Question

I am starting to have pre-menopausal symptoms, including acne. It has affected my back and chest and part of my face, around the mouth and nose. It starts as bumps that itch. What can I do? It's embarrassing.

Answer

As one enters menopause, ovarian function declines, and is eventually minimal, which means a loss of estrogen. Estrogen is considered the primary female hormone, and serves to counteract what are considered "androgenic" (masculine) symptoms such as acne. Therefore, your doctor might want to consider giving you estrogen. This can be accomplished in two ways.

The first way is using birth control pills that are often given at the time of peri-menopause (or 'around menopause'). The birth control pills that appear to help most with acne are the ones that have a relatively higher ratio of estrogenic activity. Examples are Ortho-Cyclen and Ovcon.

The second way of getting more estrogen is with what is known as 'hormone replacement therapy' (HRT). This also consists of taking estrogen and progesterone by mouth, although standard hormone replacement therapy has significantly less hormone dosage than birth control pills. There are a number of brand name estrogens that can be given by mouth, and you may want to discuss with your doctor whether the best type of progesterone would be one called Prometrium, which is less androgenic than the alternative, which is called medroxyprogesterone acetate.

Your doctor should advise you as to whether birth control pills or hormone replacement therapy would be best for you in using this approach to improve your acne.

The use of hormone replacement therapy must be reconsidered in the light of recent findings from the Women's Health Initiative Study. The potential risk of breast cancer and other side effects has been determined fairly conclusively - see link below "Hormone Replacement Therapy (HRT) - Now What to Do?" (Robert Griffith, editor)

Links

• Hormone Replacement Therapy (HRT) - Now What to Do?