The skin changes in various ways during the menopausal transition and unfortunately incidents of menopausal acne are on the rise. Research is now finding that between 20-40% of menopausal women are struggling with acne. Acne does not reduce your quantity of life but it can reduce your quality of life. Some women withdraw as they are embarrassed by the look of their skin and other women find the acne physically uncomfortable, as cystic growths can be painful.
There are various potential underlying causes:
With hormonal changes during the menopausal transition, estrogen levels fall rapidly while androgens (testosterone) decrease gradually causing a relative androgen dominance. For a small number of women (roughly 7%) it is an elevated androgen result but for most women it's a ratio imbalance of more androgens to estrogen causing a relative androgen dominance.
Other hormonal causes contributing to acne:
Relative androgen excess can also cause hirsutism (facial hair in women) and increased terminal hair growth (longer facial hair). It can also cause alopecia (head hair loss)
Metabolic syndrome and insulin resistance is another major cause of acne. Insulin promotes sebum production and epithelial cell proliferation. It is also linked with the development of skin tags. Elevations in insulin-like growth factors in combination with DHEA produce more intense acne outbreaks.
Stress aggravates acne as stress releases melanocortins and corticotrophin-releasing hormones and these hormones increase the expression of 3beta hydroxy-steroid dehydrogenase mRNA, this enzyme converts DHEA to testosterone, further promoting an androgen dominance.
The imbalanced skin microbiome. Too many of the bad skin bacteria and not enough of the good ones cause acne to develop. Cutibacterium acnes known as C. acne promotes acne development, while S.epidermidis inhibits the growth of c.acne. Biofilm formation around the skin microbiome can lead to the persistence of stronger and more pathogenic bacteria strains such as staphylococcus aureus.
Lifestyle tips to include:
Lifestyle tips to avoid
Tests to consider:
Supplements to consider:
Cosmetic procedures to consider: