What can I do about post menopausal acne?

Hi, I heard you last night on Paula Begoun's web talk and was impressed with what I heard so I have been browsing your site. My question has to do with your comment on post-menopause acne. I am 54, have had a full hysterectomy at age 50, take monthly shots of Estrodial and according to my ob/gyn should stay on this the rest of my life. I also have used Retin-A-Micro since age 40. I agree that the acne that I get now is much different than as a teenager. It is deeper and more cystic as you stated. But, I didn't see anything that you recommended to help with this. Besides the Retin-A-Micro, I occasionally use a glycolic acid. Is there something else or better to do to get rid of the under the skin white "spots" that turn up. Some become bumps, some stay under the skin. Thank you for any guidance.

I’m wondering if your acne is all month long or concentrated around when you get your monthly estradiol injection.  It might be worth seeing your gynecologist and trying a different delivery system for your estrogen like the little patches (Vivelle is just an example) that you change twice a week. It would be interesting to see if that solved the problem. 

If that’s not possible, and your blood pressure isn’t too low, ask your dermatologist or gynecologist to consider prescribing low dose spironolactone for you (50-200 mg/day).   It often alleviates those deeper, tender small cysts and has nice side effects like lowering blood pressure, decreasing fluid retention and decreasing unwanted facial hair growth. It’s been in use for 30 years for various medical problems.

Also, if the problem is more those pesky, hard white bumps under the skin (milia), a good dermatologist or a medical aesthetician can extract those for you easily with the right tools.  

Dr. I

Dr. Brandith Irwin, MD

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