Oh God, There’s Something Called a “Collagen Cliff”

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Anyone on the Internet can tell you there’s something new and terrifying to learn about our bodies everyday (Nail psoriasis! Eyelash mites! Scalp acne!). This time, the unpleasant news came from the mouth of New York City-based board-certified dermatologist Melissa Levin, MD. When beauty director Sarah Kinonen spoke with her recently for a Q and A in Allure’s Skin Check newsletter, she asked what people over 50 most often misunderstand about skin health. Dr. Levin didn’t hesitate in her response: The majority of us assume that we age gradually but in reality, women can expect to experience something called a “collagen cliff,” which means—you guessed it—that their collagen levels drop off drastically in the period of just a few years. Fun, right?

While collagen production naturally slows down for women in their mid-20s, the steep drop starts once a woman begins experiencing the symptoms of perimenopause, like hot flashes, sleep disruption, and irregular periods. Perimenopause ends when a woman has gone 12 months without a period—“menopause” simply refers to the 366th day since a woman's last period, after which she becomes “postmenopausal.” The transition can last an average of four years, though it can extend seven to 10 years for some women, according to Sameena Rahman, MD, a board-certified OBGYN based in Chicago. “Research suggests that women of color may experience more intense symptoms that persist longer,” she adds. Most women experience menopause between ages 40 and 58, with the average age being 51.

“In the first five years of perimenopause, your skin loses around 30 percent of its collagen,” says Dr. Levin. “Once this transition of menopause is complete, a woman may have lost up to 60 to 70 percent of the collagen that she had in her youth.” Why? Because estrogen declines steeply during perimenopause, and estrogen is the hormone that keeps fibroblasts (the cells that create collagen) productive and helps hold on to existing collagen, explains board-certified dermatologist Mona Gohara, MD, a board-certified dermatologist and associate clinical professor of dermatology at Yale School of Medicine. When estrogen levels drop, collagen production slows and loss accelerates.

Every woman lucky enough to reach menopause will experience this “collagen cliff” at some point, but no two drops are the same thanks to a combination of genetics, sun exposure, and baseline skin health. (And let’s get this out of the way: No, because they do not experience a dramatic hormonal change as they age, men don’t experience this cliff or anything like it.) Women with more melanin, for example, tend to experience less of a dramatic drop and more of an erosion, says Dr. Gohara, because their skin has more built-in sun protection, although genetics, sun exposure, smoking, stress, and sleep all play a part regardless of skin tone. “For others, it feels more like a Jenga tower—one or two key blocks move and the structure suddenly looks different,” says Dr. Gohara. One situation is not more common than the other, and in fact “many people experience a long erosion phase followed by a brief but dramatic Jenga moment.”

When someone loses collagen in their face, their temples and undereyes may become more hollow and fine lines more pronounced. There can be sagging along the lower face or the development of jowls. Basically, the person ages. And let’s remember: that’s a privilege. Experiencing a decline in collagen is a natural, inevitable part of the aging process. Your parents, grandparents, great-grandparents, and all the generations that have come before you also experienced this. What makes you different is that you’re armed with more tools to soften the fall, if you so choose.

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.”

Speaking of trust, while collagen supplements may be all over your Instagram feed, there’s very little evidence that mixing powdered collagen into your coffee or taking it in pill form will do anything to counteract the collagen loss caused by menopause. Ingestible collagen is unregulated by the FDA, just like all supplements—which is why we at Allure don’t cover them unless we (or the experts we interview) have reviewed at least one double-blind third-party study that verifies a supplement’s claims. On the topic of collagen supplements, Dr. Rahman says, “there is no uniformity in formulation, dosing, or quality, and regulation varies widely between brands. That means results can be inconsistent. [But] if someone chooses to use one, they should look for hydrolyzed collagen paired with vitamin C… and expectations should stay realistic.”

Last year, when Allure invited 11 dermatologists to share their personal supplement routines, none of them were taking ingestible collagen, though a couple shared that they take supplements that are said to help stimulate collagen, like Elysium Mosaic and Biosil Collagen Generator. Elizabeth Hale, MD, a board-certified dermatologist based in New York City, told us she takes Isdin SunIsdin, which can help protect the skin from the effects of sun damage, including collagen breakdown.

Growing new collagen is no easy feat, but it’s not too hard to keep your skin hydrated and dewy with the right products. Consistent use of sunscreen (look for SPF 30 or higher), antioxidants (like vitamin C, to help counteract collagen-destroying oxidative stress), and retinoids (which encourage cell turnover and build collagen over time) will help keep your skin as healthy, firm, and hydrated as it can be. “This phase isn’t about chasing what skin used to do,” Dr. Gohara says. “It’s about supporting what it’s doing now—and doing it well.”