Aesthetically relevant symptoms of menopause transition: Impact and approach to management

Menopause transition or perimenopause is the transitional period preceding menopause, marked by hormonal variability and menstrual irregularity. This period is associated with a wide range of clinical findings due to reduced levels of estrogen. The skin, in particular, is affected by the decline in estrogen, specifically 17β-estradiol and dehydroepiandrosterone, along with an increase in cortisol. The sudden onset of various menopause symptoms can be distressing for many women and significantly impacts their quality of life. The genitourinary syndrome of menopause, a typical result of hypoestrogenism, is characterized by signs and symptoms relevant to urogenital atrophy. In this discussion, we focus on the aesthetically relevant symptoms of perimenopause and the approach to management. Most of these findings, including hot flashes, rosacea flares, worsening skin quality with dryness, sagging, and increased wrinkling, dyschromia, hair thinning, and cellulite, can be effectively managed. The provider should be aware of the emotional changes that occur during perimenopause and ensure that patients have a healthy and balanced motivation for seeking treatment. We discuss valid treatment options such as hormone replacement therapy, minimally invasive procedures, and topical products, including the new dermocosmetic regimens. Because many of these treatments are geared toward maintaining results, consistency is paramount for achieving successful outcomes.