You managed to get through acne as a teen. It was a real trial but you made it into adulthood. Then, apart from the odd outburst during the menstrual cycle and those weeks during pregnancy, it was all plain sailing. Although, when you put it like that, there was quite a lot of acne as an adult, but you were less troubled by it. Somehow the world was less judgemental. You felt less threatened, more secure in yourself.

So now we are up to the menopause. That’s hot flashes, mood swings, night sweats and adding those unwanted pounds. Except, there’s still the chance of acne. Before getting into the detail of this, a few words about the industry that aims to profit from every stage of our lives. There’s a cosmetic product for everything, and one of the biggest markets is for anti-aging creams. Curiously, anti-aging products are selling to women in their 20s. This is preventive medicine. But there’s one major difference in the skin to comment on. As the female body ages, the level of estrogen slowly drops. One effect is to reduce the density of the skin, making it thinner and encouraging it to sag. The result is a loss of definition in the facial features. It makes us start to look old. The theory underlying these creams is that, by adding collagen to your skin, it retains its thickness and remains more supple. The most interesting of these are based on vitamin A, although there are some estrogen creams available as well.

The good news in all this is that, after menopause, the pore size shrinks and oil production falls. This clears up acne naturally. The problem during menopause is that, although the estrogen levels drop, the androgen levels including testosterone stay the same. This encourages the sebaceous glands to produce too much oil and acne reappears. The first piece of advice is not to panic. This outbreak is not usually severe and only lasts a relatively short period of time. Indeed, because stress can make acne worse, it’s definitely a good idea to stay calm (despite the mood swings). But if you find the change in your appearance too distressing, there are options. Hormone replacement therapy gets a bad press these days (it increases the risks of strokes, heart disease and breast cancer), but the boost to your estrogen levels clears up the skin problems. Then we come to topical creams. You are likely to be recommended the retinoids. They are derived from vitamin-A. For once, the cosmetics industry has the right product for this purpose, but you pay for the branding which makes these creams expensive.

If you have tried everything else and the acne is stubbornly refusing to go away, there is accutane. This is slightly less risky because you should not become pregnant while taking the drug. Nevertheless, there are always costs and benefits no matter what your age so, before taking accutane, you should discuss its use with a dermatologist. If you are confident the benefits are sufficiently strong, a three-month course of treatment is almost always completely successful. If there are any residual blemishes, a second course of treatment always produces completely clear skin. For the record, accutane is derived from vitamin-A.