If your rosacea seems to be flaring more often during perimenopause or menopause, you’re not imagining it.

Hormonal changes during the menopausal transition may contribute to rosacea symptoms. Research also suggests that rosacea may be more common and more severe in women aged 40 to 60.

Learn why rosacea may worsen during menopause, which treatments can help, and when to see a dermatologist.

How Menopause Affects the Skin and Triggers Rosacea

When rosacea worsens during perimenopause, hormonal changes may be part of the reason.

Estrogen plays an important role in skin health. It helps stimulate collagen production, improves skin elasticity, supports hydration, and helps maintain the skin barrier.

As estrogen and progesterone levels decline during the menopausal transition, the skin barrier may become less effective. Some people notice increased dryness, itching, skin sensitivity, and irritation.

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Hormonal shifts may also affect the blood vessels. This can cause them to widen, potentially triggering hot flashes and rosacea.

These changes can also increase inflammation, which plays a key role in rosacea. This may cause more frequent or severe symptoms. This includes persistent skin discoloration, which can appear pink, red, purple, or brown depending on one’s skin tone. Other symptoms are visible blood vessels, burning or stinging, and acne-like bumps or spots.

Rosacea Triggers

Hormonal fluctuations aren’t the only reason rosacea may worsen during menopause. Environmental factors, skin care routines, certain foods and drinks, and lifestyle habits can also trigger flare-ups.

Common rosacea triggers include:

• Heat
• Stress
• Sun exposure
• Alcohol, especially red wine
• Spicy foods
• Hot drinks
• Exercise
• Skin care products, especially those with alcohol
• Cold or windy weather

Your rosacea may become more frequent, severe, or hard to manage during perimenopause or menopause. If this occurs, a dermatologist can help identify your triggers and recommend strategies to ease your symptoms and reduce flare-ups.

Is There a Connection Between Hot Flashes and Rosacea?

In some people, hot flashes can trigger or worsen rosacea flare-ups.

Hot flashes are a common vasomotor symptom of menopause. During a hot flash, blood vessels near the surface of the skin widen, increasing blood flow and causing a sudden feeling of warmth. This can lead to flushing of the face, neck, or chest.

For people with rosacea, that sudden flushing can trigger a flare-up or make existing redness or discoloration on the face last longer or become more noticeable.

Hot flashes can feel different from person to person, and not every hot flash will trigger rosacea. But if you notice that your rosacea flares during or shortly after a hot flash, the two may be connected.

Some of the triggers for hot flashes and rosacea can also overlap. For that reason, identifying your individual triggers may help you manage both.

Managing Rosacea During Menopause

Rosacea can often be managed with a combination of lifestyle changes, gentle skin care, and medical treatments. Finding the right combination may take time. A dermatologist can help identify your triggers and develop a plan that’s right for you.

Avoiding Triggers

Rosacea triggers vary from person to person, so learning what causes your flare-ups is an important part of treating them. Some people notice that certain foods, weather conditions, or daily habits make their symptoms worse.

Keeping a journal of your symptoms and possible triggers may help. When a flare-up occurs, write down what you were eating and drinking, where you were, what you were doing, and any skin care products you recently used.

Over time, you and your dermatologist may begin to notice patterns. Once you know your triggers, you can make a plan to avoid them whenever possible.

Gentle Skin Care

Rosacea-prone skin is often more sensitive, so a gentle skin care routine may help reduce irritation.

When choosing skin care products, look for fragrance-free cleansers, moisturizers, and other products designed for sensitive skin. Also, try to avoid harsh scrubs, alcohol-based toners or astringents, and any products that sting or burn.

Your dermatologist will also likely recommend wearing sunscreen daily and protecting your face from sun exposure.

Topical Treatments

Depending on your symptoms, your dermatologist may recommend one or more topical medications for rosacea.

Here are some they might prescribe:

• Azelaic acid foam or gel — Helps reduce redness and discoloration, inflammation, and acne-like bumps
• Brimonidine gel — Helps fade skin discoloration by narrowing blood vessels
• Ivermectin cream — Helps treat inflammatory bumps and may reduce skin inflammation
• Metronidazole cream — Reduces inflammation and can improve redness and bumps
• Oxymetazoline cream — Helps fade skin discoloration by narrowing blood vessels

There are many topical creams and ointments available. Ask your provider which one is right for you. Keep in mind that it can take two to three months of consistent use before you see improvement.

Oral Medications

If topical treatments aren’t enough, your dermatologist may prescribe an oral antibiotic such as doxycycline. At low doses, doxycycline works by reducing inflammation rather than fighting infection. Because it’s a low dose, rather than the higher dose used to treat infection, it can be used long term to help control acne-like bumps.

Because stress can trigger rosacea, and menopause can be a stressful time, some doctors may recommend antidepressants. Although antidepressants aren’t a common rosacea treatment, treating persistent stress or anxiety may help reduce stress-related rosacea flare-ups.

In-Office Treatments

Some people may benefit from in-office treatments for rosacea. Laser therapy and intense pulsed light (IPL) therapy can both help reduce persistent redness, flushing, and visible blood vessels. IPL is gentler on the skin than laser treatments, but it usually requires more treatment sessions.

Hormone Therapy

Hormone replacement therapy (HRT) is an effective treatment for hot flashes and night sweats. Early research suggests it could help reduce the frequency and intensity of rosacea flare-ups. However, HRT is not a rosacea treatment.

If you’re considering hormone therapy, talk to your OB-GYN and your dermatologist about whether it’s right for you based on your symptoms and health history.

When To See a Dermatologist

Hot flashes and skin flushing are common during menopause, but persistent skin redness or discoloration, visible blood vessels, and acne-like breakouts may be signs of rosacea.

Consider scheduling an appointment with a dermatologist if you have new, changing, or persistent symptoms. A dermatologist can help distinguish rosacea from normal menopausal flushing. They can also identify factors that may be linked to your symptoms and recommend a personalized treatment approach.

With the right treatment plan and care team, many people can reduce flare-ups and manage their rosacea symptoms during perimenopause, menopause, and beyond.