If you’ve dealt with worsening hidradenitis suppurativa (HS) symptoms before or during your menstrual period, the idea of menopause may be appealing. “I hope menopause will calm my HS symptoms,” a myHSteam member said. “I’m in perimenopause now. Maybe I can get a handle on it.”

However, there’s no guarantee that the end of your periods (menses) will mean fewer or milder HS symptoms.

Menopause is the permanent end of menstruation, or having periods. The transition to menopause — known as perimenopause — generally starts between the ages of 45 and 55, and can last for several years. During menopause, the endocrine system causes hormone levels to change. The hormones estrogen and progesterone decrease. This can trigger hot flashes and other bothersome symptoms. Fluctuations in sex hormones, including estrogen and androgens such as testosterone, may play a role in HS.

To better understand how menopause affects HS, also known as acne inversa, myHSteam spoke with Dr. Tarannum Jaleel, a board-certified dermatologist and an assistant professor of dermatology at Duke University School of Medicine. Dr. Jaleel’s research largely focuses on hidradenitis suppurativa.

How Will Menopause Affect HS Symptoms?

The impact of menopause on hidradenitis suppurativa “is an area that’s been understudied,” Dr. Jaleel explained.

In one small study that included 43 postmenopausal participants with HS, nearly 40 percent reported worsening HS symptoms after menopause. Another 44 percent said there was no change. In a separate study, 48 percent of participants reported improved HS symptoms with menopause.

“I’ve seen people who have undergone menopause and gotten worse and people who have undergone menopause and gotten better,” Dr. Jaleel said.

Members of myHSteam echo Dr. Jaleel’s experience. Some have more symptoms after menopause, some have fewer, and some don’t notice much change at all.

• “I went through menopause at 40 and still have HS flares.”
• “My HS flares worsened after menopause.”
• “My mom has HS, and her symptoms disappeared after menopause.”
• “Since menopause, my HS symptoms have been different.”
• “I had early menopause and was on hormone replacement therapy. I can’t say that it made a big difference in my HS flares.”

One member noticed disease activity in new locations. “Since menopause, I’ve had HS lesions in places I never did before,” the member said. “They went from my armpits to my breasts to my groin.”

Just as HS affects people differently, so does menopause. It makes sense that combining the two also provides unique and varied experiences. Dr. Jaleel noted that larger studies can help medical scientists better understand the role of menopause in people with HS.

“As we’re doing larger registries with more detailed data points, I think this will definitely be a good area of research to be able to look at,” Dr. Jaleel said.

How Does Menopause Impact HS Treatment?

Hot flashes, insomnia, and other symptoms of menopause might not spark feelings of joy. But the end of your menstrual cycle may open the door to additional HS treatment options.

“The interesting thing about menopause is that I can actually do more treatments,” Dr. Jaleel said. “[Treating] postmenopausal [patients] allows me to use more drugs that are safe in HS patients who are not childbearing.”

If your doctor recommended stopping biologics or retinoids while you were pregnant or breastfeeding, those are back on the table after menopause, Dr. Jaleel said.

Acitretin is an oral retinoid that Dr. Jaleel sometimes prescribes for people who have gone 12 consecutive months without menstruation. “Acitretin is not a common medication, but we can use it in postmenopausal women,” Dr. Jaleel explained.

She may also prescribe finasteride, a hormone blocker that may cause birth defects in male babies. Finasteride is not appropriate for those who are pregnant or trying to get pregnant. But it is considered safe after menopause.

Spironolactone (Aldactone) is another hormone therapy that may not be recommended before menopause. “In menopausal women, I typically can go pretty high with doses on it,” Dr. Jaleel said of spironolactone.

Oral contraceptive pills (OCPs), commonly known as birth control pills, may help reduce symptoms such as lesions, abscesses, and nodules linked with HS. A postmenopausal person with HS wouldn’t take birth control pills for their original purpose (to prevent conception). But OCPs may be recommended for their hormone-regulating benefits when treating HS. Still, there are risks to consider.

