Menopause and Acne
Acne is often long forgotten after the pubescent years. Sufferers of acne during puberty generally experience this condition as a psychological stressor. Many times acne negatively affects self-esteem, confidence and the perception of beauty. Richard G. Fried, author of "Healing Adult Acne," notes that acne during menopause can be equally distressing. Losing the ability to procreate, changes in body fat distribution and sexual function can make a woman feel emotionally burdened during this transition period. Fried notes that menopausal acne only adds to the psychological stress.
Merck Manuals Online Medical Library defines acne vulgaris, the most common form of acne, as the formation of whiteheads, blackheads, pustules, nodules and/or cysts. The hair follicle and associated sebaceous gland becomes obstructed by plugs of sebum and dead skin cells. In some cases, the plugged follicle can be acted upon by normal skin bacteria, which can cause inflammation.
Bacteria will metabolize fats within the sebum and their products, irritating the wall of the hair follicle. When follicles become so inflamed that they rupture, they release inflammatory lipids, bacteria and dead skin cells into the tissue so that painful nodules and cysts appear.
The most common trigger for acne is puberty, which coincides with the beginning of adrenal hormone production. The 2005 "Experimental Dermatology" article states that this period is known as adrenarche. In addition to producing the stress hormone cortisol, the adrenal glands also produce androgens.
Androgens are precursors to testosterone in the body. The 2005 article reports that androgens increase the size of oil-producing glands in the skin, stimulates the production of sebum and increases dead skin cell proliferation. All of these promote acne formation. The article further notes that acne-prone skin is more sensitive to the effects of androgen than non-acne involved skin.
The reproductive years of a woman's life are controlled by the hormones estrogen, progesterone and testosterone. Estrogen and testosterone are opposing hormones. Prior to menopause, estrogen balances testosterone. Menopause is marked by the cessation of a menstrual bleed for greater than one year.
A progressive decline in estrogen and progesterone production occurs in the 5 to 10 years before menopause. The Mayo Clinic Online Library notes that low levels of these hormones result in symptoms such as irregular periods, vaginal dryness, hot flashes, sleep disturbances, mood swings, increased abdominal fat and thinning hair.
"Healing Adult Acne" author Fried notes that while common symptoms such as hot flashes and vaginal dryness are commonly associated with menopause, acne rarely is. The decline of estrogen during menopause leaves the androgens, like testosterone unopposed, and therefore able to stimulate tissue.
The progressive decline in estrogen production that occurs during menopause is also complemented by increased production of androgens by the adrenal glands. Androgens promote acne development. The 1991 Cutis article cited by the Mayo Clinic notes that post-menopausal acne usually occurs in darker-skinned, formerly oily-skinned, large-pored women who generally did not experience adolescent acne. Additionally the acne is associated with other symptoms of androgen dominance, including chin and upper lip hair growth.
While some types of acne can be very difficult to treat, it appears that menopausal acne is effectively treated by common conventional acne medicines. The Cutis article notes that topical tretinoin, a synthetic vitamin A product, is very effective.
In addition to other conventional therapies, Fried notes that menopausal acne subsides in most women as the hormones balance out.
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