HRT and Acne: Why it Happens and How to Treat It

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    Kristin Hall, FNP
    Medically reviewed by Kristin Hall, FNP Written by Our Editorial Team Last updated 8/24/2020

    Every year, thousands of women use hormone replacement therapy (commonly known as HRT) to manage the discomfort, hot flashes and other common symptoms of menopause.

    Although HRT isn’t as widely used as it once was, it’s still a common treatment that’s used by a large number of women. Used effectively, HRT can make menopause easier to manage, with a lower number of symptoms and a reduced impact on your quality of life.

    Unfortunately, HRT can also have some side effects, including the possibility of causing you to break out with hormonal acne. 

    Below, we’ve explained why and how hormonal acne happens after you begin HRT, as well as what you can do to manage breakouts and prevent acne from returning. 

    What is HRT?

    HRT is a common treatment for menopause symptoms like hot flashes and changes in your level of sexual interest.

    As you enter menopause, your body begins to produce lower amounts of important hormones such as estrogen. This can affect everything from the way you feel on a day-to-day basis to the quality of your sleep. 

    Research has shown that estrogen and progesterone (two of the most important female sex hormones) decline significantly as you enter menopause.

    The most common symptoms of menopause include hot flashes, chills, night sweats, difficulty sleeping and mood changes. Many women also experience some level of weight gain as they enter menopause, often due to the effects of hormones on the appetite.

    If your menopause symptoms are serious enough to affect your quality of life, your healthcare provider might recommend hormone replacement therapy as a treatment option.

    HRT involves replacing the hormones that your body no longer produces, helping you maintain healthy, optimal hormone levels. The most commonly replaced hormones are estrogen, as well as progestins such as norethindrone and norgestrel.

    The hormones used in HRT are quite similar to the hormones used in birth control pills, although the specific quantities used can differ. 

    Used effectively, hormone replacement therapy can make the symptoms of menopause less severe. This can help you maintain a high quality of life as you enter into menopause and start to produce lower quantities of hormones naturally. 

    There are two main types of HRT: estrogen therapy and estrogen/progesterone/progestin therapy. 

    Estrogen therapy involves taking a low dose of estrogen. This can help you manage some of the most common symptoms of menopause, such as hot flashes and mood changes. Regular use of estrogen can also reduce your risk of developing conditions such as osteoporosis. 

    Most of the time, estrogen therapy is administered using a daily estrogen pill similar to a birth control pill. Some healthcare professionals also prescribe estrogen patches, as well as topical creams, sprays and gels that contain estrogen designed to be absorbed through your skin. 

    It’s also possible to take in estrogen using a vaginal ring. Vaginal estrogen rings, tablets and creams are typically prescribed to treat menopause symptoms like vaginal dryness and pain during sex, both of which are quite common for menopausal women. 

    Estrogen/progesterone/progestin therapy, or combination therapy, involves taking a mix of estrogen and progestin hormones. For this type of HRT, you’ll usually be prescribed a daily progestin/estrogen pill that contains either a natural or synthetic type of progestin.

    There’s no “best” form of HRT for everyone. If you use HRT, your healthcare provider will select the best option for you based on your symptoms, needs and health history.

    Why Does HRT Cause Acne?

    While most of us view acne as something that happens during our teens and early 20s, many women get acne breakouts as they enter menopause.

    The reason for this is simple: during menopause, your body’s production of certain hormones can fluctuate by a significant amount. This can make your skin oilier than usual, causing acne breakouts to reoccur like they did when you were a teenager.

    The main hormone responsible for menopausal acne is testosterone. During menopause, both estrogen and testosterone levels decline. However, your estrogen levels usually decline faster than your testosterone levels, resulting in an imbalance that can cause acne.

    Not everyone will experience acne during menopause. However, if you’re genetically prone to acne, there’s a good chance you’ll start to break out again as your body’s hormone levels start to change.

    Most of the time, HRT actually helps acne. The estrogen and progestin hormones used in HRT can both reduce your production of testosterone, meaning you should be less likely to get acne after you start using HRT. 

    However, for some women, the temporary hormone fluctuations caused by HRT can make acne worse, triggering breakouts and giving you oilier, more acne-prone skin. 

