HS, Perimenopause and Menopause: Does Hidradenitis Suppurativa Improve After Periods Stop?

You may have heard that hidradenitis suppurativa (HS) usually improves after menopause.

The evidence is much less clear than that.

Hormones appear to influence HS in at least some people, which is one reason symptoms can change around menstruation, pregnancy and other hormonal transitions. But researchers do not yet understand exactly how menopause changes HS disease activity — and the strongest direct patient data does not support the confident version of that claim.

In the main patient survey specifically asking about HS after menopause, only 16.3% of respondents reported improvement. 44.2% reported no change, and 39.5% reported worsening. Those percentages should not be treated as universal probabilities — the study was survey-based and relied on patient recall — but they do establish one point clearly: there is no good evidence that HS is expected to disappear once periods stop.

This guide explains what is known, what remains uncertain, and how to make sense of changes in your HS during perimenopause and after menopause.

Educational content only. This article explains what patient-survey and review evidence says about HS during perimenopause and after menopause. It cannot tell you whether your own HS is hormonally driven, whether hormone testing or menopausal hormone therapy is appropriate for you, or whether your treatment should change.

Key takeaways

• HS can change during perimenopause and after menopause, but there is no universal pattern — some people improve, more report no change or worsening.
• A change that happens around menopause does not prove that a falling hormone level caused it.
• Perimenopause involves many simultaneous changes — irregular cycles, sleep disruption, sweating, body-composition shifts — that can make an old symptom pattern harder to recognise.
• Evidence on menopausal hormone therapy and HS is too limited to use HS alone as a reason to start or avoid it.
• Postmenopausal-onset HS is possible but appears uncommon, and a new lump after menopause still needs proper diagnosis rather than an assumption either way.
• If your HS pattern changes, document what actually changed and bring that description — not a guessed mechanism — to your next appointment.

Perimenopause and menopause are not the same thing

This distinction matters for reading your own symptoms.

Perimenopause is the transition leading up to menopause. During this phase, hormone levels fluctuate rather than declining steadily, and menstrual cycles typically become irregular — shorter, longer, occasionally skipped, or unpredictable in flow.

Menopause is reached after 12 consecutive months without a period, with no other explanation for the absence of bleeding. Everything after that point is sometimes called postmenopause.

If you previously noticed a pattern like “my HS gets worse a few days before my period,” that pattern can become genuinely hard to track once the cycle itself stops being predictable. An apparent loss of an old premenstrual pattern during perimenopause does not necessarily mean your HS is improving — it may simply mean the reference point you were using (a regular cycle) has gone away.

Does HS usually improve after menopause?

We do not know that it usually does, and the strongest available patient data points the other way.

A widely cited patient survey asked people with HS about their experience around menstruation, pregnancy, delivery and menopause. Among participants who reported on their experience after menopause:

• 16.3% reported improvement
• 44.2% reported no change
• 39.5% reported worsening

That is close to the opposite of the simplistic expectation that menopause routinely resolves HS. But the study has real limitations worth naming in the same breath as the numbers: it was survey-based, retrospective, dependent on patient recall, and not designed to establish a biologicalBiologic: A class of medications derived from living cells that target specific components of the inflammatory process. For Acne Inversa, biologics such as adalimumab and secukinumab are used when other treatments are insufficient.BiologicA class of medications derived from living cells that target specific components of the inflammatory process. For Acne Inversa, biologics such as adalimumab and secukinumab are used when other treatments are insufficient.Read more in the glossary mechanism. It should not be read as a precise, generalisable prevalence figure for every population.

So do not replace “HS often improves after menopause” with “HS usually worsens after menopause” — neither conclusion is justified by this single study. The accurate statement is narrower and more useful:

Published patient data show a highly variable HS course after menopause, and improvement is not the most commonly reported outcome.

Why did clinicians expect improvement in the first place?

Hormones have long been suspected of influencing HS, for reasons that are circumstantial but consistent across several observations:

• HS usually begins after puberty, when sex-hormone levels rise.
• The disease is reported to be more common in women than men in many populations.
• Symptoms can fluctuate around menstruation for some people.
• Disease activity can change during pregnancy.
• Disease activity sometimes changes after menopause too — in either direction.

That pattern makes hormonal involvement biologically plausible. It does not make it fully understood. HS is a multifactorial inflammatory disease involving follicular occlusionFollicular Occlusion: The blockage of hair follicles is considered a key starting point in the development of Acne Inversa. When a follicle becomes obstructed, inflammation can spread deep into tissue, leading to nodules, abscesses, and sinus tracts.Follicular OcclusionThe blockage of hair follicles is considered a key starting point in the development of Acne Inversa. When a follicle becomes obstructed, inflammation can spread deep into tissue, leading to nodules, abscesses, and sinus tracts.Read more in the glossary, immune dysregulation, genetic susceptibility and mechanical factors like friction, alongside whatever role hormones play — and that role may differ between individuals. There is no single “menopause mechanism” that currently explains what happens to HS in any one person.

