From the Guidelines
Perimenopausal women are not definitively proven to be more prone to hidradenitis suppurativa (HS), and the current evidence does not support a direct link between perimenopause and increased HS risk or severity. While hormonal fluctuations during perimenopause might theoretically influence HS, research has not established a clear connection between perimenopause specifically and HS 1. Hidradenitis suppurativa is a chronic inflammatory skin condition affecting hair follicles in areas with apocrine sweat glands, commonly occurring in the armpits, groin, and under the breasts. The condition is influenced by multiple factors including genetics, obesity, smoking, and hormonal changes. Some women do report flare-ups related to their menstrual cycle, suggesting hormonal involvement, but perimenopause itself has not been identified as a specific risk period 1.
Key factors to consider in managing HS include:
- Genetics
- Obesity
- Smoking
- Hormonal changes
- Menstrual cycle-related flare-ups
If you're experiencing symptoms of HS during perimenopause, treatments may include:
- Topical antibiotics like clindamycin
- Oral antibiotics such as doxycycline or minocycline
- Anti-inflammatory medications
- Hormonal therapies, such as estrogen-containing combined oral contraceptives, spironolactone, cyproterone acetate, metformin, and finasteride, which should be considered in appropriate female patients 1 Weight management, smoking cessation, wearing loose clothing, and proper hygiene can help manage symptoms. It is essential to consult a dermatologist for proper diagnosis and treatment tailored to your specific situation.
From the Research
Hidradenitis Suppurativa and Perimenopause
- Hidradenitis suppurativa (HS) is a chronic, debilitating disease with a profound impact on the quality of life of patients 2.
- The development of HS requires a complex interaction between genetic predisposing factors, endocrine dysregulation, metabolic alterations, bacterial overgrowth, and an aberrant inflammatory response 2.
- Perimenopause is associated with profound reproductive and hormonal changes, which may contribute to the development of HS 3.
Hormonal Changes and HS
- Hormonal fluctuations during menstruation, pregnancy, breastfeeding, and menopause may exacerbate HS in women 4.
- The pathogenesis of HS involves a complex interplay of intrinsic and extrinsic factors, including genetics, immunity, hormones, and environmental influences 4.
- Evidence points to an important role of sex-hormones in the emergence and progression of the disease, but the underlying mechanisms are still unclear 2.
Quality of Life and HS
- HS patients suffer from uncomfortable signs and symptoms, such as pain, pruritus, malodour, and suppuration, which may impair patients' quality of life (QoL) 5.
- The higher intensity of a sign or symptom correlated with poorer general QoL or specific QoL dimensions, including sexual distress, anxiety, depression, and sleep 5.
- Women with HS may experience sexual dysfunction, which is further exacerbated by emotional burdens such as shame, loss of femininity, and diminished intimacy 4.
Treatment and Management
- A multifaceted approach is necessary for the treatment of HS, including anti-inflammatory therapies, antimicrobials, and surgery 6.
- Adjuvant therapy, such as pain management, wound care, and attention, plays a major role in patients' perception of a successful treatment and is of practical importance to their coping and self-management 6.
- A comprehensive three-pronged approach with adjuvant therapy, medical therapy, and surgery is recommended for the management of HS 6.