The Skin Microbiome and Menopause: What Changes and Why It Matters
The skin microbiome is increasingly recognized as a meaningful factor in skin health, including in the context of menopause. Declining estrogen levels are associated with changes in skin structure—such as reduced lipid production, altered pH, and diminished barrier function—that can influence microbial composition on the skin’s surface. These shifts may contribute to dryness, irritation, and changes in treatment tolerability. Understanding these shifts provide a framework for smarter product recommendations that support barrier repair and reduce irritation risk, rather than focusing solely on visible symptoms.
What Changes: The Core Microbiome Shifts
Recent research demonstrates three consistent changes in the facial skin microbiome during menopause:
Decreased Cutibacterium Dominance
In premenopausal skin, Cutibacterium acnes comprises 60-83% of facial microbiota. Postmenopausal women show markedly lower C. acnes abundance—directly correlating with reduced sebum production that accompanies estrogen deficiency. C. acnes produces short-chain fatty acids that maintain acidic pH, secretes RoxP (an extracellular protein with antioxidant properties), and provides colonization resistance against microorganisms. Loss of C. acnes dominance compromises all three protective functions.
Increased Overall Diversity
Paradoxically, as Cutibacterium declines, overall microbial diversity increases—but this doesn't indicate healthier skin. Unlike gut microbiome diversity (which correlates with health), increased facial diversity reflects loss of beneficial dominant species and opportunistic colonization. Studies show postmenopausal women have higher levels of Streptococcus species and Gram-negative bacteria, with less stable microbial networks. These microbial changes correlate with the increased reactivity and reduced barrier resilience commonly observed in menopausal skin.
Depleted Lactobacillus
While Lactobacillus represents a minor component of facial microbiota, its reduction mirrors well-documented vaginal changes during menopause. Estrogen decline reduces glycogen synthesis—the primary substrate for Lactobacillus proliferation and lactic acid production—further disrupting pH regulation.
These shifts appear directly linked to menopausal status rather than chronological aging alone. In a study comparing pre- and postmenopausal women with only a 12.4 year age difference, significant microbiome changes were observed despite no differences in age-dependent skin biomechanical properties. This suggests estrogen withdrawal itself drives microbial restructuring. Understanding this relationship opens possibilities for microbiome-targeted interventions to address menopause-associated skin disorders.
Why It Matters: The pH Connection
Healthy skin maintains a pH of 4.5-5.5, supporting beneficial bacteria while inhibiting pathogens. Estrogen influences this through sebaceous lipid production and barrier integrity, while skin bacteria contribute through fermentation that produces acidifying metabolites.
Menopause disrupts both pathways. Reduced sebum, impaired barrier function, and decreased C. acnes collectively shift skin toward more alkaline pH. This pH elevation may further select against acid-requiring bacteria, potentially creating a cycle of estrogen decline → pH elevation → microbiome changes → further pH shifts. Studies confirm that postmenopausal skin demonstrates impaired stratum corneum acidification, though precise measurements linking menopausal status, pH changes, and microbiome composition remain limited.
Clinical Impact: What Patients Experience
These microbiome shifts correlate with measurable clinical changes. Decreased C. acnes associates with reduced skin elasticity parameters, increased wrinkle metrics, and impaired barrier recovery.
For providers, this reframes menopausal skin complaints. Dryness reflects both sebum loss and barrier dysfunction. Sensitivity likely involves structural changes (thinner epidermis, impaired barrier) alongside inflammatory processes that may be influenced by microbiome shifts.
Evidence-Based Strategies: What Actually Works
Understanding menopausal microbiome changes suggests targeted interventions beyond standard "sensitive skin" protocols.
pH-Balanced Cleansing
Alkaline soaps (pH 9-11) may compound the pH changes occurring in menopausal skin. pH-balanced cleansers (pH 4.5-5.5) help prevent further alkalinization, while amino acid-based surfactants provide gentle cleansing with less disruption to barrier lipids. Harsh alkaline cleansers cause stratum corneum swelling, protein denaturation, and increased transepidermal water loss.
Barrier-Supportive Moisturization
Ceramide-dominant moisturizers restore physiologic lipid ratios and support barrier repair. Clinical trials demonstrate that ceramide-containing moisturizers significantly improve barrier function and reduce inflammation in aging skin. Humectants (glycerin, hyaluronic acid, panthenol) address transepidermal water loss, while emollients provide occlusion. Look for formulations that provide hydration without excessive preservatives or occlusive ingredients that may create unfavorable conditions for skin flora.
Prebiotic Formulations
Emerging evidence supports prebiotics (alpha-glucan oligosaccharide, inulin, chicory root extract) that may selectively support beneficial bacteria. A 2020 study found topical Lactobacillus ferments improved hydration and supported S. epidermidis growth on normal skin. While evidence for facial application in menopausal populations remains preliminary, prebiotic moisturizers offer a potential non-hormonal approach.