Mainstream dermatologyDermatology: The medical specialty concerned with diagnosing and treating skin conditions. Acne Inversa is often managed by dermatologists, although surgery and other specialties may also be involved.DermatologyThe medical specialty concerned with diagnosing and treating skin conditions. Acne Inversa is often managed by dermatologists, although surgery and other specialties may also be involved.Read more in the glossary resources reflect this uncertainty directly: hormones “may” play a role and this “may” help explain why disease can be less severe after menopause for some people — language that describes a hypothesis, not a predictable outcome.

What might happen during perimenopause?

Perimenopause is particularly difficult to interpret because several things tend to change at once. You may notice, in overlapping and sometimes confusing combinations:

• menstrual cycles becoming irregular or unpredictable;
• a previously reliable premenstrual HS pattern becoming harder to place;
• different or new sweating patterns, including hot flushes and night sweats;
• disrupted sleep;
• changes in mood or stress;
• changes in body composition;
• new medications, including menopausal hormone therapy.

If your HS worsens during the same stretch of time, it is tempting to attribute all of it to hormones. That may be part of the explanation — but timing alone cannot establish it, because so much else is changing simultaneously. A more useful starting question than “is this hormonal?” is:

What exactly changed in my HS?

Five changes worth documenting

Rather than trying to identify a hormonal cause yourself, describe the disease itself. These five categories give a clinician something concrete to work with:

What to note	Question to ask yourself
Frequency	Are lesions appearing more often, less often, or about the same?
Location	Are the same areas affected, or are new areas becoming involved?
Duration	Are individual lesions lasting longer, or resolving faster than before?
Impact	Has this changed your sleep, mobility, work, exercise, wound-care burden or daily activities?
Relationship to cycles	If you still menstruate, does HS still seem to track your cycle? If not, note the date of any HS change alongside any bleeding and major menopause symptoms occurring at the same time

You do not need to calculate hormone levels from symptom timing — that is not something a symptom diary can do, and it is not the goal. The goal is a description precise enough that a clinician can judge whether the pattern is meaningful.

If my HS worsens during perimenopause, does that mean my hormones are abnormal?

No. A change in HS around perimenopause does not, on its own, diagnose low estrogen, high testosterone, androgen excess, polycystic ovary syndromePolycystic Ovary Syndrome (PCOS): A hormonal condition involving irregular menstruation, excess androgens, ovarian cysts, and insulin resistance. Co-occurs with Acne Inversa at higher-than-expected rates, particularly in women whose HS flares with the menstrual cycle.Polycystic Ovary Syndrome (PCOS)A hormonal condition involving irregular menstruation, excess androgens, ovarian cysts, and insulin resistance. Co-occurs with Acne Inversa at higher-than-expected rates, particularly in women whose HS flares with the menstrual cycle.Read more in the glossary or another endocrine condition.

Hormone levels naturally fluctuate during the menopausal transition — that fluctuation is part of what perimenopause is, not evidence of a disorder. Whether laboratory evaluation is useful for you depends on your broader medical history and symptoms, not on HS activity alone.

Avoid the shortcut “get your hormones checked if HS gets worse during menopause.” A more useful version is: tell your clinician that your disease pattern changed, and ask whether any additional assessment makes sense given your full clinical picture — not because HS alone points to a hormone problem.

What about menopausal hormone therapy?

This is where the boundary needs to be strongest.

Menopausal hormone therapy can be appropriate for menopause symptoms in selected people, based on their overall symptoms, risks and medical history. But HS-specific evidence is genuinely too thin to say that hormone therapy reliably improves or worsens HS. A 2026 systematic review of menopause and common skin diseases found that evidence concerning hormone therapy across dermatological conditions generally remains limited and inconsistent — and HS-specific research is thinner still.

So this article will not tell you that estrogen replacement improves HS, and it will not tell you to avoid hormone therapy because of HS. Neither claim is adequately supported by current evidence, and suitability and expected benefit can vary by individual situation.

If you are considering or already taking menopausal hormone therapy, questions worth raising with your care team include:

• Could this interact with any part of my current HS treatment?
• Has my HS clearly changed since I started or changed hormone therapy?
• Should my dermatologist and gynaecologist know about each other’s treatment plans?
• Are there other health factors that should shape which menopause therapy is right for me?

The decision about menopausal hormone therapy should rest on your overall menopause symptoms, risks, medical history and goals — not on HS by itself.

What if my HS started after menopause?

