33: Midlife Skincare with Dr. Sarah Stierman
Ep. 33
If your skin suddenly feels drier, more sensitive, or just “not like it used to be,” you’re not imagining it. Perimenopause and menopause are a full-body hormonal shift—and your skin is absolutely part of that story.
In this episode of Reset Recharge, I’m joined by Dr. Sarah Stierman, a board-certified dermatologist and dermatopathologist, to break down what actually works for midlife skin, what’s overhyped, and where hormones and skincare meaningfully intersect.
As always, this blog and podcast are for informational and educational purposes only and are not a substitute for personalized medical advice. Please talk to your own healthcare provider before starting or changing medications, hormones, or supplements.
Listen to the full episode:
By Dr. Komal Patil-Sisodia | Reset Recharge Podcast | November 10, 2025
How Perimenopause & Menopause Change Your Skin
One of the most common complaints I hear in clinic is:
“My skin feels drier, less bouncy, and it just doesn’t glow the way it used to.”
Here’s why.
Estrogen’s Role in Skin Health
Estrogen is a quiet hero for skin. It supports:
Collagen and elastin (firmness and elasticity)
Barrier function (the “brick-and-mortar” wall that keeps moisture in and irritants out)
Hydration and glow
As estrogen levels fall in perimenopause, menopause, and postmenopause, you may notice:
Increased dryness
New or worsening sensitivity (“I never had sensitive skin before!”)
Thinning skin and more visible fine lines
More wrinkles and crepey texture, especially on the face, neck, chest, and hands
And then there’s the sun.
UV Exposure + Hormonal Changes = Fast-Tracked Aging
By our 40s and 50s, most of us have decades of cumulative UV exposure—plus many of us grew up in the era of tanning beds and “base tans.”
A key reminder from Dr. Stierman:
There is no such thing as a “healthy tan.”
A tan is a visible sign of DNA damage.
When you combine falling estrogen with years of UV damage, you get:
Hyperpigmentation and sunspots
Fine lines and deep wrinkles
Texture changes and loss of elasticity
Short of a time machine, we can’t undo the past—but we can change what we do from here.
The Non-Negotiables: SPF and Retinoids
If you want an evidence-based, anti-aging skincare routine in perimenopause and menopause, Dr. Stierman is clear:
Sunscreen and a retinoid are non-negotiable.
Think of them as the foundation of everything else.
Daily Sunscreen (SPF) – Your #1 Anti-Aging Product
The American Academy of Dermatology recommends broad-spectrum SPF 30 or higher every single day. SPF 15 is no longer considered enough for daily protection; SPF 30 and SPF 50 both have clinically meaningful additional benefit.
Key points:
SPF 30 or higher every day, rain or shine
Reapply every 2 hours if you’re outdoors or near windows
If your shadow is shorter than you are, you’re in peak sun hours and should seek shade
Face, neck, chest, and hands should all be protected—these are your “giveaway” areas that age fastest
If you’re using Botox, fillers, or laser treatments but skipping sunscreen, you’re essentially paying for results you’re not protecting.
Retinoids – Waking Up Your “Lazy” Collagen Factories
Around age 26, your fibroblasts—the collagen-producing “factory cells” in your skin—start to get a little lazy. Retinoids are how we wake them back up.
What Are Retinoids?
Tretinoin (prescription) is the gold standard topical retinoid for:
Wrinkles (what dermatologists call “rhytides”)
Texture
Collagen production
Acne
Over-the-counter options include:
Retinol
Retinal (retinaldehyde) – closer in potency to prescription tretinoin and often better tolerated
“Retinoid alternatives” that mimic some mechanisms with less irritation
Retinoids:
Increase cell turnover
Stimulate collagen production
Improve texture, fine lines, and pigmentation over time
How to Use a Retinoid Without Destroying Your Skin Barrier
Retinoids are powerful—and they can be irritating at first. Here’s Dr. Stierman’s dermatologist-approved approach:
Evening only.
Retinoids can make your skin more photosensitive and many are not photostable in sunlight.Gentle cleanser first.
Use a soap-free, gentle cleanser (no harsh scrubs, no body soap).Apply to dry skin.
Wait until your face is completely dry. Applying actives on wet skin can dramatically increase irritation.Use a pea-sized amount.
One pea-sized amount for the whole face
Dot (“polka dot”) it across your forehead, cheeks, and chin
Avoid the immediate eye area, corners of nose, and edges of lips
Moisturizer is your friend.
Moisturizer after your retinoid helps support the barrier
For irritation-prone spots (outer eye corners, around nostrils, lips), you can apply a thicker ointment like petrolatum before the retinoid to protect those areas.
The “Retinoid Sandwich” Method
If you’re sensitive, try this:
Moisturizer
Retinoid (pea-sized, dotted on the face)
Moisturizer again
You’ll still get benefit, but with less irritation.
How Often Should You Use a Retinoid?
