Why Menopause Acne Happens & What to Do About It (2024)

Back in high school, pimples were a rite of passage. You weren’t a teenager if a huge zit didn’t pop up right before the prom. But it might come as a surprise when acne is suddenly back with a vengeance as you enter menopause—just in time to mess up your high school reunion (go figure).

“Acne can be surprising and frustrating for women who thought their breakout days were over,” says dual fellowship-trained dermatologist Hannah Kopelman, D.O. While acne is far more common during our high school years—more than 66 percent of teenage girls are affected by it—acne can rear its ugly head again around the time of menopause. Around 26 percent of women in their 40s and 15 percent in their 50s are still dealing with acne (1).

So what causes these midlife breakouts? And what can you do to nip zits in the bud?

About the Experts

Hannah Kopelman, D.O., is a dual fellowship-trained dermatologist who treats a wide variety of skin conditions. She practices at Kopelman Aesthetic Surgery and DermOnDemand in New York City.

Kecia Gaither, M.D., M.P.H., is double board-certified in OB-GYN and maternal fetal medicine and director of Perinatal Services/Maternal Fetal Medicine at NYC Health + Hospitals/Lincoln in the Bronx, NY.

Neelam Vashi, M.D., is an associate professor of dermatology at Boston University Chobanian & Avedisian School of Medicine, and director of the Boston University Cosmetic and Laser Center at Boston Medical Center.

What Is Menopause Acne?

As the name suggests, menopause acne occurs during the menopause transition, the period when your body’s production of estrogen and progesterone gradually slows and then stops (2).

Doctors officially define menopause as the 12 months after your last period, but for most women, the process lasts a lot longer. Perimenopause typically starts between ages 45 and 55 and can last for two to eight years (1). That can feel like an eternity if you’re dealing with symptoms like hot flashes, night sweats, mood swings—and pimples (2).

For most menopausal women, acne is nothing new. But around 30 percent of women get breakouts for the very first time in their 40s or 50s (3).

What Causes Menopause Acne?

Acne in menopause has a few possible causes, but it all starts with your changing hormones.

Hormones

“Hormonal fluctuations during menopause can lead to an increase in sebum production, which clogs pores and triggers acne,” Kopelman explains. Let’s break that down.

During menopause, the production of estrogen drops off sharply. Meanwhile, your production of male hormones called androgens (yes, women make them too) decreases more slowly. That leads to an imbalance, with more testosterone than estrogen circulating through your system.

Why does that matter? “When androgens (testosterone) increase, the skin produces more sebum, or oil,” says OB-GYN Kecia Gaither, M.D., M.P.H. That extra oil, along with dirt and bacteria, clogs pores and leads to acne.

Genes

The odds of getting acne—whether in high school or during menopause—might be written in your genes. Two out of every three people who get breakouts have at least one close relative, like their mother or sister, who gets them too (3).

Stress

Your body is changing in not-so-fun ways, and you may be juggling work, aging parents, and kids. When you’re stressed, your body releases hormones that put androgen production into overdrive. Yet another reason why you could see more pimples (1).

What Does Menopause Acne Look Like?

Acne comes in two varieties: comedonal and inflammatory. Comedonal acne consists of whiteheads and blackheads. Inflammatory acne is deeper under the skin. It shows up as red bumps that may contain pus and hurt if you try to squeeze them (4).

What does menopause acne look like? “It could look very similar to the acne that you had when you were younger, but it’s less comedonal. There’s not as many whiteheads,” Kopelman says. Another difference is that you might see more breakouts around your mouth and chin in middle age (the areas affected by hormones), instead of distributed around your face like when you were younger.
Note that the eruptions you’re seeing might not actually be acne. “You may also have rosacea, which is different than acne but can sometimes look similar,” says dermatology professor Neelam Vashi, M.D. Rosacea, which can be triggered by menopausal hot flashes, causes redness and acne-like pus-filled bumps on the skin. So be sure to see your dermatologist for a diagnosis.

How to Treat Menopause Acne

Managing menopause acne starts with a good skincare regimen. Some of the same blemish remedies you turned to in high school are still effective in menopause.

Skincare basics

The centerpiece of any menopause skincare regimen is a gentle cleanser. Wash your face with it twice daily—once in the morning and once before bed. “You want to remove debris including makeup, which clogs pores and leads to irritation,” says Vashi.

Then slather on a moisturizer with SPF 30 or higher, to protect your skin from the sun’s radiation (which damages the skin and aggravates acne) (7). Choose products that are non-comedogenic (i.e., won’t make you break out) and contain ceramides (fats that moisturize your skin), Vashi adds.

As much as you’re tempted, don’t over-exfoliate. Scrubbing more than two or three times a week will irritate your skin, says Kopelman.

Topical treatment

Acne creams and gels are available over the counter and by prescription.