That can happen, but it appears to be uncommon. A small body of case-report literature describes HS beginning for the first time after menopause. Isolated case reports are useful for showing that something is possible, but they cannot establish that menopause caused it in any individual, and they cannot tell you how often this occurs.

A new painful, recurring lump after menopause should not automatically be assumed to be — or assumed not to be — HS. The usual diagnostic principles still apply: typical lesion type, typical location, recurrence and chronicity, clinical assessment, and appropriate exclusion of alternative diagnoses.

Does HS treatment need to change after menopause?

Not automatically. The basic treatment goal — controlling inflammatory activity, pain, drainage, tunnelsSinus Tract: A tunnel-like channel under the skin that forms between abscesses or nodules. Sinus tracts indicate more advanced disease and can chronically drain fluid. They are associated with Hurley Stages II and III.Sinus TractA tunnel-like channel under the skin that forms between abscesses or nodules. Sinus tracts indicate more advanced disease and can chronically drain fluid. They are associated with Hurley Stages II and III.Read more in the glossary and disease progression — does not change because someone reaches menopause. Menopause is a life stage, not a treatment stage.

Midlife can, however, change the wider context treatment decisions sit in: cardiovascular risk, metabolic health, bone health, other medications, menopausal symptoms, and any comorbid inflammatory disease all become more relevant to review together. This is a reasonable moment to look at your general preventive health alongside your HS, using the site’s Whole-Health Check as a starting point for that broader conversation — not as a reason to change HS treatment on its own.

Do not stop HS treatment simply because you have reached menopause. In the main patient survey, the majority of people who reported after menopause described either no change or worsening rather than improvement, so persistent disease activity after menopause is compatible with what has actually been reported — not a sign that something unusual or wrong is happening.

Could hot flushes and sweating affect my HS?

Possibly, in a practical rather than hormonal sense. Increased sweating and heat can make HS harder to manage for some people by adding moisture and friction in already-affected skin folds — that is a mechanical and self-care issue, separate from whatever role declining hormones may or may not play directly.

“Hot flush → sweat → harder-to-manage skin” is a different claim from “menopause hormones directly caused an HS flareFlare: A period of acute worsening in a chronic condition. In Acne Inversa, a flare may be triggered by stress, hormonal changes, friction, or other factors and can manifest as new nodules, abscesses, or increased pain.FlareA period of acute worsening in a chronic condition. In Acne Inversa, a flare may be triggered by stress, hormonal changes, friction, or other factors and can manifest as new nodules, abscesses, or increased pain.Read more in the glossary.” If sweating is the practical problem, the site’s clothing and friction guidance is the more useful next step than trying to reason your way to a hormonal explanation.

What about weight changes during midlife?

Body weight is associated with HS at a population level, but neither menopause-related weight change nor body weight alone explains what is happening in any individual’s disease. Resist the tempting but oversimplified version of this: “menopause worsens HS because of weight gain.” If your body composition or metabolic health is changing during midlife, treat that as a general health topic worth raising on its own terms — not as proof that you caused a flare.

Six questions to take to your next appointment

1. My HS pattern has changed during perimenopause — does that change how we should assess whether my current treatment is working?
2. Is this change likely to be HS itself, or should another skin or health issue be considered?
3. Could any medication I use for menopause affect my HS treatment, or the other way round?
4. Do my other symptoms make an endocrine or gynaecological evaluation relevant?
5. Should any midlife health factors change which HS treatments are appropriate for me?
6. What should I track over the next few months so we can judge whether this is a real change rather than normal fluctuation?

What this article cannot tell you

• Whether your HS is “hormonal.”
• Whether your estrogen or another hormone level is low.
• Whether hormone testing is needed in your case.
• Whether menopausal hormone therapy is appropriate for you.
• Whether menopause caused a specific flare.
• Whether your HS treatment should change.
• Whether persistent HS after menopause is unusual for you specifically.

Those questions all need individual clinical context that a general article cannot supply.

The bottom line

Menopause is often described as a point when HS becomes milder. Some people do improve.

But the evidence does not support telling patients that improvement is expected. The limited direct patient data show a highly variable course: some improve, many report no change, and a substantial share report worsening. The biological role of hormones in HS remains plausible but incompletely understood, and that is true across menstruation, pregnancy and menopause alike.

So if your HS changes during perimenopause or after menopause: describe the change before trying to explain it. Track what actually happens, review whether your existing treatment is still controlling the disease, and bring your menopause therapies and broader midlife health into the same clinical conversation rather than treating them separately.

If your main question is about monthly patterns rather than this longer transition, HS and Your Menstrual Cycle covers that separately. If pregnancy or fertility is your current question, HS, Pregnancy & Family Planning is the better starting point.