This is crucial:
3 nights per week is the minimum for meaningful benefit.
Less than 3 times per week? You’re getting mostly side effects without results.
If you’re very sensitive, you can also try:
Short-contact therapy:
Apply retinoid after dinner
Leave it on for a short period
Wash it off and then repair with moisturizer before bed
Consistency over time matters more than being “perfect” every single night.
Supporting Your Skin Barrier: Cleansers, Moisturizers & Exfoliation
As estrogen drops, barrier function becomes a major player. Think of your skin as a brick wall:
Bricks = skin cells
Mortar = lipids (fats), especially ceramides
When the “mortar” is weak or missing, you get:
Dryness
Irritation
“Sensitive skin” that you may never have had before
Cleansing: Less Scrubbing, More Respect
What to avoid:
Harsh soaps (especially body soaps or bar soaps for the face)
Physical scrubs (think old-school apricot scrubs or rough exfoliators)
Over-washing
What to use:
Soap-free, gentle cleansers from brands like CeraVe, Cetaphil, La Roche-Posay, etc.
Hands or a very soft cloth (no old loofahs that harbor bacteria)
You do not need an expensive cleanser. Save your budget for leave-on products (retinoids, growth factors, antioxidants).
Do You Need a Toner?
Short answer: No.
Historically, toners existed to remove a waxy soap film left on skin from lye-based cleansers + hard water. Modern cleansers and treated water mean that function isn’t really needed.
If you truly enjoy the sensory experience of a toner, choose:
Alcohol-free
Gentle formulas (e.g., rose water)
But they’re absolutely optional, not a core part of a menopause skincare routine.
Growth Factors, Peptides & Exosomes: “Emails” to Your Fibroblasts
Once SPF and a retinoid are in place, the next upgrade—in Dr. Stierman’s view—is growth factors and peptides.
Growth factors: Signal from the surface of the skin down to the dermis to wake up fibroblasts and stimulate collagen.
Peptides: Think of them as tiny emails—small signaling molecules that nudge cells to behave more youthfully.
Exosomes: “Little FedEx trucks” carrying growth factors and peptides in a more comprehensive package, often derived from blood products and currently not regulated by the FDA.
These can:
Support collagen production
Improve texture and fine lines
Enhance the overall effect of your basic regimen
If you’re exploring exosomes, be especially cautious and work with a knowledgeable dermatologist; sourcing and regulation are still evolving.
Antioxidants: Vitamin C and Beyond
Most dermatologists would put antioxidants as the third pillar, usually in the morning routine.
Vitamin C is the star, but form matters:
L-ascorbic acid:
Classic form
Effective, but unstable and often irritating
Needs opaque packaging (think dark glass)
Tetrahexyldecyl ascorbate:
A more stable, lipid-soluble form of vitamin C
Better tolerated and photostable
Can be used any time of day
Other antioxidant ingredients Dr. Stierman likes:
Green tea – antioxidant and soothing, often great in calming products
Again, these are add-ons—not substitutes—for SPF and retinoids.
Supplements for Skin & Hair in Midlife: What’s Worth It?
The nutraceutical world is crowded. Let’s hit the big ones you hear about all the time.
Collagen Supplements: Hype or Helpful?
Hydrolyzed collagen powders release small collagen peptides in the gut, which can act as messenger molecules to stimulate fibroblasts in the skin.
Key points:
Look for collagen types that support skin and hair:
Type I (most abundant in body, important for skin, bones, teeth, hair, nails)
Type III (also relevant for skin)
Multi-collagen products may also support joint health.
Marine-based collagen may have a slight edge for skin, but both bovine and marine can be effective.
While many studies are subjective (self-reported), Dr. Stierman has seen enough benefit in her practice—and personally—that she considers collagen a reasonable “yes” for many women, assuming no contraindications.
Biotin: Why Many Doctors Are Moving Away From High Doses
Biotin is heavily marketed for “hair, skin, and nails”, but:
The original “evidence” comes from veterinary studies in horses (thicker hooves), not robust human trials.
High-dose biotin can interfere with lab assays, including:
Thyroid tests
Cardiac enzymes (e.g., troponins used to detect heart attacks)
This means your lab results can look falsely normal—or abnormal—even though your actual thyroid or heart function hasn’t changed.
Because of this, many clinicians (myself included) recommend:
Avoiding high-dose biotin supplements
Sticking to the small amount in a regular multivitamin or diet, unless your own specialist advises otherwise
If you’re already on high-dose biotin, be sure to tell your doctor before thyroid testing or any evaluation involving cardiac labs.
Hair Supplements: What to Look For
Hair nutraceuticals often target hormonal hair loss pathways, especially DHT (dihydrotestosterone), which can shrink hair follicles.
