ingredients

The Menstrual Cycle

Monthly hormonal fluctuations affect skin in predictable ways:

• Days 1-5 (Menstruation): Oestrogen and progesterone are at their lowest. Skin may be drier, more sensitive, and prone to irritation. Avoid aggressive treatments during this phase
• Days 6-14 (Follicular phase): Rising oestrogen improves skin quality, hydration, and healing capacity. This is the optimal window for aesthetic treatments — skin heals well and is less prone to adverse reactions
• Days 15-20 (Ovulation/early luteal): Oestrogen peaks around ovulation. Skin looks its best — glowing, hydrated, and plump. Good timing for treatments if the follicular phase is missed
• Days 21-28 (Late luteal phase): Progesterone dominates. Increased oil production, potential breakouts, water retention, and heightened sensitivity. Avoid elective procedures if possible. Bruising may be more likely during menstruation and the late luteal phase

Pregnancy

Pregnancy brings dramatic hormonal changes with significant skin implications:

• Melasma: Pregnancy hormones can trigger significant facial hyperpigmentation (the “mask of pregnancy”), affecting up to 70% of pregnant women
• Increased skin sensitivity: Heightened immune responses make skin more reactive
• Treatment restrictions: Most aesthetic procedures are contraindicated during pregnancy, including botulinum toxin, dermal fillers, retinoids, chemical peels (beyond very superficial), laser treatments, and microneedling
• Safe options: Gentle facials, LED therapy (with caution), pregnancy-safe skincare (SPF, vitamin C, azelaic acid, niacinamide)

Postpartum and Breastfeeding

• Hormonal shifts can trigger telogen effluvium (hair shedding) 2-4 months after delivery
• Most injectable treatments remain contraindicated during breastfeeding as a precautionary measure
• Skin concerns such as melasma may persist or worsen; treatment can begin after breastfeeding ceases
• Many patients find this an opportune time to establish a treatment plan for post-breastfeeding

Perimenopause and Menopause

The decline in oestrogen during perimenopause and menopause is the most significant hormonal shift for skin ageing:

• Collagen loss: Up to 30% of collagen is lost in the first five years after menopause, with a continued decline of 2% per year thereafter
• Skin thinning: Progressive loss of dermal thickness
• Dryness: Reduced hyaluronic acid and sebum production
• Elasticity loss: Accelerated degradation of elastin fibres
• Treatment implications: This is often when patients benefit most from collagen-stimulating treatments (Profhilo, polynucleotides, microneedling, RF treatments), bio-remodelling, and skin quality treatments. Treatments may need to be more frequent or intensive to compensate for reduced natural collagen production

Hormone-Informed Treatment Planning

Timing Treatments with the Menstrual Cycle

While not always practical, scheduling treatments during the follicular phase (days 6-14) may optimise outcomes by:

• Taking advantage of better wound healing capacity
• Reducing the risk of post-inflammatory hyperpigmentation
• Minimising sensitivity and discomfort during procedures
• Potentially reducing bruising risk

Addressing Hormonal Skin Conditions

Effective aesthetic treatment planning should consider hormonal factors:

• Hormonal acne: Address the hormonal component (potentially with medical management) alongside aesthetic treatments for best results
• Melasma: Sun protection is critical; treatment should account for ongoing hormonal triggers (contraceptive pill, HRT)
• Menopausal skin changes: Consider whether HRT might complement aesthetic treatments in managing skin ageing

Communicating with Your Practitioner

Sharing relevant hormonal information with your practitioner helps optimise your treatment plan:

• Menstrual cycle status and regularity
• Use of hormonal contraception
• Pregnancy or breastfeeding status
• Menopausal status and any HRT use
• Known hormonal conditions (PCOS, thyroid disorders)
• Current stress levels and sleep quality

Frequently Asked Questions

Should I avoid Botox during my period?

Botox is not contraindicated during menstruation, but you may experience slightly more bruising and sensitivity during this time. If you have the flexibility, scheduling treatment during the follicular phase may be slightly more comfortable.

Can HRT improve my skin enough to avoid aesthetic treatments?

HRT can significantly improve menopausal skin by partially restoring collagen production and hydration. However, most patients find that HRT alone does not fully address visible signs of ageing, and aesthetic treatments remain beneficial as complementary interventions.

Why does my skin break out before my period?

Pre-menstrual breakouts are caused by the progesterone surge in the luteal phase, which increases sebum production and creates an environment conducive to blocked pores and bacterial growth. This is a normal hormonal pattern experienced by up to 65% of women.

Can stress hormones affect my aesthetic treatment results?

Yes. Chronically elevated cortisol impairs wound healing and collagen production, potentially reducing the effectiveness of collagen-stimulating treatments. Managing stress through lifestyle measures supports better treatment outcomes. This is yet another reason why holistic wellbeing should be part of any aesthetic treatment plan.