Cystic Acne and chronic illness plus peri

Hi! As if perimenopause was not hard enough, the cystic acne I’ve battled since my 20’s has returned with a vengeance. It has Never been this bad. I’m several months into treating peri at age 45 and on estrogen bc patch. I see my OBGYN at end of month to discuss potentially adding progesterone 100mg nightly to deal with sleep issues.

Unfortunately, I also have chronic illnesses and health issues that prevent me from taking spironolactone. I asked my dermatologist for compounded winlevi and received compounded DNS. It’s still very new (two weeks in) so I may be purging but things have never been this bad. I’m trying to push through. I have never been able to tolerate tretinoin (tried many times over years) but I’m wondering if anyone has had success treating cystic acne in peri? I am truly considering accutane but will give the DNS at least 6 weeks of a college try before making that call. It’s just so depressing to see my skin looking worse than I did as a teen girl, while sweating, dealing with pain and brain fog!