Menopause is a time of fundamental change, and not all of them are welcome. You might have thought you’d finally left behind the woes of acne in your youth, but it’s since reared its ugly head again. Dealing with menopausal acne is particularly difficult, not just for the stress it can cause, but because your skin is significantly more fragile. This means your go-to products could be irritating and no longer applicable for your skin.
Why is it happening?
During menopause, your skin goes through a lot. It loses collagen and is affected by the drop in estrogen women experience as their hormone levels shift. New York dermatologist Michelle Henry, MD explains how the opposite of estrogen, androgen, is the main culprit of menopausal acne.
“Acne during menopause is fairly common due to hormonal fluctuations that occur at this stage of life,” Dr. Henry says. “As estrogen levels drop, androgens like testosterone become more prominent, leading to increased sebum production. This excess oil can clog pores, resulting in acne breakouts.”
Miami, Florida dermatologist Anna Chacon, MD explains that most menopausal women with acne have had to deal with it throughout their lives. “The majority of adult and menopausal women with acne have had persistent or relapsing acne since adolescence,” Dr. Chacon says. “The primary cause is a hormonal imbalance with relative hyperandrogenism; other contributing variables include stress, genetics, cosmetics, dietary changes, and lifestyle modifications.”
When we’re teenagers, our hormones are also in flux, but not in the same ways. That means that the kind of acne older women get isn’t the same and can’t be treated the same as the blackheads and whiteheads of youth. At the same time, our skin becomes more easily broken and harder to heal.
Celebrity aesthetician Nerida Joy explains that teenaged skin can handle a lot more than mature skin. “You can do extractions on a teenager and five days later, you’d never be able to tell they had an extraction,” Joy explains. “On more mature skin that time is almost double just because the healing isn’t going to be happening as quickly.”
On top of that, the products and treatments you might have relied on in the past may no longer be effective for you. “Menopausal skin may be more sensitive, dry, or thin, making it less receptive to acne treatments that were effective during adolescence,” Dr. Henry explains.
As we age, our skin is more sensitive and reactive to common ingredients in most acne cleansers. This means topical retinoids and benzoyl peroxide, despite being two of the most suggested treatments for acne, can be irritating and drying if used in excess. To curb this irritation, Joy suggests using these products only as spot treatment for pimples.
“You really only need half as much as you think you would,” Joy explains. “This way you can still use those effective treatments as a spot treatment without drying and frying your skin.” Medical aesthetician Amy Peterson adds that newer formulations of acne products with benzyl peroxide are gentler than they used to be, “but that should still be a spot treatment and never used all over the face.”
Our skin becomes drier as we age, so it’s important to focus on hydration and products that offer more moisture. “Someone who is generally in their 40s (sometimes older or younger) who is premenopausal, they’ve lived a life,” Joy explains. “That life may often consist of drinking and smoking. So, the slate you’re starting with is often very dehydrated, which will add to the fact that it just doesn’t heal as quickly as when you were a teenager.”
Dr. Henry adds that it’s vital to treat your skin gentler as we age. “Opt for gentle, non-comedogenic cleansers and skin care to avoid irritating the skin,” Dr. Henry says. Additionally, surface dryness can lead to an over production of oil and sebum that exacerbates acne. “If you’re surface dry, you have to get that surface soft and supple,” Joy says. “You can’t heal acne if there is dryness on top. Oil has got to be able to get out and the skin needs to be able to accept its treatment.”
Mature Skin Needs Mature Products
“It can be difficult to find suitable skin-care products for menopausal acne because the skin has different needs at this stage of life,” Dr. Henry says. “Furthermore, many skin-care products are not specifically designed to address the unique hormonal changes that occur during menopause.”
“The majority of anti-acne products are made for the oily skin of adolescents,” Dr. Chacon explains. “Leaving fewer options for the delicate mature skins of the menopausal age group. This makes treatment challenging in clinical practice.”
Skin care and beauty have begun to expand to include the needs of mature skin, but you may ultimately need to consult with a dermatologist or aesthetician to determine what ingredients and products are good for you.
“We’re really talking about feeding the skin,” Joy says. “That doesn’t mean over nourishing. It means keeping it hydrated and able to receive treatment.” Joy suggests avoiding foaming cleansers that are drying, harsh exfoliators, and alcohol-based treatments. Instead, opt for gentle and hydrating ingredients like vitamins P and K. Additionally, products that highlight their hydrating qualities or that indicate they are for mature skin are good to consider.
Lifestyle and Diet Changes
Dr. Henry recommends a focus on over all wellbeing when considering skin health. “A balanced diet, regular physical activity, and stress management (will) promote overall skin health.” Peterson explains that considering a person’s lifestyle and diet can reveal hidden causes of inflammation.
“We talk about their diet, what could be causing inflammation in the skin, the amount of sleep they’re getting, oxidative stress from environmental factors are important to consider as well,” Peterson says.
You also need to remain active. “Movement is medicine,” Joy says. “It helps support circulation and if you have good circulation, you’re going to heal better.” Improving your circulation will not only improve the speed of healing, but also reduce the pins and needles feelings in your extremities and limb swelling.
“What happens when we get older is sometimes we can retain fluid in the tissue and that restricts blood vessels,” Joy explains. “So, you always want to be mindful of correcting and helping circulation.”
Treating the topical aspect of acne is certainly important, but it’s just as vital to address the potential underlying issues, like the disruption in hormones. “You really have to address the sub conditions that are present when you’re trying to treat acne,” Joy explains.
There are hormone replacement therapies, usually an oral pill, that can help lessen the number of the “male” hormone, androgen, by blocking the receptors that produce it.
“Hormone Replacement Therapy (HRT) can help alleviate menopausal acne by addressing the root cause, which is hormonal imbalance,” Dr. Henry explains. “By balancing hormones, HRT may reduce oil production, decrease inflammation, and improve overall skin health. It’s crucial to weigh the potential risks and benefits of HRT with a healthcare professional before starting treatment.”
These treatments will take longer to see results, usually within 3 to 6 months, but address the underlying cause of menopausal acne.