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‘I can’t believe that I’ve got acne! It’s broken out all over my chin and forehead, I feel like a teenager again, but not in a good way!’

Acne can occur when hormone levels become unbalanced during the perimenopause and menopause. HRT and our skin. There is a drop in estrogen levels and a relative increase in the activity of androgen hormones such as testosterone. Once your hormones are rebalanced through HRT this type of acne should clear up. However, it is also worth remembering that stress can be a factor in a breakout of acne at this age or any age in fact. Stress also increases the production of all androgen hormones, including cortisol. 

One of the most noticeable changes to your skin may be that it becomes drier and more sensitive to the products that you use, such as soap, bubble bath, moisturiser, face creams and so on. Because estrogen is related to the production of collagen, which is an essential building block of the skin, its depletion can cause texture, elasticity, and tone to change. You may notice it on your face, but also other parts of your body: chest, back, shoulders, legs, anywhere in fact, but especially areas that you struggle to reach easily. Once the skin becomes drier it may also become itchy. It is important not to scratch these areas, because scratching can cause a rash to develop. Again, hormone replacement therapy treatments may help reduce this irritating symptom by increasing estrogen levels. In the meantime, it is worth considering changing what products you use on your skin to provide increased hydration. Monitor how your skin reacts as the HRT starts to rebalance your hormone levels and adjust your products accordingly. 

A definite no no is hot baths or showers as high-temperature water can very easily rob your skin of essential oils more quickly than warm water. Apply your moisturiser immediately after washing as the pores remain open and are better able to absorb and retain the product. 

Along with losing its elasticity and tone your skin may also develop increased pigmentation, in particular on your face, hands, neck and chest. These ‘age’ spots often occur in areas of the body that have been previously exposed to UV rays over the years. Whereas melanin synthesis was once regulated by estrogen, as estrogen levels reduce so the production of melanin can increase and it is melanin that causes the brown age spots to occur. It is a natural process and HRT may help to slow down or even sometimes reduce pigmentation as it rebalances your hormone levels. Clearly, the more fastidious you have been and continue to be in protecting your skin against UV rays, the smaller the chance of developing serious pigmentation becomes. 

Finally, there is perhaps the biggest bugbear of maturing, wrinkles and fine lines, in particular on the face, neck and chest. While hormone replacement therapy can improve the condition of your skin, it is not possible to reverse or prevent some lines forming. The best we can hope to achieve is to enhance our skin tone and texture and ensure that we are quite literally ‘comfortable’ in our own skin – with no dryness, itchiness or rashes, which can be irritating or even, in some cases, prevent us from sleeping. 

Perhaps one of the easiest ways to keep your skin hydrated is to drink plenty of water. It sounds too simple, but, with our busy lives, it is common for people to forget that glass of water first thing in the morning, or during the day. If you work in an office, air conditioning can dry out your skin and it is tempting just to keep drinking coffee or tea, but try switching to or adding a bottle of water several times a day. It may just be enough to work in harmony with other changes in lifestyle that you adopt during the perimenopause and menopause. 

If we know what to expect as our hormone levels change we can seek out appropriate products and remedies that will enhance our changing skin tone, texture, and elasticity instead of fighting against them or feeling despondent.