The passage towards menopause is a time of hormonal changes that can significantly affect women's physical and emotional wellbeing. During this period women who have never experienced acne before, or not since their teenage years, may begin to experience breakouts.
Acne over the age of 40 can be emotionally difficult, especially for those women who had moderate or severe breakouts when they were younger and thought that it was behind them.
Luckily, perimenopausal acne is much less common than other types of hormonal acne experienced by younger women. It is also temporary and will clear up once the woman enters into menopause.
This article will explain what perimenopausal acne is, why it happens, and how it can be treated.
First, let’s look at the difference between perimenopause and menopause to avoid any confusion.
Perimenopause vs menopause
Perimenopause is the transitional time, the passage each woman goes through as her hormonal system changes. The end result is menopause. Once a woman reaches menopause her hormonal system stabilises into how it will be for the remainder of her life. At this point any symptom or discomfort that she was feeling from the process of perimenopause will alleviate.
When a woman has not had a menstrual cycle for at least twelve months, she has officially reached menopause.
The average length of perimenopause is four years, but it can be as little as a few months or for as long as fifteen years. It’s during this time in perimenopause that fluctuating hormones can cause acne.
Typically women will begin perimenopause in their mid-40’s, and enter into menopause at an average age of 51. Menopause before the age of 40 is called early menopause or premature ovulation failure. Menopause after the age of 55 is late-onset menopause.
What perimenopausal hormonal changes cause acne?
A woman going through the passage of perimenopause has many changes happening within her hormonal system, including:
- Decreased estrogens
- Increased, then decreased follicular stimulating hormone (FSH)
- Decreased progesterone
- Increased sex hormone-binding globulin (SHBG)
- Increased androgens (male-sex hormones)
Perimenopausal women develop acne for much of the same reason as puberty – hormonal fluctuations. However, perimenopausal acne are much less common, as women over the age of 40 are usually not producing enough sebum in their skin to be able to cause breakouts as this decreases with age. Acne requires both excess sebum production and bacteria to be present.
When perimenopausal acne is not caused by hormones
While perimenopausal and menopausal women produce less sebum and are therefore less likely to experience acne, they are not completely immune to breakouts. They can also experience acne that is not caused by hormonal fluctuations, for example cosmetics or skincare, dairy consumption, disease and certain medications can also be responsible.
Hormonal Replacement Therapy (HRT) and acne
Hormone replacement therapy (HRT) is a commonly used pharmaceutical treatment to alleviate the symptoms of perimenopause.
HRT is often prescribed when perimenopausal symptoms are significantly adversely affecting a woman’s quality of life. These symptoms may include:
- Hot flashes
- Insomnia
- Anxiety or depression
- Night sweats
- Reduced libido
Typically HRT for perimenopause is a combination of estrogens and progesterone. They can be very effective at alleviating perimenopausal symptoms, including acne. However in some cases the use of HRT can also cause the side effect of breakouts. This is because some HRTs use progestin, the synthetic form of progesterone that is also found in some hormone releasing birth control pills. Progestin is a known cause of excess androgens in the body, and therefore breakouts.
If a woman is experiencing perimenopausal acne from HRT medication, she then has the option to change to an alternative HRT or to try alternative methods of treatment.
Treating perimenopausal acne
Like all treatments of acne in women, there is always a choice to treat the skin condition using natural or pharmaceutical methods.
The first step in treating the skin through either method is to determine if the acne is in fact caused by the perimenopausal hormone fluctuations, or if it’s caused by another factor such as cosmetic use or medication.
If the woman is experiencing perimenopausal acne and is on HRT, it is recommended to talk with her doctor to consider changing the pharmaceutical as the HRT may be the cause of the breakouts.
Topical treatments such as salicylic acid and benzoyl peroxide can also be used, however it’s important to note that these will cause a further drying of the skin. And as perimenopausal women already typically experience dryer skin, this side effect can be difficult.
In conclusion
A woman’s passage towards menopause is a very significant time in her life, but it can come with many challenges in the form of both emotional and physical symptoms.
For women who experience breakouts as a symptom of perimenopause, there are options for both natural or pharmaceutical treatment. The hormonal acne will also completely clear up after the period of perimenopause has ended and you enter into menopause.
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