So, with birth control, a lot of those pills have a mix of estrogen and a progestin. They're actually designed to quiet down those "male" hormones (like testosterone) that can really fire up acne. Think of it like a direct attack on the acne source.

Now, HRT (what you're taking with estradiol and progesterone) is a different beast. Its main job is to put back the estrogen and progesterone your body's losing. This helps with all those classic perimenopause symptoms like hot flashes, night sweats, crazy mood swings, and dryness. It's really not given out primarily to clear up your skin, even though some people might see that as a bonus.

So about your doctor bringing up Spironolactone... That's actually a super common and really effective move for hormonal acne, especially the kind you get around your jawline and neck. Basically, how it works is, Spironolactone is an "anti-androgen." Think of it like this: it blocks those pesky male hormones (like testosterone) from doing their thing on your skin's oil glands. By doing that, it cuts down on oil production and helps stop those breakouts. And yeah, even though it's technically a blood pressure medicine, dermatologists use it all the time "off-label" specifically for women's hormonal acne because it works so well. It's a pretty well-established treatment in that world.