I am in my early 40s and experiencing perimenopausal symptoms, the worst of which seems to be acne! I’ve tried many changes to my skin-care routine and nothing is helping. My dermatologist suggested that the only treatment is Accutane, which I want to avoid. However, she also referred to it as likely “hormonal” acne, which makes me wonder if HRT would be helpful in treating this specific symptom. Is there any data on this?
— Anonymous
Hormonal acne is a common symptom for women in their 40s. It occurs because estrogen levels are rising and falling as they have throughout our reproductive lives, but they rise higher and fall lower than in our peak reproductive years. However, testosterone and other male hormones, collectively called androgens, remain about the same. As a result, at certain times in the menstrual cycle, androgens may be higher relative to estrogen than was the case in the past. This can result in acne.
Birth control pills containing both estrogen and progesterone have been shown to reduce hormonal acne by maintaining a stable level of estrogen and reducing androgen production. Most women can safely take birth control pills until the average age of menopause (51.4 years).
Given that hormone replacement therapy is estrogen and progesterone combined, it would stand to reason that it, too, might treat hormonal acne. However, HRT is not recommended for the treatment of acne.
If birth control pills are not an option for you, another medication called spironolactone may be an alternative. Spironolactone works by blocking testosterone from acting on receptors in the skin. It has been used off-label for years, but recent studies confirm that it is effective in managing acne in women. The main side effects include increased urination and elevations of potassium levels in the blood, but this occurs mostly at high doses. Most of my patients tolerate spironolactone quite well.
The takeaway: Birth control pills, but not HRT, have been shown to effectively treat hormonal acne. If birth control pills are not an option, spironolactone may be a reasonable alternative.
Community Guidelines
Log in