It’s Not Puberty, It’s Perimenopause. Let’s Talk About Acne.

3 minute read

By: Sharon D. Malone, MD|Last updated: November 2, 2022
Asian woman applying dots of cream to cheek while looking in the mirror, wearing towel around her hair. AW450

As if the indignities of perimenopausal hot flashes, brain fog, and mood swings weren’t enough, now we have to deal with the possibility of acne and wrinkles? Just like in puberty, perimenopausal skin is subject to periodic acne, even in women who never experienced outbreaks as a teenager. Why is that? During perimenopause, our hormones are all over the place. Imbalances between the estrogen and testosterone produced by the ovaries are common. The more testosterone relative to estrogen, the more oily the skin becomes, and the more prone you are to acne eruptions that tend to crop up on the face, chest and back.

Unsurprisingly, the same remedies that work for teenagers work for perimenopausal people.  Since the issue is a hormonal one, a hormonal remedy usually does the trick. Low-dose birth control pills have been used for decades for teen acne, and they’ll work now, too. The estrogen in oral contraceptives decreases the circulating testosterone by stimulating the production of SHBG (Sex hormone binding globulin). The SHBG binds the testosterone in the bloodstream and makes it less available to wreak havoc on your skin. Estrogen also has an anti-inflammatory effect, which can also help reduce facial acne and promote healing. Low-dose birth control pills will also provide relief from your other perimenopausal symptoms.

But what about those wrinkles? Can estrogen help with that? Glad you asked. The 2022 North American Menopause Society’s position statement affirms that “Estrogen therapy increased epidermal and dermal thickness, increased collagen and elastin content, and improved skin moisture, with fewer wrinkles.” Pretty great, huh? And, you already know this, but I’ll say it again: Taking care of your skin should always be a priority. Wash your face, moisturize, don’t smoke, and avoid overexposure to the sun with a good sunscreen (use it daily!) and keep a good hat handy. 

Finally, remember this: We can’t turn back the hands of time. But really, who wants to? We’ve earned every line on our faces and every gray hair on our heads. That said, taking good care of your body’s largest organ is never a bad idea. You’ve got questions. We’ve got answers. We got you.

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