Stephanie was asked to put together a presentation at the last minute for an upcoming board meeting. Though it’s a fantastic opportunity, one she has been waiting for, this new responsibility has also added to her stress level and taken a big chunk of time out of her already busy schedule. Sure, she'd had more hot flashes in the past few days, but whatever... she handled it, sweated through it, and moved on in her focus and work.

So the day comes, and Stephanie is ready. Prepared, confident, and ready. 100%. She woke up early, drank a big glass of water before her first cup of coffee and was feeling amazing about the day ahead until…

She looked in the mirror and saw a big, red, swollen bump on her chin. A double-take and then a close-up only confirmed her dread and suspicion: a cyst. Painful and hot to the touch, this one was deep… and mad.”Grrreat,” thought Stephanie, “Important day, huge zit right on my face… that I can’t get to and pop. Aghhhh.”

Stephanie is 52.

Acne and menopause? The results are… vague

A couple of years ago, a review of six studies called Emerging Issues in Adult Female Acne was released in The Journal of Clinical and Aesthetic Dermatology. And of course, as science and the medical industry "catch up" to menopause, the results are inconclusive and "more research is needed."

Despite the fact that middle-aged women have long complained about a resurgence of adolescent acne, the incidence of peri/menopause-plus-acne wasn't studied specifically. Up until recently (the article was released in 2017) all women over 25 years old who reported an incidence of adult acne were studied together. Further subdivision (women 25-44, and then women 45 and up) for some additional study wasn’t really suggested until a couple of years ago. 

What was clear?

Adult acne is more prevalent in women than in men across all age groups. One study also noted that depression was more common in women experiencing adult acne than in men (specifically, 10.6% in women versus 5.3% in men).

It was also noted that women seek treatment for this skin disease across age groups as well. 

Beyond the physical

Does adult acne bring the same embarrassment and self-consciousness it might have done in puberty? The best and fastest thing to do is to check in with yourself about this question. Does this acne affect me on a psychological level? Is my quality of life being affected? If so, how?

A few prompts for reflection: Am I...

• Self-conscious to the point I am limiting my social interaction and time with friends, family, and in groups? 
• Withdrawing from activities and relationships? 
• Staying at home more when I have breakouts?
• Depressed? And am I more depressed when I’ve got a breakout?

On androgens and estrogens

Androgens and estrogens are two of the major types of hormones that regulate the sebaceous glands in the skin system. (Any of this ringing any middle-school science class bells?) 

In the stages of menopause, we’re fairly familiar with the fact that estrogen levels are decreasing over time, so that is one major hormone that is in a state of change. Check.

The major androgens are testosterone, androstenedione, and dehydroepiandrosterone (DHEA). These are produced in the adrenal glands and the ovaries in women. 

According to this study, most of the decrease in the androgen testosterone happens in women between the ages of 20-40 years old. No further decrease happens in menopause, but slight increases may occur. Could this be considered a “fluctuation”? It’s not unreasonable to think so.

Hormone fluctuations, plus stress, may increase the frequency of breakouts in menopause. Speaking of stress...

Stress and acne flare-ups

Would it really surprise you to find that chronic stress is one of the primary aggravating factors in adult acne? Given the levels and intensity of responsibilities that women work with on a daily basis in modern life, it isn’t much of a "revelation," in our minds.

Continual stress increases hormone levels. Increased hormone levels can lead to increased oil production in the skin, starting in the sebaceous glands.

Painful cysts deep in the skin… Ow!

So what’s the deal with cysts vs. pimples? Cysts are usually buried deep in the dermal tissues, where a pimple is a clogged pore that is closer to the surface of the skin. Many times cysts are reported to be located in the lower third of the face (jawline and chin).

More than a clogged pore, a cyst is often attributed to infected, clogged pores, which then develop bacteria and go deeper into the skin. A cyst can be itchy and painful, and, a gross bonus here, it’s filled with pus. If a cyst bursts, the infection can spread and lead to more breakouts. Ugh.

If you think you may have cystic acne, consider putting a call out to your doctor (or call our Telemed docs) to talk.

How can you level-up your anti-inflammatory lifestyle?

What you can do is review 4 major pillars in your life and health: nutrition, hydration, exercise, and stress levels. If you can improve any or all of these foundational aspects, you’ll also be better flushing your system and promoting balance and regularity in all of your body and mind’s systems. That’s a big win. 

A few small steps to improvement:

• When can you drink a little more water? Instead of an 8 oz glass, maybe you switch to a 10 or 12 oz tumbler and drink the same number of glasses, but, sneaky-sneaky, you get more ounces in? Or, maybe you try to drink 4-5 ounces before you’re fully awake in the morning, while the kettle is heating?
• One more vegetable. Even one more bite of a vegetable will count. Two bites of leftover cauliflower mash? A few cherry tomatoes or snow pea pods will also work here. How about splurging a little on a pre-made side dish from the deli you would never make for yourself? It’ll make a difference to get that little extra veg into your body to fuel it.
• Fruit before or with a processed snack or candy? Perhaps it’s not about substituting, but about adding in. Do you have an afternoon ritual that must include salty chips? Great! Keep it! And how about a little fresh fruit to go with it? A couple of berries, a tangerine or satsuma orange pack a zippy-fresh, nutritional punch.
• When can you do two more minutes of new movement in your day? Stretch or try a wall squat while the kettle is heating or the coffee is brewing. Alone in an elevator? How about stretching both of your arms overhead or a gentle twist at the waist, right and left? Sure, you can still be holding your phone. Absolutely. And... where else can you eek in some new movement?

A final word about skincare and cleansing

According to the Mayo Clinic:

• Wash your skin twice each day with a gentle cleanser
• Shower after you exercise to remove oil and sweat that can trap bacteria and dirt
• Avoid touching or picking at acne-prone areas

What’s missing here? Moisturizer!

A decrease in estrogen is a big part of how the skin dries, thins, and changes. Your skin’s moisture-level is an important factor here. So find a good one that your skin and body can just drink in and pat it on to your freshly washed, still-damp skin with pride and pleasure. And sunscreen... don't forget your sunscreen.

The largest organ of your body is your skin system, and it’s working doing a tremendous amount of work for you day in and day out. Take a moment to find some appreciation for it, see if you can be grateful, and see how you might continue to take good care of your skin.

What else are you noticing in your skin? What's surprising, maddening, confusing, or even hilarious about your menopause path? Join us in the Gennev Community Forum to share with other women on the same path.