Generally, menopause begins around age 50-51, occasionally it can start in the mid to late forties, during this time most women experience changes in their skin which is due to both intrinsic and extrinsic factors.

Intrinsic Factors: Occurs as a result of chronological aging and often is determined by genetics. Intrinsic factors include such things as decrease in metabolic processes (which often affects the skin), epidermal thinning, decreased number of sebaceous glands, decreased collagen production and elastic fibers, and decreased subcutaneous fat.

All of these changes contribute to a decreased ability of the skin to act as a barrier and, as a result, the body becomes more susceptible to environmental agents. A reduction in immune function, decreased melanocyte production and visible blood vessel atrophy. Wound healing capabilities and the skin's ability to produce Vitamin D are also reduced.

Extrinsic Factors: Primary factors are sun exposure and smoking. Prolonged exposure to the sun leads to sallowness of the skin, decreased elasticity, an irregular surface, wrinkling, sagging and dryness, about half of a person's sun exposure occurs before the age of 18, but the resulting damage may not become apparent for another 20-30 years. Smoking causes wrinkling of the skin (the amount of wrinkling is directly proportional to the amount of cigarette use).

At the time of peri-menopause many of these aging factors are increased due to the decrease in the amount of estrogen being made by the body. Decreased collagen formation and pigmentation changes may be caused by both sun exposure and decreased estrogen levels.