I also suspected that I was developing cysts. If you are nearing, or in perimenopause small imbalances in the hormones can make things show up on your face. I had my hormones tested and for my age/stage of life, it was all in the normal range. But progesterone dipping and testosterone going slightly elevated are normal in your 40s, due to the beginning of perimenopause...hence, the acne. It can also cause more cysts on the ovaries to occur at this time, which further contributes to acne. Progesterone is an androgen inhibitor, but too much elevates testosterone and you get wicked acne/oily skin (hello Aunt Flo breakouts). The past two months, I've had little to no acne and no cysts. I'm going to post my regime shortly to share, I think it will help a lot of women on here in similar situations as mine.