Your Hormones Might Be the Reason Your Aesthetic Treatments Aren't Working So Well.

The aesthetics industry has come a long way in the last decade. There’s an array of complexion-enhancing injectables, a host of smarter and more inclusive devices, and many are a lot safer, too. But there’s a growing body of evidence suggesting that hormonal changes—specifically during perimenopause—may be one of the most significant and least-discussed drivers of how skin ages and how well it responds to treatment.

For those of us in our 30s and 40s who’re noticing our Botox is wearing off faster than it used to, our filler isn’t sitting quite right, or our skin is reacting to treatments it used to tolerate well—it’s probably not the treatment failing. It’s our hormones. And according to Dr Mayoni Gooneratne, integrative aesthetics specialist and founder of Skin Fit, the aesthetic industry has yet to catch up.

Perimenopause, explained

Before you reach menopause (which is the day you’ve gone 12 consecutive months without a period), you have to contend with perimenopause. It’s a long and often arduous transitional phase that can last anywhere from two to eight years, typically starting in a woman’s early-to-mid 40s, though it can begin as early as the mid-30s.

“Progesterone declines due to less frequent and less robust ovulation as our egg supply decreases. While oestrogen levels fluctuate wildly, sometimes spiking to higher levels than ever before, creating a hormonal rollercoaster effect. These more dramatic fluctuations, rather than simple declines, are what trigger many perimenopausal symptoms,” explains Gooneratne. Those symptoms include the ones we commonly associate with ‘the change’ —think mood swings, hot flashes, and night sweats —as well as many we don’t realise are hormone-related—like major changes in how we look.

How perimenopause affects your skin

Oestrogen is one of our skin’s secret weapons. It stimulates collagen production, maintains elasticity, triggers hyaluronic acid production and reinforces the ceramide and lipid layers that keep skin hydrated and protected. Beyond the surface, it dictates where and how much fat we hold in our face, and it's responsible for maintaining bone density and structural support. When oestrogen levels become erratic and eventually decline, everything starts to unravel. Cue, menopause-face.

“As the skin barrier weakens, ceramide levels drop, making skin drier, more reactive and less able to retain moisture. Over time, lower oestrogen levels also trigger a reduction in firmness and an accelerated breakdown of elastin. Eventually, we can lose up to 30 per cent of our skin's collagen within just the first five years after menopause, with an ongoing annual decline of approximately 2.1 per cent thereafter,” reveals Gooneratne.

But this all starts way before we hit menopause. Sudden dryness in previously oily skin, increased reactivity to products previously tolerated, dullness, loss of luminosity, hyperpigmentation around the mouth, neck and hairline as well as hollowing under the eyes, deepening nasolabial folds and jowling, are all little clues that you’re in perimenopause, even if you’re not getting hot flashes and headaches.

How perimenopause affects aesthetic treatments

Perimenopause doesn’t just change how your face looks, it also changes how your skin responds to intervention.

“A compromised skin barrier with reduced ceramide levels makes skin more reactive and prone to inflammation following procedures. Declining collagen and elastin production weakens the structural scaffolding that supports injected fillers, potentially affecting how products integrate and how long results last. Disrupted sleep—common in perimenopause—impairs the skin's natural healing and regeneration processes, potentially slowing recovery and compromising optimal treatment outcomes. Alongside that, the hormonal fluctuations themselves create a less stable treatment environment, as skin characteristics may vary significantly depending on where a woman is in her perimenopausal cycle,” explains Gooneratne.

When it comes to wrinkle-relaxing injections (botulinum toxin) like Botox, they often wear off faster during perimenopause due to a combination of hormonal drops, accelerated collagen loss, and shifting metabolism. Essentially when oestrogen does start to drop, the skin thins and loses elasticity, this causes the treated muscles to "pull" through the skin more quickly, while overall hormone shifts can alter your metabolic rate and speed up how quickly your body breaks down and clears the botulinum toxin from your system.

And then there’s cortisol. The increased cortisol sensitivity during perimenopause creates a heightened inflammatory response, meaning treatments that involve any degree of tissue trauma (microneedling, lasers, radiofrequency, hifu, peels and injectables) can cause more pronounced swelling, longer downtime, and an increased risk of adverse reactions. “This isn’t genuine treatment failure, but rather a mismatch between what the treatment can deliver and what the hormonally-changing skin actually needs,” believes Gooneratne.

How to approach menopause-face

The solution isn’t to stop having treatments altogether; it’s to approach them differently. Dr Gooneratne argues that hormone-informed consultations should be the standard, not the exception. “Practitioners should be asking questions they currently aren’t,” she says. Questions like, has your cycle changed in regularity or flow? Do you have symptoms like hot flashes, night sweats, sleep disruption, increased anxiety or brain fog? Have previously successful treatments stopped delivering the same results? “This conversation should normalise perimenopause as a relevant factor in aesthetic outcomes and position treatment planning as a collaborative process,” adds Gooneratne.

In terms of what we can do, addressing our hormone levels is key. Hormonal replacement therapy (HRT) can help restore collagen production, improve barrier function and reduce inflammatory sensitivity, creating a more stable environment for treatments to work in. But equally, lifestyle interventions can be massively helpful too. “Prioritising sleep architecture through consistent sleep-wake times, managing stress through nervous system regulation rather than chronic high-intensity exercise, stabilising blood sugar through balanced meal timing, and correcting nutrient deficiencies - all improve the skin's baseline responsiveness,” shares Gooneratne.

When it comes to the outside, aka our skin, it just takes a little more prep and planning to get the results you desire from your treatments. Gooneratne advises, “barrier repair through ceramide-containing products and appropriate hydration strategies to create skin that's less reactive and better able to tolerate procedures. Treatment timing may need to be adjusted to account for hormonal fluctuations within the perimenopausal cycle, and protocols may need modification—gentler approaches, longer intervals between treatments, or combination strategies that support skin health alongside cosmetic correction.”

If this sounds like you...

So, it turns out that if you’re perimenopausal, what you’re experiencing isn’t necessarily treatment failure. It’s your body entering a new hormonal phase that changes how your skin behaves and responds. “This isn’t your fault, and it’s not that you’ve become difficult to treat, it’s that the standard aesthetic approach hasn’t yet caught up to the reality that hormonal ageing requires a different, more comprehensive strategy than chronological ageing alone,” says Gooneratne.

If your practitioner doesn’t ask you about your hormonal health, share it with them anyway (or find someone who does). When you factor in how perimenopause impacts the skin, you’ll likely find you’ll start getting the results you want out of your favourite in-clinic treatments.