When you're a teenager and you get pimples, your surging hormones are the culprit. But you might not realize that if you're a woman and get acne at menopause, your hormones also are the culprit. Acne develops when the skin responds to hormonal shifts in your body, and those shifts can occur at menopause as well as at adolescence. Hormonal and antibiotic treatments can curb your menopausal acne.
It's the sebaceous glands—the glands deep in your skin that keep it lubricated by making oil—that respond to hormonal shifts in your body. Specifically, androgens—or male hormones—stimulate oil production in your sebaceous glands. At menopause, your levels of the female hormones estrogen and progesterone decline, allowing your androgen hormones more influence over your sebaceous glands. Oily skin causes pimples.
Some acne at menopause might yield to over-the-counter acne products, especially if they're designed to be less irritating to the skin. But in many cases, you'll need help from your physician, potentially your ob-gyn or your dermatologist. Prescription medications can help put an end to hormonal menopausal acne. Hormone replacement therapy, for example, can treat other menopausal symptoms that commonly appear with acne, including thinning hair, mood swings and absentmindedness. The medication spironolactone, a diuretic, also has anti-androgen effects and can be prescribed for menopausal acne.
Both spironolactone and hormone replacement therapy carry side effect risks. A major study released in 2002 showed that hormone replacement therapy potentially can raise your risk for heart disease, and many physicians now prescribe only the lowest possible dose to control menopausal symptoms. Spironolactone, meanwhile, can cause lightheadedness, drowsiness and confusion, and drinking alcohol can accentuate these side effects. Both types of medications can cause post-menopausal menstrual-type bleeding.
Several other treatment options might help clear your skin of menopausal acne. According to the American Academy of Dermatology, oral antibiotics can effectively help your body kill bacteria that cause acne. Your dermatologist might prescribe an oral antibiotic together with a retinoid such as Retin-A, which clears your pores and offers the added bonus of improving your wrinkles.
According to women's health expert Dr. Christiane Northrup, diet and skin care can help improve acne at menopause. She suggests avoiding foods that are high in refined carbohydrates because these can raise your insulin levels, which in turn can raise your androgen levels. If you're overweight, you should try to lose weight, she says. And she recommends applying tea tree oil to pimples that are starting to form.