Unfortunately, there’s a chance that we may have to face the indignity of pimples once again as we move through the menopause transition.
And as you might guess, it’s the hormonal kind, which is most likely to appear around the mouth, chin and jawline. It tends to occur cyclically along with our period, usually about a week before and during, and is often inflamed. For many, it also involves cystic acne, those really horrible, painful blemishes that develop deep beneath the skin. The “regular” non-hormonal acne, on the other hand, is less inflamed and instead marked by white and blackheads.
The science behind why hormonal acne appears (or, for the lucky among us, reappears) during menopause is multi-faceted, spanning everything from hormones to endocrine disorders, genetics to lifestyle factors. Below, we break it all down.
During the menopause transition, we are in a state of androgen excess relative to dropping estrogen levels. Androgens are a group of hormones that include testosterone. With more testosterone, we’re more prone to acne, hirsutism (male-pattern hair growth on the face, chest, and back), and male-pattern hair loss. And because of this relative increase of testosterone, women with polycystic ovarian syndrome are also at higher risk of acne.
To be clear, acne in this time period does not mean that one’s testosterone or overall androgen level is too high. Testosterone, for example, starts to gradually decline in our late 20s. Rather, it is the relationship of androgens to the other hormones that may be responsible.
Although the connection is unclear, hypothyroidism caused by autoimmunity (Hashimoto’s) is associated with adult acne, perhaps because of an effect on sebum production (sebum is the oil that’s produced by glands in your skin for lubrication). Factors related to chronic inflammation may also be at play.
Insulin resistance is correlated with acne, and is thought to be an effect of insulin on sebum production.
Diet plays a huge role in acne, with dairy and sugar/refined carbohydrates as the primary culprits.
Proteins found in dairy can be an inflammatory food for many, and the proteins themselves can vary from cow to cow, based on how they’re raised and what they eat. And remember, inflammation is something to avoid if you’re concerned about acne.
When we say “inflammation,” we’re referring to our body’s normal response to infection or injury. It’s what causes damaged tissues to release chemicals that signal to white blood cells that it’s time to start repairing — which is totally a good thing and exactly what we want to happen when there’s an injury. What we DON’T want, however, is for the inflammation to become chronic and spread throughout the body, because then it can cause damage to your skin, in addition to increasing your risk of heart disease, stroke, cancers, diabetes, and more.
Eating sugar and refined carbs leads to insulin spikes, and we know there’s a correlation between insulin and acne. These types of foods also contribute to inflammation.
Stress can significantly impact acne. Through its effect on our adrenal glands and stress hormone production, inflammation throughout the body is increased, which can lead to acne. So more stress = more stress hormones = more acne.
Outside of diet and stress, other lifestyle considerations are lack of sleep and exercise, obesity, ultraviolet radiation (yes, sunlight can actually contribute to a particular form of acne called acne aestivalis – wear sunscreen!), cosmetics and skin care products, and smoking.
So you may be asking the question: At what point do I see a doctor about acne? And the answer really depends on you. If acne is bothering you, then go see a dermatologist. There are a lot of very effective over-the-counter and prescription medications available to help manage acne, and a dermatologist is the one to help you navigate through. You can find one in your area here.
Dr. Anna Barbieri, MD
Pro tip #1
Acne is frustrating. No surprise there. So to have to wait three-six months to see results definitely doesn’t help. But trust us when we tell you that there’s no magic pill to improve your symptoms overnight. Once you decide on a proper course of treatment with your dermatologist or Elektra, give it some time!