The invisible skin struggle women face as they transition into mid-life

Menopause might 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 a majority of women report skin problems as they age — in particular, one they might not have experienced since their teen years.

Dr. Amy Wechsler, a dual board-certified dermatologist and psychiatrist in Manhattan, specializes in treating perimenopausal and menopausal women who are battling acne — sometimes for the first time in their lives.

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“And for them, it’s just horrible because they’ve never had it — it’s so foreign to them,” she told Fox News Digital. “There’s so much psychological overlap and effects of acne on people in terms of lowering self-esteem and self-confidence, and causing anxiety and sometimes depression.”

The mid-life paradox

For most women, there are two “peaks of acne” — one during adolescence and another at perimenopause and menopause, according to the doctor. 

“So there are many women who have been clear of acne for 20 years, and then, starting at around 40-ish, they start to break out again,” she said. “And this time it’s centered around their lower face, chin and jawline, which is where hormonal acne tends to occur.”

“Women often come to see me, age 35 to 55, complaining about 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 for acne may continue to break out into older adulthood, for women, “there’s a particular hormonal component from the late 30s through the early 50s, around perimenopause and menopause.”

The breakouts usually stop when menopause is finished, Wechsler said.

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

“I see patients all day long who are taking GLP-1s, so I would imagine if there were a link, I probably would have picked up on something by now,” Wechsler said.

Treatments for adult acne

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

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

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

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“Some people come in with just small blackheads and whiteheads, and they might not need something oral,” she said. 

“That’s when we might prescribe something topical, often a retinoid with the brand names of Differin, Retin-A or Tretinoin. Those are often very helpful for the smaller pimples. Also they’re anti-aging, which is nice. They grow collagen.”

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

“If the acne is different or covering more of the face or the upper face, sometimes we’ll try a low dose of Accutane,” she added. “It really depends on the individual and how bad the acne is.”

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 optimal sleep, which is the “anti-inflammatory” time when the body heals.

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

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

For people who are acne-prone, Wechsler also emphasized the importance of choosing the right skincare products.

“It’s really important that all products are non-comedogenic, or oil-free,” she recommended. “That means the company has tested the product and that it will not clog your pores and cause pimples.”

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

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