Key ingredients Dr. Stierman looks for:
Pumpkin seed oil
A phyto-sterol that can block DHT at the receptor level
Generally well tolerated
Vitamin D
Important for hair health overall
Saw palmetto
A 5-alpha reductase inhibitor (blocks conversion of testosterone to DHT)
Effective, but can interact with certain medications—always review with your clinician
Brands differ, and formulations change, so the key is to read the ingredient list and check for these core players, rather than chasing labels or pricey marketing.
Topical Estrogen for Skin: Promise and Caution
This is one of the most hotly requested topics in menopause skincare right now.
There are two main forms discussed for topical facial use:
Estradiol (E2) – the more potent estrogen
Estriol (E3) – a weaker estrogen with lower receptor affinity
What Topical Estrogen May Do for Skin
Estrogen in the skin can:
Improve barrier function
Increase collagen synthesis
Enhance thickness, elasticity, and hydration
Improve dullness and crepey texture, especially under the eyes
So why isn’t everyone on it?
Systemic Absorption & Safety Questions
Topical estradiol is known to be systemically absorbed—this is the same mechanism behind transdermal estrogen hormone therapy.
Potential concerns:
Clotting risk, especially in women with predispositions
Theoretical concerns regarding hormone-sensitive cancers (e.g., breast cancer), though definitive data for small localized facial doses are still limited
Estriol is:
Weaker pharmacologically
Thought to have less systemic uptake, especially when used on small areas
Still not fully studied head-to-head with estradiol for facial use
Current best data:
Strongest evidence is for under-eye application
Some data for neck, but not yet robust for large areas like full face, chest, or hands
Dr. Stierman’s own practice:
Uses compounded topical estriol under the eyes nightly
Uses it on the neck every other night
Is cautious about using it on large surface areas, especially while already on transdermal systemic estrogen in perimenopause
If You’re Considering Topical Estrogen
You must have a tailored conversation with your care team if you:
Have a history of breast cancer, blood clots, or clotting disorders
Are already on systemic hormone therapy
Have complex medical history or risk factors
Talk to:
Your OB/GYN
Your endocrinologist
Your oncologist if you have or had hormone-sensitive cancer
This is not a “TikTok trend” to DIY. It’s a medical decision, and your safety comes first.
Sample Skincare Routines for Midlife Women
You can adjust products based on your skin type and what you tolerate, but here’s a simple framework based on the conversation.
Morning (AM) Routine – Perimenopause/Menopause
Gentle, soap-free cleanser
(Optional) Vitamin C / antioxidant serum
Moisturizer supporting barrier (look for ceramides, glycerin, cholesterol)
Broad-spectrum SPF 30+ (face, neck, chest, backs of hands)
Optional: Tinted SPF or makeup
Night (PM) Routine – Perimenopause/Menopause
Double cleanse if wearing makeup:
Oil-based cleanser or micellar water
Then a gentle, soap-free cleanser
Growth factor / peptide serum (if using)
Retinoid (pea-sized amount, 3+ nights/week as tolerated)
Use “retinoid sandwich” or short-contact therapy if sensitive
Moisturizer to repair barrier
Targeted treatments:
Under-eye topical estriol (if prescribed and cleared by your doctors)
Spot treatments as directed by your dermatologist
When to See a Dermatologist or Specialist
Consider seeing a dermatologist if:
You have new or changing lesions, spots, or growths
Your skin suddenly becomes extremely irritated, red, or inflamed
You’re struggling with adult acne, rosacea, or severe dryness
You’re interested in prescription retinoids, topical estrogen, or advanced procedures
See an endocrinologist (like me!) or your primary care clinician if:
You’re noticing wider hormonal changes: hot flashes, irregular periods, weight changes, sleep disturbance, mood changes
You’re unsure whether hormone therapy or certain supplements are safe for you
You have thyroid concerns, PCOS, or complex metabolic issues alongside skin changes
Final Thoughts: You’re Not “High Maintenance”—You’re Changing
If you’re in your late 30s, 40s, or 50s and feeling confused about what’s happening to your skin, you’re not vain—and you’re not alone. Your hormones, your collagen, your barrier, and your sun history are all converging.
The good news?
There are science-backed tools that work.
You don’t need a 13-step routine to see results.
Small, consistent steps with the right ingredients can make a big difference.
On Reset Recharge, my goal is to give you information you can use to have better, more confident conversations with your own healthcare team.
Listen to the Full Conversation
To hear the full, nuanced discussion with Dr. Sarah Stierman—including product families she likes, personal routines, and more hair-supplement talk—tune in to this episode of the Reset Recharge Podcast wherever you listen to podcasts.
And if something we discussed today resonates with your own skin or health journey, bring it to your next visit with your healthcare provider and ask:
“Given my history, what version of this makes sense for me?”
That’s how you reset, recharge, and take control of your health—one informed decision at a time. 💛
Disclaimer
This content is for educational purposes only and should not replace medical advice. Always consult your healthcare provider before making decisions regarding screening, testing, or treatment.