Patient Question: Why am I getting acne in my 40s?
Short Answer: Women’s hormones are always changing. From puberty to middle age, to when the ovaries cease producing hormones in menopause. When we hit our 40s, our progesterone starts to decline. And our estrogen levels drop slightly as well. But the androgens, which are testosterone and DHEA do not decline. That means that there is less progesterone and estrogen to buffer the effects of the androgens.
Testosterone and DHEA are great, useful hormones for a female’s body. They help with muscle mass, motivation, ambition, libido, bone density, and stress management to name a few. But in our 40s when estrogen and progesterone start to decline that makes the androgens the ‘leaders of the hormonal pack.’
There is no buffer against the negative side effects of androgens. One being, acne. Women in their 40s are usually still getting a period and cycling. So that means that the breakouts and acne are worse anywhere from 7-14 days before their period. That is because women really only make progesterone in the last half of their cycle. Those days being days 14-28. Because of the decline of progesterone, acne can be quite prominent before a period.
But because the estrogen may have declined a bit in our 40s, we are still apt to have breakouts all month long. Because acne in the 40s is from the unopposed androgens, the acne is mostly on the chin and jawline. Although the neck and back are also common in a lot of women in their 40s. And the breakouts are more cystic in nature. They are deep and hard to “pop” (which we all know we should never ever do, and yes, I can’t help it either). And cystic acne lasts for weeks. So when one cystic pimple is starting to heal, aggravatingly three more show up. It is very frustrating.
In addition too unbalanced androgens, stress, and cortisol levels can exacerbate acne. Women in their 40s are busy. There are family commitments, work, home life, and trying to stay fit is certainly not as easy as it was in our 20 and 30s. Plus the drop in progesterone and estrogen lets the androgens (testosterone and DHEA) make us feel more easily ‘testy.’ The stress and unbalanced hormones cause cortisol levels to rise. Which unfortunately also makes the breakouts worse.
Below are some other episodes where we discuss other issues related to Perimenopause.
Also, if you are in your 40’s, check out my new book: The Perimenopause Plan.
Buy the book on Amazon.
If you have more questions about your hormones, feel free to contact us.
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Episode 052 – What Biest Ratio is Best for Menopause?
This is such helpful information. I have often wondered who 80:20 is good for and who 50:50 is good for.
One thing I'm still confused by is the estrogen weight gain component. You said that estrogen (as well as menopause in general) could be the cause of her weight gain. I can relate. I was very thin my whole life, now 53 and about 30 lbs overweight. But you also said she might benefit from getting her estrogen balanced, and she was not using enough.
If too low a dose made her gain weight, won't an increased dose cause more weight gain? I have heard other podcasts and read articles that in menopause, we gain weight because our estrogen falls. Estrogen seems to be blamed for weight gain, whether it's high or low. Can you help clarify? There's something I'm not understanding. Thank you! Tracy
Often estrogen has been the scapegoat for weight gain. I'm sure you have heard too much causes weight gain. Too little can pack on the pounds. It can be pretty confusing. So which is it? Is too much estrogen causing my pants to become uncomfortably tight? Or is it too little estrogen that has given me the gut I never had?
Well, it’s not that simple. Estrogen levels do have a hand in weight gain and weight loss. But it is not the only variable. It really is the combination of the balance of estrogen with other hormones in your body. To name a few main players, progesterone, insulin, and cortisol, as well as enzymes, lipoprotein lipase (LPL), and hormone-sensitive lipase (HSL). Okay, I know that sounds vague and doesn't answer the question. Let's back up a bit and look at what women are saying about estrogen.
As soon as menopause hits, women complain that they are instantly 15-30 lbs heavier. Not because of diet or lifestyle. It's like menopause adds an unwanted 15-30 lbs overnight. Then some women are on hormone replacement therapy, taking estrogen, and are horrified because the HRT caused them to gain 10 lbs in a month. So what is it? Did the lack of estrogen in menopause cause that 20 lb weight gain? Or did that hormone replacement estrogen create rolls that were never there? Well, actually, both are true. Before you throw out your jeans in favor of high-waisted yoga pants, let’s learn about the other players in weight gain.
Progesterone will buffer estrogen. Estrogen does like to grow things'. That is why in puberty, you grow breasts and hips. Progesterone helps to balance some of the growth' that estrogen can cause. That is why in perimenopause, when the progesterone drops and the estrogen is running the show, the weight gain begins. That is also why when a woman starts estrogen therapy for menopause but not enough progesterone, there is weight gain.