What to Avoid
Practices that may worsen skin condition include over-cleansing (more than twice daily), antibacterial soaps outside of medical indications, alcohol-based toners, and excessive exfoliation. For menopausal women experiencing acne or inflammatory conditions, recognize that these often reflect barrier dysfunction rather than excess sebum. Aggressive protocols designed for younger, oilier skin may worsen menopausal skin conditions.
Hormone Replacement Therapy (HRT) Considerations
Systemic or topical hormone replacement therapy may influence menopausal microbiome changes by affecting physiologic conditions such as sebum production, pH, hydration, and barrier integrity. Limited data suggest HRT improves skin barrier function, though its effects on the skin microbiome in menopausal women have not been directly studied. For women already using HRT for vasomotor symptoms or other indications, potential skin benefits may represent an additional effect. Current evidence doesn't support HRT use solely for skin or microbiome concerns.
The Practical Takeaway
Menopause is associated with microbiome shifts that correlate with clinical complaints—dryness, sensitivity, barrier dysfunction, and visible aging. Evidence-based skincare for menopausal women should prioritize barrier support through pH-balanced gentle cleansing, ceramide-rich moisturization, avoidance of harsh or disrupting ingredients, and consideration of prebiotic formulations.
As our understanding of the skin microbiome deepens, microbiome-targeted interventions may play an increasing role in managing estrogen-deficient skin. For now, practitioners can apply existing evidence to support both skin physiology and microbial health, recognizing that these systems are fundamentally interconnected.
References
Byrd AL, Belkaid Y, Segre JA. The human skin microbiome. Nat Rev Microbiol. 2018;16(3):143-155.
Rizopoulou G, Makrantonaki E, Zouboulis CC, et al. Menopause and facial skin microbiomes: a pilot study revealing novel insights into their relationship. Front Aging. 2024;5:1353082.
Jung Y, Lee C, Jeong J, et al. Aging-induced changes in Cutibacterium acnes and their effects on skin elasticity and wrinkle formation. Microorganisms. 2024;12(11):2179.
McLoughlin IJ, Wright EJ, Tagg JR, et al. From dysbiosis to healthy skin: major contributions of Cutibacterium acnes to skin homeostasis. Microorganisms. 2021;9(3):628.
Lephart ED, Naftolin F. Estrogen action and gut microbiome metabolism in dermal health. Dermatol Ther (Heidelb). 2022;12(7):1535-1550.
Choi EH, Man MQ, Xu P, et al. Stratum corneum acidification is impaired in moderately aged human and murine skin. J Invest Dermatol. 2007;127(12):2847-2856.
Berson DS, Alexis AF, Desai S, et al. Ceramide-containing adjunctive skin care for skin barrier restoration during acne vulgaris treatment. J Cosmet Dermatol. 2023;22(6):1742-1750.
Fournière M, Latire T, Souak D, et al. Staphylococcus epidermidis and Cutibacterium acnes: two major sentinels of skin microbiota and the influence of cosmetics. Microorganisms. 2020;8(11):1752.
Proksch E. pH in nature, humans and skin. J Dermatol. 2018;45(9):1044-1052.
Kim HJ, Kim CH, Ryu JH, et al. Connecting microbiome and menopause for healthy aging. Nat Rev Endocrinol. 2023;19(8):442-458.
Pagac MP, Stalder M, Campiche R. Menopause and facial skin microbiomes: a pilot study revealing novel insights into their relationship. Front Aging. 2024;5:1353082. doi:10.3389/fragi.2024.1353082.
Howard B, Bascom CC, Hu P, et al. Aging-associated changes in the adult human skin microbiome and the host factors that affect skin microbiome composition. J Invest Dermatol. 2022;142(7):1934-1946
Townsend EC, Kalan LR. The dynamic balance of the skin microbiome across the lifespan. Biochem Soc Trans. 2023;51(1):71-86.
Kamp E, Ashraf M, Musbahi E, DeGiovanni C. Menopause, skin and common dermatoses. Part 2: skin disorders. Clin Exp Dermatol. 2022;47(12):2117-2122.
Zouboulis CC, Blume-Peytavi U, Kosmadaki M, et al. Skin, hair and beyond: the impact of menopause. Climacteric. 2022;25(5):434-442.
Wojciechowska K, Dos Santos Szewczyk K. The skin microbiome and bioactive compounds: mechanisms of modulation, dysbiosis, and dermatological implications. Molecules (Basel). 2025;30(22):4363.
Disclaimer: The information shared on this website and all blog articles by Esther's Wellness is for educational and informational purposes only. It is not intended to diagnose, treat, cure, or prevent any disease and should not replace advice from a qualified healthcare professional. Always seek the guidance of your physician, dermatologist, or other licensed healthcare provider with any questions you may have regarding your skin, medical conditions, or before starting any new skincare regimen, supplement, or treatment. Although the founder of Esther's Wellness is a licensed pharmacist, all content provided here is shared in a general educational capacity and does not create a pharmacist-patient or provider-patient relationship. Esther's Wellness makes no guarantees regarding the accuracy, completeness, or suitability of the information provided and assumes no liability for any actions taken based on this content.