Having graduated from perimenopause to menopause and proudly now to postmenopause, I’m no longer a slave to the vagaries of hormonal fluctuations. The postmenopausal chapter has issues of its own (lacking enough hormones to fluctuate), and I have to say — actually, I don’t have to say, but I will because we don’t talk about it enough — I miss my periods. Not the cramps, or the inconveniences, or the crankiness. But for me (and I know well it’s not the same for everyone), I miss the predictability, the profound, primal suggestion of fecundity, the monthly relief of going with the flow.
On the other hand, the hormonal fluctuations I do not miss: the flood of tears at a laundry commercial, the burning rage at an overdone burger. A relatively brief stint on a low-dose birth-control pill got me through the worst of it.
Hormonal havoc wears many hats, like the aforementioned mood swings — and hormonal acne is one of the least flattering. A reader approaching a big birthday asks for help treating the issue.
Q: I’m about to turn 30 this year, which feels scarier than it has to be. I never used to have problems with my skin, but it seems to be becoming more sensitive to hormonal fluctuations and I’m getting breakouts regularly. I’m wondering if you have any ideas for how to manage hormonal acne before it flares up.
A: Dear reader, please come on up here and sit on Val’s old, wrinkled knee. I remember that turning 30 can seem like a big deal, but in hindsight — of which I now, at 72, have plenty — my 30s were both challenging and rewarding in equal measure. And bottom line, waaay easier than my 20s. Be there for it!
As for your complexion issues, I turned for advice to two excellent dermatologists.
The reality is that flare-ups, which often appear on the jaw and chin, are to be expected, said dermatologist Brooke Jackson, M.D. We don’t cure hormonal acne, but we can manage it. For managing it at home, there are lots of treatment options. Among the suggestions that seem uniformly helpful, says Jackson, are a couple of dietary changes: Avoid dairy products and highly processed foods, as both can promote inflammation. Especially keep this in mind when you might be experiencing premenstrual cravings, which often include dairy and sugar. You might try the over-the-counter prescription-strength retinoid (vitamin A–derived anti-acne ingredient) adapalene, found in Differin Adapalene Gel .01% and La Roche-Posay Effaclar Adapalene Gel .01%. Remember to use a pea-size amount only and to ease into it with gradual use at least every other night. You also might add a salicylic-acid cleanser, like the Cerave Renewing SA Cleanser, to your routine. And be patient, said Jackson. Don’t be tempted to stop and start different products when there’s no visible improvement right away. Topical treatments typically take six to eight weeks to start to work.
“You’re spot-on about thinking ahead when it comes to acne management,” said dermatologist Estee Williams, M.D. A good way to help prevent hormonal breakouts before they occur is to ensure that your menstrual cycle is normal and regular. Excessively spaced-out periods or irregular cycles suggest an underlying hormonal imbalance, which usually can be remedied with birth-control pills. Both Williams and Jackson suggest that prescription oral spironolactone, which suppresses the androgen hormone, can work very well in the right patient to reduce hormonal acne. If you’re more comfortable with a topical treatment only, and your symptoms are mild, you might talk to your doctor about prescription clascoterone cream 1 percent, a new topical treatment Williams says might be worth a try along with a retinoid. She also suggests the less invasive strategies of sipping spearmint tea, decreasing both sugar and alcohol intake, and making sure to eat lots of orange and red fruits and vegetables, all rich in vitamin A.
“Make an appointment with a board-certified dermatologist so that you can be examined and so that a doctor can construct a treatment plan based on your specific needs,” Jackson advised.
And if you can’t, for some reason geographical or otherwise, get to a dermatologist in good time? There are various online options, including Curology, that offer assessments with a doctor or nurse practitioner and individually tailored prescription treatments.
Valerie Monroe was beauty director at O, The Oprah Magazine, where she wrote the monthly “Ask Val” column for nearly 16 years. Now she writes the weekly newsletter How Not to F*ck Up Your Face. Her goal continues to be to shift our thinking in the beauty arena from self-criticism to self-compassion and to learn how to be loving witnesses to ourselves and one another as we age.
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