Menopause and Acne: Causes and Control

Acne in adulthood can often be an unexpected menopause symptom

Hot flashes, night sweats, weight gain: These are menopause symptoms that are all too familiar to most of us. And yet acne — the bane of our teenage years — is also associated with menopause.

Why Does Acne Appear in Menopause?
Whether you are 17 or 47, acne outbreaks have the same root cause: Changes in hormone levels affect the way your skin protects and regenerates itself, sometimes with unpleasant results.
At the onset of menopause, or more accurately, the phase that leads into it, called perimenopause, levels of the female hormones, including estrogen, drop. But androgen levels, the male sex hormones that each woman has as well, remain constant. This situation in effect causes the body to experience a relative increase in the effect of these "male" hormones.
One of the strongest of the androgens, testosterone, often triggers skin conditions that result in menopausal acne. As testosterone levels rise, the skin's sebaceous glands go into overdrive, producing excess sebum, an oily substance that can block pores. The problem is further exacerbated by the slowed-down cell regeneration in older skin. As excess skin cells build up, they block pores already clogged with sebum, resulting in inflammation and infection. The body's immune response causes a buildup of white blood cells in the infected area, and the result is a blemish or zit.
Medical Treatments for Adult Acne
If a pimple or even more widespread acne develops, "don't panic!" recommends Jerilynn Prior, MD, founder of the Centre for Menstrual Cycle and Ovulation Research. "Women in perimenopause rarely experience severe acne." Dr. Prior also points out that stress hormones are linked to acne as well, so stressing out about zits is the last thing you want to do.
Typically, menopausal acne is a temporary condition that goes away once a woman settles into postmenopausal hormone levels. But sometimes the discomfort and cosmetic impact of acne is severe enough to prompt a woman to seek medical attention. Among the most popular options are:

• Hormone therapy. Women who participate in hormone replacement therapy (HRT) often cite an improved complexion as one of its benefits. Supplemental estrogen provided by HRT not only helps your skin retain the elasticity and softness of its younger days, it can also help ward off blemishes and acne. On the other hand, in some women HRT may actually trigger an acne problem. It is rare for doctors to prescribe hormones for dermatological issues alone, as HRT is typically undertaken to address a suite of menopausal symptoms. Furthermore, any potential dermatological benefits are highly unlikely to outweigh HRT's significant risk factors, including those for heart disease, stroke, and breast cancer.
• Topical treatments. Skin-care specialists often recommend over-the-counter topical medications such as benzoyl peroxide to target blemishes and/or a topical antimicrobial gel like the prescription antibiotic erythromycin (Benzamycin) to combat acne-causing bacteria. Retinoids, a vitamin-A derivative, are another effective class of topical medications prescribed to help treat blackheads or small blemishes. Retinol increases the skin's sensitivity to sunlight, so daily sunscreen application is critical when using these products.
• Oral medications. In addition to topical treatments, doctors may also prescribe oral medications such as antibiotics, low-dose oral isotretinoin (an acne treatment commonly known by the brand name Accutane), or spironolactone, an anti-androgen diuretic.

Self-Care Strategies for Menopausal Acne
Maintaining a good self-care regimen is necessary for skin health throughout your life, but it is especially important for women experiencing the dual challenges of delicate skin and breakouts during menopause. Dermatologists recommend:

• Daily cleansing. Wash your face twice a day with a gentle, nondrying cleanser followed by a light moisturizer.
• Gentle approach. Harsh products and vigorous scrubbing are a definite no-no for mature skin that can be easily irritated or damaged.
• No picking. Squeezing or picking at pimples must be avoided completely since skin, which becomes more fragile at menopause, may scar more easily.

In addition to proper skin care, Prior encourages women to reevaluate their cosmetics collection. "Oil-based cosmetics can exacerbate the problems for skin that is already clogged with excess oil." Look for water-based or mineral cosmetics to replace oily products and "take extra care to remove all traces of makeup when you wash your face," she says.