“There are other reasons I might not prescribe OCPs,” Dr. Jaleel noted. “Postmenopausal women who have severe disease may have other risk factors, like a high risk for blood clots.”

If pregnancy isn’t an issue, OCPs may be advised. “I don’t have to worry about postmenopausal patients getting pregnant, which really makes it easy to use some of these drugs without having to do the same degree of monitoring,” Dr. Jaleel said.

Tell your dermatologist or other healthcare provider if you’re going through or have gone through menopause. Your doctor may or may not recommend switching treatments, depending on your particular condition and risk factors. If you’re considering a new HS treatment option, discuss potential risks and side effects in detail with your doctor.

Can Estrogen Replacement Therapy Cause HS Flare-Ups?

Menopause is a natural part of aging, not a disease to be cured. However, it can cause bothersome symptoms. Treatments for menopause aim to alleviate symptoms and improve quality of life.

Hormone replacement therapy (HRT), also called estrogen replacement therapy, is a standard menopause treatment. Fluctuations in hormones like estrogen and progesterone can trigger hot flashes and other menopausal symptoms. For that reason, supplementing or replacing those hormones can often provide relief. In some people, HRT may aggravate HS and cause flare-ups. If you’re taking HRT for menopausal symptoms, let your doctor know if you experience more HS flares.

“I had early menopause at 39 and was on HRT for eight years. I can’t say that it made a big difference in my HS flares,” a myHSteam member said.

Another member wrote, “I’ve just been suffering with a nasty flare-up in my groin/nether regions since having a full hysterectomy including the ovaries (due to a benign tumor) and then being put onto HRT. I hadn’t had a flare-up for a little while so I’m assuming it is down to the massive hormonal disruption my body is dealing with.”

Dr. Jaleel said hormone replacement therapy can be appropriate for people with HS, depending on other health risk factors. Researchers have linked long-term use of HRT to an increased risk of cancer and cardiovascular disease. However, depending on your personal health factors, the benefits may outweigh any potential risks. Before starting HRT, meet with your doctor to discuss your individual risk factors. This includes your personal medical history, family history, and any risk of heart disease, cancer, blood clots, stroke, and osteoporosis.

If you and your healthcare provider determine that HRT isn’t for you, your doctor may recommend other treatment options. These may include low-dose antidepressants, vaginal estrogen, gabapentin, or other alternatives.

How Does Care Change as You Age?

When asked how people with HS can best care for themselves as they age, Dr. Jaleel had some key advice. “Make sure you’re not developing more comorbidities as you get older,” she said. A comorbidity is when two diseases occur at the same time.

Lifestyle choices that can improve your quality of life as you age may also reduce HS symptoms. Some doctors and dietitians recommend the following lifestyle changes to support your immune system and overall health:

• Eating an anti-inflammatory diet
• Stabilizing your blood sugar
• Quitting smoking
• Limiting or avoiding alcohol

“Many patients I see have diabetes and prediabetes even at a younger age,” Dr. Jaleel said.

Dr. Jaleel and her colleagues presented their research on this topic at a conference. They found that people with diabetes or prediabetes are more likely to experience severe HS than people without. She routinely screens for comorbidities such as depression, sexual dysfunction, substance use disorder, and diabetes.

“We don’t know the exact link,” Dr. Jaleel continued. “But there is a strong association with diabetes even after controlling for body mass index and smoking and all the things that we think to be associated with disease severity.”

Your dermatologist can help you manage HS and other skin disorders. If you’re experiencing menopausal symptoms that may be affecting your HS, talk to your doctor. During and after menopause, you may want to add additional providers to your care team. This includes those specializing in gynecology, mental health, aging, and nutrition.

Join the Conversation

On myHSteam, people share their experiences with hidradenitis suppurativa, get advice, and find support from others who understand.

Are you experiencing menopause or perimenopause with HS? Let others know in the comments below.