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 will mean fewer or milder HS symptoms.
Menopause is the ending of menstruation, or having periods. The transition to menopause generally starts between 45 and 55, and can last for several years. Fluctuations in hormones like estrogen and progesterone can trigger hot flashes and other bothersome symptoms. Sex hormones, including androgen and estrogen, may also play a role in HS.
To better understand how menopause affects HS, myHSteam spoke with Dr. Tarannum Jaleel, a board-certified dermatologist and an assistant professor of dermatology at Duke University School of Medicine.
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 people 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 worse symptoms after menopause, some have fewer, and some don’t notice much change at all.
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 reliable data depends on sample size, and perhaps more research is on the horizon.
“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.
While hot flashes, insomnia, and other symptoms of menopause might not spark feelings of joy, 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. “Being postmenopausal 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. Acitretin is an oral retinoid that Dr. Jaleel can prescribe 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 can 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 safe after menopause.
Spironolactone (Aldactone) is another hormone therapy that may be avoided 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, can also address the lesions, abscesses, sinus tracts, and nodules associated with HS. A postmenopausal individual with HS would not take them for their original purpose — to prevent contraception — but could use them 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.”
Tell your dermatologist or other health care provider if you are going through or have gone through menopause. While therapies like topical antibiotics and steroids are generally always safe, not having a period may increase your HS treatment options.
“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.
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. Because fluctuations in hormones like estrogen and progesterone can trigger hot flashes and other menopausal symptoms, supplementing or replacing those hormones can often provide relief.
Dr. Jaleel said hormone replacement therapy can be appropriate for people with HS, depending on other health risk factors. Health experts have linked long-term use of HRT to elevated cancer and cardiovascular risks. However, depending on your personal health factors, the benefits may outweigh any potential risks. Before starting HRT, meet with your doctor to discuss your personal medical history, family history, and any risk of heart disease, cancer, blood clots, stroke, and osteoporosis.
If you and your health care provider determine that HRT is not for you, they may recommend low-dose antidepressants, vaginal estrogen, gabapentin, or other alternatives.
When asked how people with HS can best care for themselves as they age, Dr. Jaleel advised, “Make sure you’re not developing more comorbidities as you get older.” 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 experts recommend:
“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 her patients for comorbidities like depression, sexual dysfunction, substance abuse, 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 with HS and other skin disorders. During and after menopause, you may want to add additional providers to your care team, including those specializing in gynecology, mental health, aging, and nutrition.
On myHSteam, the social network for people with hidradenitis suppurativa, more than 35,000 members come together to ask questions, give advice, and share their stories with others who understand life with HS.
Are you experiencing menopause or perimenopause with HS? Share your experience in the comments below, or start a conversation by posting on your Activities page.