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Acne in Menopause

Let's talk about acne. Oh, did you think you’d left that behind in high school? The truth is, acne can show up at any age, especially for women who have more hormonal imbalances throughout their lives (thanks periods and pregnancies… and of course, perimenopause).

Ok, But What Actually IS Acne?

Acne is an inflammatory disorder of the skin and is a common condition that happens when hair follicles under the skin become clogged and irritated. Sebum - oil that helps keep skin from drying out - and dead skin cells clog the pores, which leads to outbreaks of lesions, commonly called pimples or zits.

The skin has sebaceous (oil) glands that connect to the hair follicle through a pore. In healthy skin, the sebaceous glands make sebum that empties onto the skin surface through the pore. Keratinocytes, a type of skin cell, line the follicle. Normally as the body sheds skin cells, the keratinocytes rise to the surface of the skin and slough off. When someone has acne, the hair, sebum, and keratinocytes all stick together inside the pore. This prevents the keratinocytes from shedding and keeps the sebum from reaching the surface of the skin. The mush of oil and cells allows bacteria that live on the skin to grow in the plugged follicles and cause inflammation—swelling, redness, heat, and pain. When the wall of the plugged follicle breaks down, it spills the bacteria, skin cells, and sebum into nearby skin, creating lesions or pimples. You can learn more about the science of acne here.

Hormonal Impact on Skin

Hormones play a huge role in keeping everything running smoothly in our bodies, including our skin. But sometimes, things change and we are left wondering why pimples start popping up out of nowhere.

Let’s take a look at the hormones that can impact our skin:

  • Estrogen: This hormone is like the calming force for our skin. It helps keep oil production in check and promotes collagen production, which gives our skin that plump, youthful appearance. Low estrogen levels can affect your skin by reducing its ability to retain moisture, making it dry. Dry skin is more susceptible to irritation and may lead to the clogging of pores with oil and dead skin cells.
  • Progesterone: Progesterone works alongside estrogen to regulate our menstrual cycles and reduce inflammation, including skin inflammation. However, when women have anovulatory cycles - i.e. they don’t actually ovulate, progesterone levels will be low and this can influence skin inflammation. Women can have anovulatory cycles when they eat a high carb diet or when they are in perimenopause and the ovaries just don’t release an egg each month.
  • DHEA: Dehydroepiandrosterone (DHEA) is a hormone produced in our adrenal glands. DHEA levels naturally decrease as we age. While DHEA has many benefits, such as boosting mood and energy levels, it can also contribute to increased oil production, potentially leading to breakouts. This is because some of the DHEA will be converted to Testosterone and then on to another “male” hormone called DHT.
  • Testosterone: We all have testosterone, but women usually have much less than men. Some testosterone gets converted to DHT. Testosterone and especially DHT stimulate the oil glands in our skin. When women have high blood sugar (usually due to a high carb diet), testosterone levels often increase. As testosterone and DHT increase, so does the sebum production which can clog pores and trigger breakouts, especially along the jawline and chin. Low progesterone exacerbates this situation still further because progesterone is important for slowing the conversation of DHEA to testosterone.

Ensuring an adequate level of progesterone in perimenopause can go a long way to keeping acne away. The unpredictableness of progesterone during these years is often a significant contributor to acne. After menopause, ensuring sufficient estrogen and progesterone will help keep skin healthy and strong.

Pesky Pimples?

Sadly, it’s not just hormones we have to watch out for… Other factors can also play a role in adult acne:

  • Stress: Feeling overwhelmed? That stress hormone, cortisol, can also trigger breakouts. When we're stressed, our bodies go into fight-or-flight mode, which can lead to an increase in cortisol production. Cortisol can stimulate the oil glands in our skin and also weaken the immune system, making us more susceptible to bacteria that contribute to acne.
  • Diet: Sugary treats and processed foods might be tasty, but they can wreak havoc on our skin. Sugary foods cause spikes in blood sugar, which can lead to inflammation throughout the body, including the skin. Processed foods are often high in unhealthy fats and refined carbohydrates, which can also contribute to breakouts.
  • Skincare routine: Harsh scrubs and too many products can irritate our skin, making things worse. Harsh scrubs can strip away the skin's natural oils, leading to dryness and irritation. This can actually make your skin produce more oil to compensate, creating a vicious cycle. Using too many products can also clog pores and irritate the skin.

Skin Support

Now, let's get down to the good stuff - what can we do?

  • Talk to a dermatologist: They can help assess your unique situation and recommend the best course of action, whether it's topical treatments, birth control adjustments (if appropriate), or other options.
  • Chill out: Easier said than done, but managing stress through exercise, meditation, or spending time in nature can work wonders for both your skin and your well-being.
  • Eat clean: Focus on a balanced diet with plenty of veggies, some fruit, plenty of protein and whole grains. Limiting sugary and processed foods can also help.
  • Simplify your skincare: Stick to gentle cleansers and moisturizers. Look for products that are non-comedogenic, meaning they won't clog your pores. To better understand different skincare options, check out this blog on all things skin!
  • BHRT: Progesterone supplementation will help decrease testosterone levels by slowing the conversion of DHEA to testosterone. Estrogen will help the skin cells be healthy and supple, more able to defend against bacteria.

It’s Not Spots, it’s Lines!

For some women, it’s not adult acne that bothers them, it’s the (often sudden) increase in fine lines and wrinkles that can occur during perimenopause that gets to them!

During perimenopause, estrogen levels do start to drop and this can cause dry, thinning skin. This can also lead to wrinkles and age spots on the face. Decreased estrogen levels can cause other skin issues such as eczema or psoriasis flare-ups. Another type of skin change during perimenopause is thinning of the skin which occurs due to decreased collagen production in the body. This results in sagging and wrinkles appearing on the face as well as other areas such as hands or neck.

If you’re free from acne, but worried about fine lines, there are options! We wrote about skin care options in this blog on all things skin! But, we also covered how you can use Silky Peach cream on your face (as well as your vulva) to help with fine lines and wrinkles!