A Dermatologist’s Guide to Perimenopause

For many women, the signs of perimenopause arrive like a whisper—slight fatigue, some stubborn weight gain, changes in mood or hair—but too often, they’re brushed aside. Then, one day, they walk into my office feeling like a stranger to themselves.

After 35 years in dermatology, I can tell you this: what we see on the outside—hair thinning, tired, dull, and crepey skin, osteoporosis that affects bone infrastructure—is often a reflection of internal imbalances, most of which begin long before menopause officially sets in.

That’s why we need to educate and empower women to recognize the early shifts in their bodies and take a proactive, whole-body approach to support themselves—not just cosmetically, but hormonally, emotionally, and physically.

Perimenopause doesn’t have a clean beginning or a tidy end. It can span years, with hormone levels sputtering like a car running out of gas. Estrogen, progesterone, and testosterone can fluctuate wildly, impacting everything from sleep and mood to skin elasticity, metabolism, and—very noticeably—hair growth.

When I compare notes with anti-aging physicians, we see a consistent theme: women in their 40s and early 50s presenting with fatigue, brain fog, low libido, muscle loss, poor sleep, hot flashes, urinary issues, cardiac issues, and anxiety. Often, they’ve been given piecemeal treatments—antidepressants, sleeping pills, or vaginal moisturizers—but rarely has anyone looked at the full picture. And hardly anyone checks their hormones.

Women are often dismissed or handed “quick fixes” that don’t address the root causes of their concerns. It’s time to stop that. Perimenopause can and should be a time of powerful renewal when approached proactively.

So, if you’re in your 30s or 40s and starting to notice changes—even subtle ones—it’s not too early to act. With my patients, I begin by running the right labs. Having a clear understanding of your hormone levels gives us a roadmap—so beginning with a thorough round of testing is essential. If your provider isn’t used to ordering certain tests, advocate for yourself or seek out a hormone specialist.

The next step I recommend is adopting a nourishing, whole-body supportive diet. The right nutrition can make a noticeable difference—especially when it comes to your hair and skin. In our practice, we focus on whole, organic foods like lean protein, colorful vegetables, and healthy fats, while cutting out common triggers such as dairy, soy, peanuts, gluten, and alcohol. Minimizing sugar and processed foods is also key to supporting hormone balance. Most patients also begin a foundational supplement routine that includes vitamin C, vitamin D, omega-3s, and a high-quality skin, hair, and nail formula.

In-office tools like lasers, PRP, and filler can be helpful to treat the visible signs of aging—but no amount of Botox or sculpting will restore a woman’s vibrancy if she’s exhausted and hormonally depleted. That’s why our approach blends cosmetic dermatology with lifestyle coaching and referrals to other experts.

When women walk into my office, I want them to know they are not alone, they are not broken, and they are not “just aging.” They’re entering a new phase that deserves education and support.

It starts with awareness. It continues with action. And it ends with women feeling strong, seen, and beautifully themselves again.

Don’t wait for a crisis.  If you’re noticing changes in mood, energy, sleep, or hair, check in early.

Check your labs—not just your feelings. A full hormone and metabolic panel provides essential data.

Treat stress like a vital sign. Elevated cortisol can disrupt sleep, mood, and hair health. Try walking, breathwork, or meditation.

Don’t treat symptoms in isolation. Perimenopause isn’t just one issue after another. It’s a whole-body shift that deserves whole-person care.

Let go of the guilt. You’re not overreacting. Prioritizing your health isn’t selfish — it’s essential.

Dr. Jody Comstock is the founder of Skin Spectrum and Associate Clinical Professor of Dermatology at the University of Arizona. With 35 years of experience, she is recognized for her integrative, whole-body approach, which combines dermatologic care with nutrition, hormone balance, and lifestyle medicine to help women feel strong, supported, and seen. She is a Nutrafol Partner who was compensated for sharing her expertise and experience.