The Invisible Skin Struggle Women Face as They Transition to Middle Age

Menopause may be best known for hot flashes and mood swings, but it can also come with many other less talked about symptoms, including skin changes.

Studies have shown that most women report skin problems as they age, particularly one they may not have experienced since adolescence.

Dr. Amy Wechsler, a double board-certified dermatologist and psychiatrist in Manhattan, specializes in treating perimenopausal and menopausal women struggling with acne, sometimes for the first time in their lives.

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“For them, it’s just horrible because they’ve never had it; it’s very strange to them,” he told News Digital. “There’s a lot of psychological overlap and effects of acne on people in terms of decreased self-esteem and self-confidence, and it causes anxiety and sometimes depression.”

Midlife Paradox

According to the doctor, for most women, there are two “acne peaks”: one during adolescence and another in perimenopause and menopause.

“There are many women who have been acne-free for 20 years and then around age 40, they start having breakouts again,” she said. “And this time it’s centered around the lower part of the face, chin and jaw, which is where hormonal acne tends to occur.”

“Women often come to me, ages 35 to 55, complaining of wrinkles and pimples, and they feel too young for their wrinkles and too old for their pimples,” she said.

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While men who have a genetic predisposition to acne may continue to have breakouts into adulthood, for women, “there is a particular hormonal component from the late 30s to early 50s, around perimenopause and menopause.”

Breakouts usually go away when menopause ends, Wechsler said.

Some studies have suggested that taking GLP-1 medications for weight loss and diabetes could increase the prevalence of acne, but others have not identified a link.

“I see patients all day long who take GLP-1, so I imagine if there was a link, I probably would have noticed something by now,” Wechsler said.

Treatments for acne in adults

The main remedy for aging-related acne is taking hormone-related medications.

“Spironolactone is specific for hormonal acne in women,” Wechsler said. “It blocks testosterone from binding to testosterone receptors on the lower part of the face.”

Taking hormone replacement therapy or a birth control pill can also help with acne, she noted, but treatments will vary depending on each person’s situation.

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“Some people come in with just little blackheads and whiteheads, and they may not need anything oral,” he said.

“That’s when we might prescribe something topical, often a retinoid under the brand names Differin, Retin-A or Tretinoin. These tend to be very helpful for smaller pimples. Plus, they’re anti-aging, which is good. They produce collagen.”

Wechsler said he sometimes prescribes a low dose of doxycycline, an antibiotic that also works as an anti-inflammatory.

“If the acne is different or covers more of the face or upper face, we sometimes try a low dose of Accutane,” he added. “It really depends on the individual and the severity of the acne.”

proactive defense

While genetics and hormones can contribute to acne, stress can also affect the skin, the doctor said. One of the best ways to address this is to get enough sleep, which is the “anti-inflammatory” time when the body recovers.

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“Unfortunately, many Americans don’t get enough sleep,” Wechsler said. “Adults need between seven and a half to eight hours. That’s when the stress molecule, cortisol, is at its lowest level, and when all the healing molecules, like beta-endorphins, growth hormones and oxytocin, are at their highest.”

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In addition to sleep, the doctor recommends looking for ways to reduce cortisol levels during the day to help reduce stress levels, such as exercising, getting fresh air, connecting with friends, and stretching or breathing deeply.

For acne-prone people, Wechsler also stressed the importance of choosing the right skin care products.

“It is very important that all products are non-comedogenic and oil-free,” she recommended. “That means the company has tested the product and it won’t clog pores or cause breakouts.”

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It’s also important to wash your face after exercising and at the end of the day, and never go to bed wearing makeup, the doctor advised.

For those who are bothered by acne and haven’t seen results after two months of taking over-the-counter products, Wechsler recommends seeing a dermatologist for help.