47-Year Old Planning to Start Accutane for Peri-Menopausal Acne - Minneapolis, MN

So I struggled with moderate cystic acne from age 13 to age 38 (always bad enough for antibiotics and retin-a but never quite bad enough for accutane). I know there is a genetic component to my acne since my mom had severe acne, my grandpa had acne and oily skin until he died at 76, and my brother had the worst acne I'd ever seen (did accutane in high school and then it never came back). I thought it was wonderful when I neared age 40 and things seemed to FINALLY clear up a bit. I had what I would consider normal skin issues (occasional pimple here and there - but nothing major). It was wonderful, and I got used to not wearing much makeup (which had always been the dream).
And then about a year ago the other shoe dropped. Around the same time my periods starting become irregular with what I'm assuming is the onset of menopause, I started having issues with cystic/nodular acne again. My skin is oily, pores are huge and I always seem to have at least two painful, nasty zits going at any given time. What's worse, is now that I am older dealing with this I notice that every pimple seems to take longer to clear and inevitably leaves a purple or indented scar afterwards (even if I don't pick at them). I initially went to the derm and they prescribed minocycline short term along with spirolactonone and retin-a (been on that forever). It seemed to help -but not cure the acne- for about the first 3 months. Then everything came back and I'm even more pimply and oily than I was before.
So earlier in December I sprouted a very prominent, monstrous zit on my cheek and I went in for my first acne cortisone injection (which I think is fantastic - although not exactly the overnight remedy I had read about). While in the derm's office I was venting my frustration about having to go through acne YET AGAIN and how the scarring is getting worse. I told her I even try to work from home and avoid interacting with people when it is bad, because it makes me so self-conscious. She mentioned that because I had tried all the other available options without success, that accutane would be something she would be willing to prescribe.
Now I know that my skin is not as bad as what some have to deal with, but I feel like I'm once again living my life as a hostage to my breakouts. My whole day hinges on how many and how bad my pimples are (bad breakout =crappy day). I'm hoping that I can at least get a little breather between breakouts so my husband and I can have a date night out where I don't have to struggle for an hour with concealer and powder just to keep from looking oozy and inflamed (and my two youngest kids who are 7 and 9 are always looking at me and saying "mommy do you know you have a big pimple on your cheek"...).
But I also saw my brother go through accutane and have read the reviews here on RS, so I know it will not be as simple as just popping a pill every day to get rid of the pimples. I already have a lot of dry skin spots and my lips are always chapped and cracked in the winter without accutane. I'm terrified of the initial breakout and just how much worse it can get before it starts to get better. I am an avid weightlifter/gym enthusiast and I have a lot of aches and joint pain already so I am a bit anxious about the potential for that to get worse (and I have this vision of stinging sweat on dry, cracked skin during workouts at the gym). Retin-a makes my skin bright pink for about the first hour after application - will I look sunburned for the duration I'm on the isotretinoin ? I just wish there was more info available about the impact on women my age.
And... Not least, is my concern about how much this will end up costing since I have a high deductible health plan and have had to fight for acne treatments in the past to be considered covered because of my AGE (retin a was a bunch of additional paperwork with my insurer - and all just so they would post the cost to my never-to-be-met deductible).
So my journey starts 1/18 when I complete my one month after being entered in iPledge. I'll post more then.

Today is my second pill of the Claravis. I'm just on 40mg a day to start - not sure what the doc will up the dosage to later. Of course when I picked up the prescription yesterday I was having a (what I'm sure will be short-lived) reprieve in my normal acne so I was thinking some sort of alarm would go off and the pharmacist would identify me as an imposter who does not have acne bad enough to warrant isotretinoin.

I was also expecting side effects to start immediately (headache, joint pain), but the first pill didn't cause any noticeable effects. I did drink 5 liters of water yesterday so I'm hoping that helps.

Also, as a side note to those that may be concerned about pricing like I was. I shopped around on price before dropping off my prescription (since with my high deductible plan the expense of the medication will all be out of pocket). I found that the Walmart pharmacy had the best pricing and even had a coupon! I don't normally use their pharmacy (and we don't have one near our home so I don't ever shop there either) - but it ended up being about $100 less than the lowest price I had seen elsewhere ($156 with my insurance and the coupon).

I'll post more once I start noticing some side effects. I'm excited to finally be starting the journey to clear skin!

Today I noticed the start of some side effects. My lips and the skin around my mouth is a bit dry and a little flaky. I'm not sure if the initial breakout is starting but I have 4 new pimples (two of them look like they might get bad). I have a pain/soreness in my back that is unusual as well - it feels a bit like the pain you get when you swallow an ice cube and you can feel it in your esophagus. I've seen other people mention this, but I've also been having vivid crazy dreams...maybe it just affects sleep and I just have more wakeful periods in the night? That would make sense since I feel a bit more tired/fatigued than usual.

My overall skin is still oily so I haven't switched cleansers yet. I'm still using neutrogenia liquid cleanser or glycerin bar soap. I have some cetaphil but haven't felt a need to start using it yet. I'm looking forward to drying out!

I'm interested to see how the new pimples do with the isotretinoin - I'm hoping they clear faster than they would normally. I'll post more as things progress.