Managing Perimenopause With Eczema
Eczema can flare during perimenopause as oestrogen affects skin barrier function. Learn how to care for your skin through the hormonal transition.
Hormones and Skin: A Close Relationship
Skin is one of the body's largest oestrogen-sensitive organs. Oestrogen stimulates collagen production, maintains skin moisture, supports the renewal of skin cells, and underpins the skin's barrier function. As oestrogen declines during perimenopause, the skin tends to become thinner, drier, and more reactive to irritants and environmental stressors. For women with eczema, this hormonal shift can trigger flares or make previously manageable symptoms significantly harder to control. Many women who had well-managed eczema through their 30s find it becomes unpredictable and more severe in their mid-40s, even without any obvious changes to their skincare routine or environment.
Why Perimenopause Triggers Eczema Flares
The mechanisms connecting perimenopause and eczema are several and they often act together. Declining oestrogen reduces the production of ceramides, which are critical components of the skin barrier, making it easier for irritants, allergens, and bacteria to penetrate the skin and provoke immune reactions. Lower oestrogen also reduces hyaluronic acid content in the skin, leaving it drier and more prone to the itch-scratch cycle that characterises eczema. Disrupted sleep from night sweats and insomnia raises cortisol levels, and cortisol worsens skin inflammation directly. Psychological stress, which is frequently elevated during perimenopause for both physical and situational reasons, is also a well-established eczema trigger that amplifies the hormonal effects.
Building a More Protective Skincare Routine
Consistent, thorough moisturising is the cornerstone of eczema management throughout life, and it becomes even more critical during perimenopause when the skin's own moisture retention declines. Applying a thick, fragrance-free emollient immediately after bathing, while the skin is still slightly damp, locks in moisture effectively. Opting for warm rather than hot showers reduces additional skin drying. Choosing washing products, laundry detergents, bubble baths, and personal care items that are free from fragrance and known contact irritants removes unnecessary triggers. During active flares, topical corticosteroids prescribed by your doctor address the inflammation. Using them as directed and stepping down gradually rather than stopping abruptly prevents rebound flares.
The Role of Stress and Sleep
Eczema is notoriously sensitive to psychological stress, and the compounding pressures of perimenopause make effective stress management more important than ever. When sleep is fragmented by night sweats, the skin has less time for overnight repair and regeneration, and stress hormones remain elevated into the following day, creating a sustained inflammatory environment. Addressing night sweat severity through environmental adjustments such as a cooler bedroom, breathable natural fibre bedding, and moisture-wicking nightwear, and through medical management where appropriate, can break the cycle of poor sleep, elevated cortisol, and skin flaring. Even modest improvements in sleep quality tend to produce visible improvements in skin condition within a matter of days.
Diet and Gut Health Connections
The relationship between diet and eczema is individual and not always predictable, but for some women certain foods reliably contribute to flares. Common culprits include dairy products, eggs, gluten, and certain nuts, though the list varies considerably between individuals. Perimenopause can alter gut microbiome composition through hormonal changes, and this has downstream consequences for immune regulation and skin inflammation. Supporting gut health through a diet that prioritises vegetables, fibre, fermented foods, and oily fish may benefit some women's skin alongside their perimenopausal symptoms more broadly. Identifying specific food triggers is best approached systematically with the support of a registered dietitian, rather than eliminating multiple food groups simultaneously.
Medical Treatments Worth Discussing
For women with moderate to severe eczema that does not respond adequately to emollients and topical steroids, additional medical options exist. Dupilumab, a biologic injection given every two weeks, is highly effective for chronic moderate to severe eczema in adults and does not interact with hormonal therapies. Some women find that HRT, by restoring oestrogen and improving skin barrier function and hydration, has an indirect beneficial effect on their eczema alongside its primary benefits for perimenopausal symptoms. This is not a primary clinical indication for HRT, but it can be a welcome secondary benefit worth raising with your GP. Sedating antihistamines taken at night can reduce nocturnal itch and improve sleep quality.
Managing Both Conditions Together
Perimenopause and eczema share several management principles that make a combined approach both practical and efficient: reducing stress, prioritising sleep, avoiding known triggers, maintaining a consistent daily skincare and wellness routine, and keeping in regular contact with your healthcare team. Tracking eczema severity alongside your perimenopausal symptoms over time can reveal correlations you would not otherwise notice, such as skin flares coinciding reliably with weeks of particularly disrupted sleep or identifiable hormonal shifts in your cycle. Sharing this kind of detailed, time-stamped record with your GP or dermatologist supports more targeted and responsive treatment decisions. The goal is not perfect skin every day but a sustainable approach that keeps both conditions manageable through the transition.
Related reading
Get your personalized daily plan
Track symptoms, match workouts to your day type, and build a routine that adapts with you through every phase of perimenopause.