Retinoids

These vitamin A-based products include tretinoin (Retin-A, Tretin-X), adapalene (Differin), and tazarotene (Tazorac). Retinoids are effective at treating acne and offer some extra perks. “They also boost cell turnover and tackle fine lines,” Kopelman says.

One downside? They can dry out and irritate skin, so a lower-strength over-the-counter formulation may be better for mature skin. Vashi recommends starting at a low dose and gradually increasing if you need more. And remember: retinoids make your skin more sensitive to the sun, so wearing sunscreen is extra important (1, 2).

Benzoyl peroxide and salicylic acid

These are the main ingredients in OTC acne products like Clearasil and PanOxyl. Benzoyl peroxide works in two ways: by killing bacteria on your skin and reducing inflammation. Salicylic acid reduces swelling and redness. Kopelman recommends using a cleanser containing either benzoyl peroxide or salicylic acid in the morning, and then a gentle cleanser with a retinoid at night. Because benzoyl peroxide can be irritating in high doses, start with a low-dose (2.5%) cream or wash (1).

Azelaic acid

This natural acid reduces inflammation, kills bacteria, gets rid of whiteheads and blackheads, and can also help with redness. In one study on individuals with mild-to-moderate acne, an azelaic acid cream decreased pimples by 54 percent after three months of use (5).

Oral treatment

If you’ve been slathering on one or more of these creams and your acne isn’t budging, it might be time to call in the big guns. These oral prescription medicines help with stubborn acne, but they do have some possible side effects.

Spironolactone

Prescribed clinically to lower blood pressure, spironolactone also treats acne by reducing androgens. But you should discuss its side effects with your doctor. You’ll have to pee more often (because it’s a diuretic), your breasts may be sore, and if you still get periods, they could be even more irregular than they already are in perimenopause. If you have normal to low blood pressure, it could lower it even more, leading to dizziness upon standing, with the potential to be dangerous (1).

Antibiotics

Medicines like doxycycline and erythromycin lessen inflammatory acne by killing the bacteria that cause pimples and reducing swelling. They’re only meant to be taken short-term when acne creams haven’t worked (1) because long-term use contributes to antibiotic-resistant germs (8).

Isotretinoin (Accutane)

Accutane is very effective for people with severe or persistent acne, but it’s often prescribed as a last resort. That’s because it comes with an intimidating list of side effects, including headaches, high triglycerides, reduced night vision, weak bones, liver problems, and mood changes. Accutane also causes birth defects, which is a problem if you can still get pregnant (1).

Natural remedies

There’s some evidence that probiotics might improve acne by reducing inflammation and blocking harmful bacteria, but the science hasn’t 100 percent confirmed they work, says Vashi (6).

Better evidence supports a low glycemic diet—one low in processed foods and high in fruits, vegetables, and nuts. Here’s why: foods high on the glycemic index (white bread, cookies, bagels, etc.) boost levels of the hormone insulin, which in turn leads to inflammation, androgen production, and pimples (6).

Menopause hormone therapy

If your mid-life acne was caused by a drop in estrogen, it makes perfect sense that replacing this hormone might treat it. A low dose of oral estrogen and progestin treats mild-to-moderate acne by reducing androgens and sebum. But before you pop a pill, talk to your doctor about the best course of treatment for you. They’ll determine if you’re predisposed to side effects like blood clots or an increased risk for uterine and breast cancers (1).

How Long Does Menopause Acne Last?

Menopause acne should clear once you’re through “the change,” but it could take years. Prescription treatment can speed up healing, but its effectiveness differs depending on the product and your skin’s unique needs.

Antibiotics and Accutane start clearing acne quickly, within a few weeks, while a retinoid can take a few months to see results. “With a topical regimen, you’re not going to see [results] right away. But you have to stick with it,” says Vashi.

When to Consult a Professional

If you’ve been using over-the-counter acne cream on your own but your pimples aren’t budging, or your acne is severe enough to mess with your quality of life, make an appointment with a dermatologist. It might be that you’re not using the right products, or you’re using the right ones but in the wrong way, Vashi says.

Another possibility is that menopause has changed your skin. It happens. “I have a lot of people who come to me and say, ‘I’ve been using this [product] for years and it’s not working anymore,’” she says. “The skin changes, and sometimes we have to change what we’re doing, too.”

Recommended Skincare Products for Menopause Acne

These products, which contain ingredients recommended by our experts, are smart choices for acne-prone skin at any age:

CeraVe Renewing SA Cleanser: This noncomedogenic formula, developed with input from dermatologists, contains ceramides to increase skin moisture, plus salicylic acid to treat acne.

Vanicream Facial Cleanser for Sensitive Skin: This product is noncomedogenic and free from fragrances, dyes, and other additives that might irritate sensitive skin.

La Roche-Posay Anthelios Ultra Light Fluid Facial Sunscreen SPF 60: All of La Roche-Posay’s products are noncomedogenic, which makes them a dermatologist favorite. This one is lightweight but still offers some heavy-duty sun protection.