Perimenopause May Mark Rosacea’s Onset or Worsening
Menopause is the stage of life when menstruation stops, defined as not having menstruated for 12 consecutive months. However, the 4 to 10 years leading up to menopause commonly involve a wide variety of physical, mental, and emotional symptoms caused by decreasing estrogen and progesterone. This tumultuous stage of life is called perimenopause, in which symptoms such as irregular periods, hot flashes, mood disorders, joint issues, brain fog, and insomnia are quite common.
Research on perimenopause and rosacea is somewhat limited, but recent studies have shown perimenopause to be a time of both increased incidence of rosacea development and worsening of symptoms for patients with existing rosacea.1,2 Some evidence also suggests that women in perimenopause may have different triggers and experience different signs and symptoms than younger women.3
“During perimenopause, estrogen levels fluctuate markedly and eventually decline,” said Dr Shoshana Marmon, assistant professor and director of clinical research in the dermatology department at New York Medical College. This natural loss of sex hormones can lead to thinning and drying skin, higher susceptibility to irritation, and a disrupted skin barrier, all of which can predispose a rosacea diagnosis or worsening of signs and symptoms. In addition, inflammation increases throughout the body during menopause, and hot flashes are common, particularly on facial skin. “For women who experience hot flashes, the associated heat and flushing may aggravate rosacea symptoms,” Dr Marmon noted.
More holistically, perimenopause is a time of life when increased stressors are common, and this can make symptom management difficult in several areas. Getting good sleep, eating well, exercising regularly, and practicing stress-coping habits can become challenging, which can lead to an exacerbation of rosacea symptoms or an initial diagnosis. Although hormone replacement therapy is often used to reduce hot flashes and improve sleep and energy levels, studies seem to indicate a complex relationship between rosacea and hormones, so it may not be the right choice for everyone.4
“The core treatment of rosacea does not change during perimenopause. Treatment should be directed at the patient’s specific features, using established therapies,” said Dr Marmon. Applying prescription topical medications and/or taking oral medications daily, keeping a regular diary of triggers and their associated signs and symptoms, doing activities to promote stress relief, gently cleansing skin, and regularly applying sunscreen are essential. “Gentle skin care, regular moisturization, and daily sun protection remain particularly important since declining estrogen is associated with dryness and impaired barrier function,” she indicated.
References
1. Roster K, Fleshner L, Karatas TB, et al. Menopause and common dermatoses: a systematic review. Am J Clin Dermatol. 2026;27(1):67-84. doi:10.1007/s40257-025-00994-0
2. Yang F, Wang L, Jiang X. Clinical characteristics of rosacea in perimenopausal women. Skin Res Technol. 2024;30(1):e13542. doi:10.1111/srt.1342
3. Study suggests rosacea may be more complex in women over age 45. National Rosacea Society. March 1, 2023. Accessed September 8, 2026. https://www.rosacea.org/ blog/2023/march/study-suggests-rosacea-may-be-more-complex-in-women-over-45
4. Wu WH, Geng H, Cho E, et al. Reproductive and hormonal factors and risk of incident rosacea among US White women. J Am Acad Dermatol. 2022;87(1):138-140. doi:10.1016/j.jaad.2021.06.865
