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Hormonal Acne in Menopause

Podcast Episode 15 transcript.

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Androgens are a group of hormones, including testosterone, usually associated with male characteristics. However, androgens are reproductive and growth hormones produced in male and female bodies in different quantities. In women, androgens are made in the ovaries, adrenal glands, and peripheral tissues like the skin.


It is thought that in post-menopausal women, ovaries remain producing androgens up to around ten years after menopause. 


While oestrogen concentration decreases abruptly to undetectable levels, androgen concentration decreases gradually. This may lead to symptoms like acne, increased facial hair growth, like those dreaded chin hairs, and worsening scalp hair loss.


Adult acne tends to happen mainly around the jaw, chin and sometimes around the mouth.


Acne lesions produce post-inflammatory redness, pigmentation, and sometimes scarring, so avoid squeezing or picking your face.


  1. There are four stages in the formation of a spot:

  2. First, there is Excess and unbalanced sebum production under the control of androgens

  3. Then, the skin over the spot thickens a process called hyperkeratosis. This is followed by a particular strain of bacteria called C. Acnes entering the follicle.

  4. Lastly, the body fights this infection, producing chronic inflammation.


We know that androgens play a significant role in acne flare-ups in perimenopausal and menopausal women. It's not the number of androgens that causes acne but that the sebaceous glands in some women are hypersensitive to androgens. As we have discussed, this causes their sebaceous glands to enlarge and overproduce sebum, which starts the formation of acne lesions.


Managing Hormonal Acne is an ongoing process that requires patience—and a lot of it. Acne is a very frustrating condition and quite distressing for many women. Whatever treatments you choose to trial, medical or not, managing acne will take time, and it's usually around 12 weeks before you see if what you are trying is having an effect. There is no overnight treatment for acne.


So now, for the best bit, how do you manage hormonal acne?


Treatment is not a one-size-fits-all and usually depends on the severity of acne and skin type. Consistency is key.


Medical Management might include spironolactone, which blocks androgens, hormonal therapy, antibiotics, and isotretinoin. All these medications can be very effective, but they come with contraindications and risks that are not to be taken lightly, so it's important to have these discussions with your doctor or dermatologist.


Again, topical medical treatments can be very effective. However, they must be chosen carefully during menopause and used sparingly, as they cause dryness and irritation. Menopausal skin already tends to be more sensitive and dry.


Some women decide not to go down the medical route and manage their acne using skincare, supplements and treatments.


Skincare is very important whether you are using medical treatment or not. A good consultant routine must be carefully selected to avoid irritation and dryness. 


Physical scrubs should be avoided, as they can spread infection and irritate the skin. Tanning should also be avoided, as it can cause hyperpigmentation. Heavy, oil-based foundations should be avoided and replaced with water-based cosmetics.


Ingredients like salicylic acid, Niacinamide, and retinol can be carefully included in your routine while maintaining hydration and preventing dryness. Adding ingredients like hyaluronic acid and monitoring your skin daily can also maintain hydration and prevent dryness. Using an SPF daily, morning and night, is also essential.


Supplements like zinc and probiotics have been shown to improve the skin barrier and acne. The diet also plays a role in blemish balance. Consider adopting an anti-inflammatory diet rich in fruits, vegetables, and omega-3 fatty acids. Hydration is vital, too—water helps flush out toxins and keeps your skin looking radiant.


Several studies show that weight loss, exercise, getting enough sleep, smoking cessation, a healthy diet with low sugar content, and avoiding milk can all help to reduce acne. Stress management plays a pivotal role in hormonal balance. Incorporate relaxation techniques into your daily routine, whether meditation, yoga, or a simple walk in nature.


We must stress the importance of seeking professional advice if you are struggling or unsure what to do about your acne.


Remember that you're not alone in this journey. Many women are navigating the same challenges, and with the right approach, you can continue to improve your skin and keep it in the best condition.


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