ABC’s of Menopause: Acne

Menopause is the “gift” that keeps on giving. With 34 associated symptoms that can easily be ascribed to a myriad of other health conditions, it can be impossible to know if what you’re experiencing is tied to menopause without a hormone test. Each week this series will break down symptoms to empower women to take back control of their health and enjoy some relief.

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You may wonder why you’re suddenly experiencing the horrors of teenage acne as an adult. Diet and skincare products may play a role, but if you’re a woman whose adolescent source of insecurities has radically returned in your 40s or 50s, there is a very good chance it’s related to hormonal imbalances.

What Causes Menopausal Acne?

The same factors that cause teenage acne are often similar contributors to adult acne including excess oil production, pores becoming clogged by "sticky" skin cells, bacteria, and inflammation. When it comes to menopause-related acne, a decline in estrogen levels can lead to an increase in androgen levels. Androgens are male hormones that can stimulate the production of sebum, the skin's natural oil. Excess sebum can clog pores which lead to acne breakouts. 

Menopause is also notably quite stress inducing due to other symptoms like anxiety, depression and brain fog which we will get to in a future article. Stress triggers cortisol in the body and in turn increases oil production.

How Do I Know My Acne is Menopause Related?

Hormonal acne can show up as whiteheads and pimples, but often takes shape in the form of cystic bumps. These develop deep under the skin, and are extremely painful and tender. Unlike the aberrations of our youth that appeared on an oily T zone, these tend to show up around the jawline, chin and mouth. They also love to stick around for weeks and even after subsiding, have a tendency to return to the scene of the crime and show up in the same area.

What Else Causes Adult Acne?

As we age, our skin becomes more sensitive, especially as we lose elasticity and collagen. Hair products, skin care products, and makeup can all clog pores or have skin irritants that cause skin to dry out, which leads to an overproduction of oil to compensate for that loss of moisture. Diet can also influence inflammation throughout the body; another stressor that leads to oil production. And, some medications, including corticosteroids, anabolic steroids, and lithium, can also cause acne.

Acne can be a red flag of a systemic condition like polycystic ovarian syndrome, or other endocrine disorders, so it's important to consult with a healthcare professional who can also conduct a hormonal test to see if skin issues are linked to menopause.

What Are My Treatment Options?

Acne can have a significant impact on morale and confidence. Thankfully, it’s fairly easy to treat with options such as: 

• Some dermatologists recommend topical antibiotics such as clindamycin, metronidazole, and azithromycin along with retinoids and androgen-blocking spironolactone.
• Hormone Replacement Therapy (HRT) can reduce cystic acne while addressing other menopausal symptoms. 
• Seek out a gentle cleanser that doesn’t strip moisture from the skin and encourage over-production of oils.
• Use a moisturizer that is oil-free and non-comedogenic (will not clog pores).
• Manage stress and sleep to mitigate inflammation in the body.

When Should I See A Doctor?

While acne may not be a life threatening symptom of menopause, you should see a doctor if your acne is severe or persistent, it’s causing emotional distress or anxiety, and most importantly, if it’s accompanied by other symptoms like hair loss, irregular periods, or hot flashes. Your healthcare provider should assess the severity of the acne and recommend the best treatment option. It’s also best practice to rule out other possible causes of the acne, such as an underlying medical condition or a reaction to a medication.

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