Dr. Gohara says that before perimenopause begins, the goal is to “bank” collagen. “Think of it like maxing out your 401(k) while the employer match—estrogen—is still generous,” she says. “That means daily sunscreen applied generously and repeatedly—not just to the face, but to the neck, chest, and hands—along with topical retinoids to stimulate collagen and antioxidants to limit oxidative stress,” which can cause damage to cells that further breaks down collagen. Dr. Levin agrees, adding that taking these steps is like resistance training for your face—you do those deadlifts in your 30s and 40s so that in your 60s your body still feels strong. The same goes for diligent skin care.

For those whose budget allows, Dr. Levin and Dr. Gohara both recommend several in-office collagen-building treatments for perimenopausal women, like laser resurfacing and radiofrequency microneedling, with a focus on undereyes, the lower face and jawline, and the neck. “Lasers are best for improving tone, texture, and pigmentation while stimulating collagen, which is great for sun damage and fine lines,” Dr. Gohara says. “Microneedling excels at overall collagen induction and improving crepey texture.” For undereye hollowness, she recommends using energy devices like Ultherapy to help skin quality, but adds that deeper hollowness often needs volume restoration using a hyaluronic acid filler or injectable biostimulatory treatments like Sculptra or Radiesse, which help you build more of your own collagen.

All of these treatments can be done at any time, but will be more effective the earlier you start them. Remember, the goal is to maximize collagen levels before they dip, says Dr. Gohara, while noting that it’s never too late to start. “Returns don’t disappear with age, they just change scale,” she says. For post-menopausal women, she recommends a resurfacing Fraxel laser or what’s often referred to as its little sister, Clear + Brilliant, for improving texture and tone; radiofrequency microneedling devices, like Morpheus8, for laxity and crepiness; and, again, biostimulatory injectables such as Sculptra for volume loss. “Hydration-focused [injectable] treatments like Skinvive can also be helpful as skin becomes drier and more reactive,” she adds.

Also worth considering: menopause hormone therapy (MHT), a subset of hormone replacement therapy (HRT), which refers to supplementing estrogen including through pills, creams, and patches. MHT can be started during perimenopause and may provide some benefit for skin health, but the treatment is “not primarily prescribed for collagen loss,” says Dr. Rahman. Still, some evidence suggests estrogen creams may improve skin elasticity, hydration, and thickness. MHT could also mean staying on, or going back on, the pill through your 40s, but many women choose to get their estrogen transdermally, wearing a small patch that they change every few days. “Many clinicians prefer the patch [to the pill] because it goes directly into the circulation and bypasses the liver,” Martha K. Richardson, MD, a board-certified OBGYN based in Boston, has previously told Allure. “This is thought to reduce the risk of blood clots—a serious risk seen with oral hormones, which go through the GI tract to the liver.” If a woman still has her uterus, she will also need to take oral progesterone to protect the uterine lining. “From a skin standpoint, estrogen—with appropriate progesterone—can support collagen, hydration, and elasticity, but skin benefits alone should never drive the decision,” says Dr. Gohara. “This is about whole-body health, guided by a trusted clinician.”