When you think of hormonal skin changes, images of teenagers usually comes to mind. But the skin continues to change as we age, and many of the mid- to later-in-life surprises that show up on the face are also a result of hormones.
The hormone testosterone has a reputation for causing acne and with good reason. It increases the amount of sebum your body produces. (Sebum is an oily substance secreted by the sebaceous glands—glands in the skin that are found on hair follicles.) Conditions that increase testosterone can lead to acne on the face, chest, and other parts of the body.
Acne and PCOS
In PCOS, or polycystic ovarian syndrome, women often have higher levels of luteinizing hormone (LH) and high insulin. Both tell the ovaries to make more testosterone. This hormone imbalance can cause breakouts, especially around the jaw, chin, cheeks, and neck. The acne lesions may not look like a typical pimple and may also feel extra sensitive.
Some other symptoms of PCOS include thinning hair, unwanted hairs, irregular or absent periods, and weight gain. Women well past their teens who have these symptoms should check in with their provider for an evaluation and to discuss the best treatment.
Acne and menopause/postmenopause
Acne has no age limits and can pop up in perimenopause, menopause, and even beyond. In menopause and postmenopause, the ovaries are less active. The sex hormones progesterone and estrogen are low.
Low estrogen causes sex hormone binding globulin (SHBG) to decrease. (SHBG is a protein that binds to hormones and makes them biologically unavailable.) With less SHBG to bind to, free testosterone levels rise and can even become a woman’s dominant hormone. This increased testosterone leads to the production of more sebum, which results in acne.
Acne with high progesterone
High levels of progesterone can also flare up acne in some women. Progesterone may be a natural diuretic. However, too much progesterone can lead to water retention and fluid build-up in the tissue. This makes the skin plump. Pores temporarily become smaller. This leaves them more prone to clogging from oils beneath the surface.
Fine lines and wrinkles
In perimenopause and menopause, estrogen levels decline and eventually hit all-time lows. Because there are estrogen receptors (even in your skin!), this can have a huge impact on the appearance of your epidermis. Estrogen improves blood flow, stimulates collagen, and affects the amount of hydration in your tissues. The result can be dryness or skin that seems to have lost its fullness or plumpness—in other words, more rapid aging.
Studies are limited on whether or not topical estrogen products can help restore a more youthful appearance to skin. And there’s ongoing research as to if isoflavones can help, too. A diet that includes soy products may be helpful for women in menopause or postmenopause. Soy contains isoflavones and phytoestrogens (plant estrogens). Even though phytoestrogens are weaker than the estrogens found in the body, they may help raise overall levels in the absence of natural estrogen.
PCOS, perimenopause, and menopause can all bring on facial hair. The answer: testosterone, and its conversion to dihydrotestosterone (DHT). On the scalp, dihydrotestosterone (DHT) causes follicles to shrink, resulting in thinning. But on the face and other areas of the body, it leads to thicker, longer hair growth. It’s possible for total testosterone levels to be normal with PCOS. However, sex hormone binding globulin (SHBG) may be on the low side. This can cause more free testosterone to circulate and be converted to DHT.
In perimenopause and menopause, a decline in progesterone may lead to the issue of facial hair. Sometimes, hairs are dark and coarse. But they can also be light. Progesterone drops in woman’s mid- to late-thirties and continues as she ages. Even if testosterone levels aren’t elevated, low progesterone could cause hair on the face to grow or become more noticeable. Adequate progesterone prevents too much testosterone from being converted into DHT.
Okay, so there’s no research out there that definitively links rosacea with hormones. But women seem to have more issues with it around menopause or at certain times of their cycles. Rosacea can easily go undiagnosed, especially in the early stages.
Because rosacea can have a fungal component, some experts say using a dandruff shampoo as face wash can help. Dandruff shampoos often contain about 1% of selenium sulfide. Flares during menopause can be aggravated or triggered by hot flashes, which dilate blood vessels and send heat and redness to the skin’s surface. Avoiding hot flash triggers, like stress, spicy foods, alcohol, and very hot or cold environments can help with rosacea, too. In menopause, rosacea flares are sometimes treated with low levels of estrogen through hormone replacement therapy. But, depending on your medical history, your doctor may suggest other options to help, like topical antibiotics or even Clonidine (if you also have high blood pressure).