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Many women expect hot flashes and mood changes during menopause. But acne? That can come as a surprise.
Breakouts are actually common during this stage of life. Some women even feel like they’re going through puberty again. “I sweat a lot more, and I’m getting acne like a teenager,” one woman told ThisIsMenopause. “My mood swings are worse, and I’m barely eating or sleeping, but always feel exhausted.”
“Acne, weight gain, hot flashes — that’s what it’s been like,” another woman shared.
If you’re getting new breakouts in your 40s or early 50s, you’re not alone. Hormonal changes around menopause can affect the skin in many ways, including acne.
The good news is that once you understand why menopause acne happens, you can try several strategies to treat it.
Acne that appears during this time of life is often called adult female acne or menopausal acne. Health experts say it’s usually caused by hormonal changes. In the years leading up to menopause, hormone levels can rise and fall unpredictably. These changes can affect the skin and oil glands.
Hormones affect the skin by controlling oil production. The skin contains tiny oil glands called sebaceous glands, which produce sebum. This oily substance helps protect and moisturize the skin. However, when too much oil is produced, pores can clog more easily.
During menopause, estrogen levels drop, while androgens (often called male hormones) become more dominant. Even though women naturally produce small amounts of androgens, these hormones can increase oil production.
When excess oil mixes with dead skin cells, pores can become blocked. Bacteria can grow inside these clogged pores, leading to inflammation and pimples. Hormonal acne often appears on the chin, jawline, lower cheeks, or neck — areas more sensitive to hormone changes.
Hormones are the main cause of menopausal acne, but they’re not the only factor. Other midlife changes — such as stress, sleep problems, medications, and slower skin renewal — can also contribute to breakouts. When several of these factors happen together, acne may become more noticeable.
Stress affects many parts of the body, including the skin. During stressful times, the body produces more cortisol, which can increase oil production.
Menopause can already be stressful due to sleep problems, mood changes, and daily responsibilities. These stress hormones may worsen breakouts.
Some skin care products can clog pores and contribute to acne. Heavy creams, oils, or certain makeup products may trap oil and dead skin cells. Products labeled “noncomedogenic” are less likely to clog pores. Dermatologists often recommend these for people prone to breakouts.
As estrogen levels drop, skin renews itself more slowly. Dead skin cells may stay on the surface longer. These extra cells can mix with oil and clog pores more easily. This is one reason acne may appear during menopause, even in women who have never had it before.
Acne during menopause can usually be treated. A dermatologist can identify the type of acne and recommend the best treatment plan. Treatment often includes topical medications, oral medications, and skin care adjustments. The goal is to reduce oil production, unclog pores, and calm inflammation.
Topical treatments — medications applied directly to the skin — are often the first step for mild or moderate acne. These treatments help prevent clogged pores, reduce bacteria, and calm inflammation.
Retinoids are medications derived from vitamin A. They help speed up skin renewal and prevent pores from becoming clogged. Common retinoids include:
Dermatologists often recommend retinoids because they treat acne and can improve skin texture and fine lines.
Benzoyl peroxide helps kill acne-causing bacteria and reduces inflammation inside clogged pores. This ingredient is available in cleansers, creams, and spot treatments. Benzoyl peroxide is often combined with other acne treatments.
Azelaic acid helps reduce bacteria and unclog pores. It can also improve discoloration and dark marks left after breakouts. Because it’s gentle, azelaic acid is often recommended for people with sensitive skin.
If topical treatments aren’t enough to control acne, dermatologists may prescribe oral medications. These treatments, which are taken by mouth, work inside the body to regulate hormones or reduce inflammation.
Spironolactone is commonly used off-label — meaning the U.S. Food and Drug Administration (FDA) hasn’t approved it for this use — to treat hormonal acne in adult women. It works by blocking the effects of androgens on the skin. By reducing androgen activity, spironolactone lowers oil production and helps decrease breakouts. Acne on the chin or jawline often responds well to this treatment.
Oral antibiotics may be prescribed for moderate or severe acne. These medications reduce bacteria and inflammation in the skin. They’re usually used for a short time while other treatments begin to work.
Hormonal treatments may help improve acne during menopause. However, these treatments are usually prescribed based on overall health needs. Doctors consider age, medical history, and menopause symptoms before recommending hormone therapy.
Some birth control pills regulate hormone levels and reduce androgen activity. This can decrease oil production and improve acne. These medications are often used for hormonal acne in younger women but may not be appropriate for everyone in menopause.
Menopause hormone therapy increases estrogen levels and may help rebalance hormones. For some women, this can improve certain skin symptoms. However, hormone therapy is typically prescribed for symptoms such as hot flashes or night sweats, not only for acne.
Acne is just one of several skin changes that may occur during menopause. Hormone shifts can affect the skin’s structure, moisture, and elasticity. Because estrogen supports collagen and hydration, lower levels can change how the skin looks and feels.
Many women notice their skin becomes drier. Estrogen helps the skin retain moisture, so lower levels can lead to dryness and sensitivity. Using gentle cleansers and moisturizers can help restore hydration and protect the skin barrier.
Collagen levels decline as estrogen decreases. Collagen is the protein that gives skin strength and structure. With less collagen, skin becomes thinner, and wrinkles may appear more easily.
Some women notice new hair growth on the chin or upper lip. This happens because androgen hormones become more dominant as estrogen declines. Although it can feel surprising, it’s a common change during menopause.
Hormonal shifts and sun exposure can contribute to hyperpigmentation, or dark spots. These spots may appear on the face, chest, or hands. Daily sunscreen and certain dermatology treatments can help prevent and reduce pigmentation.
If acne appears suddenly during menopause or becomes difficult to manage, seeing a dermatologist can help. A specialist can determine whether the acne is hormonal and recommend effective treatment. Dermatologists can also prevent long-term problems such as scarring or persistent dark spots.
“I wish I had known about the acne it causes,” one woman told ThisIsMenopause. Understanding that acne can be part of menopause may help women seek treatment earlier and feel less alone.
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