Night sweats, hot flushes, irritability and weight gain are some of the most talked about symptoms of the menopause, but there’s one that you may not have even realised was linked to this time of change, and that’s acne!

We quizzed Etre Vous Expert Dr Emmaline Ashley, on all things menopausal acne, from how it appears to how to treat it…

What is menopausal acne? 

Menopausal acne is a complex issue, but hormonal imbalance is the major contributing factor. As women age there is a decline in the female reproductive hormones, oestrogen and progesterone. The decline in these hormones leads to the cessation of menstruation that defines menopause, but before this cessation women tend to be subjected to a range of issues, all controlled by their changing hormone levels.

Hormonal acne tends to present as bumps under the skin or cysts, and usually forms along the jawline as opposed to the oily areas of the face like the T-zone, which is where non-hormonal acne tends to develop.

What’s happening to our hormones during menopause?

There is a long period of transition leading up to the menopause called the perimenopause. It encompasses between two to eight years, plus the year after menstruation has completely stopped.

During the perimenopause period, oestrogen levels will fall very quickly while other sexual hormones, known collectively as androgens, fall more slowly. This imbalance in the levels of oestrogen in comparison with the other androgens leads to an excess of androgens, most specifically testosterone. This triggers the sebaceous gland to produce excess sebum leading to acne formation.
 

What makes menopausal acne worse?

Other common triggers for acne that may be worsened during this transitional time of perimenopause include things like stress (which is incredibly common during this period of major change) and poor sleep.
 

How can you treat menopausal acne? 

Menopausal acne can be treated in the first instance with a good skincare routine. Skincare ingredients like retinoids work wonders at keeping pores clear of oil, dead skin and dirt and help reduce inflammation. Other acne-fighting powerhouses you should include in your regime are ingredients like benzoyl peroxide, which stops spots from forming by keeping pores unclogged and has antimicrobial effects to the tackle the bacteria that contributes to acne formation. Finally, azelaic acid is a great well-tolerated ingredient that has anti-inflammatory, pore clearing, and antimicrobial effects.

Hormone replacement therapy (HRT) has been incredibly beneficial for women going through menopause and has the benefit of tackling all the symptoms related to this transition, as well as the added benefit of improving the skin. Spironolactone, which should be prescribed under the guidance of an experienced dermatologist, is an oral medication that is quite useful in blocking the effects of excess androgens and thus improving the appearance of the skin.

In-clinic treatments such as chemical peels are a must for acne, particularly salicylic acid, mandelic acid, and glycolic acid peels. They work by increasing cell turnover and exfoliating the skin, which unclogs pores and improves the appearance of acne scars too. However, it’s worth noting that hormonal shifts during this time also leave skin thinner and sensitive, so it’s important to let your practitioner know you’re going through the perimenopause. There is also some evidence that LED light therapy may be beneficial for acne: blue light is said to help destroy the bacteria that causes acne, while red light has an anti-inflammatory effect.