    How to Treat Acne Caused By HRT

    Most of the time, the acne caused by HRT goes away by itself. Acne breakouts can be triggered by the sudden fluctuations in your hormone levels caused by starting HRT, leaving you with oily, acne-prone skin in the weeks and months after you start HRT.

    Over time, your body should adjust to the hormones, meaning your skin will eventually clear up and the acne breakouts should disappear. This can take anywhere from a few weeks to several months. In general, if you’ve noticed acne after starting HRT, it pays to be patient.

    In fact, over time, your skin might begin to look better than it originally did. This is because the estrogen used in HRT not only prevents acne over the long term, but it also contributes to skin that’s softer, smoother and less prone to wrinkling.

    If your acne doesn’t disappear on its own, there are several treatments you can use to bring it under control and prevent future breakouts:

    Tretinoin

    Tretinoin is a topical retinoid that’s used for treating acne and slowing down the effects of aging on your skin. 

    As an acne treatment, tretinoin works by helping your body replace old skin cells with new cells at a faster rate. This means there are fewer dead skin cells on the surface of your skin, lowering your risk of developing blocked pores and pimples.

    Studies show that tretinoin works very effectively as an acne treatment. In a study from 2009, people who used tretinoin had significantly fewer acne lesions after 12 weeks than people who used a non-therapeutic placebo. 

    As an added bonus, tretinoin also has anti-aging effects that can help you make wrinkles, smile lines and other signs of aging less visible. 

    Our guide to tretinoin and hormonal acne goes into more detail on how tretinoin works, as well as how you can use it to treat acne from menopause and HRT. 

    Antibiotics

    While acne is mostly caused by oil and dead skin cells blocking your pores, bacteria also plays a significant role.

    When bacteria gets trapped inside a pore that’s already clogged with oil and dead skin cells, it can lead to inflamed, infected acne. In severe cases, infected acne can become cystic, leaving you with painful, inflamed acne nodules that can leave permanent scars.

    Topical antibiotics like clindamycin work by killing the bacteria that can make pimples become inflamed and infected. It’s usually used alongside topical medications like tretinoin as part of a multi-pronged approach to treating menopausal or HRT-induced acne.

    Our guide to clindamycin and acne goes into more detail on how clindamycin works, as well as how you can use it to treat menopausal or HRT-induced acne. 

    Spironolactone

    Spironolactone is an anti-androgen that reduces your body’s production of testosterone, helping to keep hormonal acne under control.

    Although spironolactone isn’t FDA-approved specifically for the treatment of acne, studies show that it works well as an acne treatment. In a 2017 study, women with acne experienced a 70+ percent reduction in hormonal acne lesions after using spironolactone for several months.

    Like other hormonal medications, spironolactone can have a range of side effects. As such, it’s available by prescription only and is usually only prescribed to treat severe, persistent cases of menopausal or HRT-induced acne.

    Our guide to spironolactone and acne goes into more detail on how spironolactone works as an acne treatment, its potential side effects and how you can use it to treat acne caused by HRT or menopause. 

    Other Risks of HRT

    Used safely and effectively, HRT can help to make the common symptoms of menopause easier to manage, giving you a higher quality of life as you get older.

    However, HRT can have several potential side effects in addition to its effects on your skin. In a variety of clinical trials, researchers found that the estrogen/progestin medications used in HRT can increase your risk of stroke, blood clots, breast cancer and heart disease.

    These potential side effects are similar to those of combined birth control pills, which also affect your blood clot and stroke risk.

    Also, like hormonal birth control, the side effects of HRT tend to become more common as you get older. Women who start HRT shortly after entering menopause usually have a lower risk of side effects than women who start HRT 10 or 20 years after beginning menopause. 

    Other health factors, such as your genetics, lifestyle, family medical history and use of tobacco, can all affect your risk of experiencing side effects from HRT.

    As always, it’s best to talk to your healthcare provider about side effects before you consider HRT. By looking at your symptoms, medical history and needs, your healthcare provider will be able to make an informed and safe decision about the best option for your health and wellbeing.

    Learn More About Hormonal Acne

    Whether it occurs during adolescence or menopause, any acne caused by fluctuations in your body’s androgen levels is hormonal acne.

    Our guide to hormonal acne goes into more detail on how hormonal acne occurs, from specific hormonal triggers to common factors that can make your breakouts more severe. It also shares the most effective topical, oral and lifestyle treatments for getting rid of hormonal acne. 

    This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.