Acne in Perimenopause: Causes & Treatment

Menopause can throw you some real curveballs, and one of them may hit you right in the face: acne. Pimples and breakouts are surprisingly common as you approach the menopause transition. The good news is that there are a range of safe, effective treatments available. Here’s what you need to know about menopausal acne.

What Is Menopausal Acne?

Acne is often thought of as a teenager’s problem. And it’s certainly most prevalent in that age group, affecting nearly 70% of teens. But for many of us, acne continues well into adulthood and only gradually declines with age. Roughly a quarter of women in their 40s and about 15% of women in their 50s experience acne regularly.

For some people, this leads to menopausal acne. Menopausal acne is simply acne that occurs around the time of menopause—i.e., the point at which you stop menstruating and can no longer become pregnant. 

Why Does Acne Happen During Perimenopause?

As you approach menopause, your hormones begin shifting. This gradual transition, which may take years, is called perimenopause. Your estrogen levels fall during perimenopause, which can cause a cascade of changes impacting almost every part of your body—particularly your skin, as it contains plentiful estrogen receptors. This causes your skin to become thinner, drier, and less elastic while losing its moisture-retaining collagen. For people who are already dealing with acne, the menopause transition may exacerbate skin issues.

During perimenopause, testosterone declines more slowly and gradually than estrogen. This temporary excess of testosterone can trigger a slew of issues including hair loss, facial hair growth, and acne.

Researchers don’t fully understand how testosterone causes acne, but it seems to be related to an increase in the production of sebum. Sebum is an oily substance produced by special glands in the skin. It plays a very important role in protecting your skin from damage and pathogens. But excess sebum can clog pores, trapping dirt and bacteria in the skin and sparking infection.

What Are the Risk Factors for Menopausal Acne?

Not everyone will experience menopausal acne, and not everyone who has it will experience it to the same degree of severity. Fortunately, many of the variables influencing your skin health are under your control. Talk with your doctor or dermatologist about which of these factors are most important—and how you can work with them to steer your skin in the right direction.

• Dietary factors: There is research linking cow’s milk and high-glycemic foods to a worsening of acne in some individuals.
• Ultraviolet radiation: UV rays can damage your skin at any age, and this damage can become more pronounced during menopause. It may dry out your skin, causing your oil glands to work harder and potentially triggering acne.
• High Stress: Stress causes an increase in androgens—i.e. male sex hormones—that increase skin oils, potentially worsening acne. Roughly 70-80% of people experience more acne during times of stress.
• Sleep deprivation: Menopause can cause insomnia, which raises your levels of cortisol (the “stress hormone”). This, in turn, can cause or worsen acne. 
• Obesity: Excess body weight is linked to menopausal acne through a complex metabolic relationship. Obesity may trigger a hormonal imbalance favoring androgens, which in turn increases your sebum production and triggers acne.
• Genetics: Some people are genetically predisposed to adult acne. If you have a first-degree relative with adult acne, your risk is greater.

How Is Menopausal Acne Treated?

If you’re dealing with acne during menopause, we’ve got great news: There are treatments available and they work! Partnering with a dermatologist can keep you looking your best through the menopause transition and beyond, so there’s just no reason to “tough it out.” 

After examining your skin and exploring your medical background, your healthcare provider will likely recommend a number of lifestyle changes, over-the-counter treatments, and possibly prescription medications. Here are some of the changes they may suggest:

Revamp Your Daily Skincare Practice

You probably already practice some form of daily skincare, but your healthcare provider may recommend an update. After all, your skin is evolving and may have different needs now than it did in your twenties. For instance, you may need to start washing your face more frequently using a gentle soap or special cleanser. Or you might want to wash your face less frequently, as overwashing can be an acne trigger. Your provider may also recommend a daily moisturizer and facial sunscreen to protect you from harmful UV rays. Research has demonstrated that the best moisturizers for acne are hyaluronic acid, glycerin, dimethicone, and sodium pyrrolidone carboxylic acid.

Use a Basic Antimicrobial Treatment

The standard, first-line response to acne is benzoyl peroxide. Benzoyl peroxide is an antimicrobial agent that helps eliminate the bacteria that cause acne. You can also try dapsone 5% gel. Available with a prescription from your clinician, dapsone is an antimicrobial and anti-inflammatory agent that has been proven safe and effective for acne treatment.

Try Menopausal Hormone Therapy

Menopausal hormone therapy (MHT) uses estrogen to supplement your falling natural hormone levels. This is a very effective treatment for hot flashes and many other symptoms of menopause. MHT has been shown to increase the elasticity, thickness, and hydration of your skin, while boosting the content and quality of its collagen. It may also prevent menopausal acne by restoring your hormone balance.

Avoid Oil-Based Cosmetics

Give your makeup shelf a once-over and make sure you’re not using any oil-based cosmetics, as they can actually clog pores and worsen your acne. (The best products will be labeled oil-free and non-comedogenic.) You should also throw out any expired products and periodically clean and sanitize your makeup brushes and sponges to prevent bacterial growth. Finally, be diligent about fully removing your makeup every night before you go to sleep.

Stop Picking & Popping

The temptation to pop a pimple can be enormous, but it’s often a bad idea. Picking and squeezing pimples can irritate the skin even further, increasing swelling and redness and potentially leading to scarring. It can also drive bacteria deeper into the skin or into adjacent pores and follicles, causing even more acne. Remember—you can always go to your dermatologist for help. They may be able to extract the pimple’s contents or use a steroid (like cortisone) to reduce the swelling.

Topical Retinoids

Retinoids are another powerful topical treatment for acne. They work by increasing cell turnover in the skin, thus opening clogged pores and preventing future outbreaks. They also penetrate deep into the skin where they prevent inflammation, boost collagen growth, and improve elasticity. Retinoids can thus help rejuvenate aging skin and lessen sun damage. Tretinoin, tazarotene, and adapalene are commonly prescribed topical retinoid medications..

Oral Isotretinoin

Isotretinoin is a prescription retinoid drug that is taken orally rather than used topically. It is very effective at treating more severe cases of acne. Because it is a powerful medication with the potential for side effects, isotretinoin is generally only prescribed when other treatments have failed. Isotretinoin reduces your skin’s sebum production, reduces inflammation, and prevents acne-causing bacteria from growing in your pores..

Oral Antibiotics

Due to growing concerns around antibiotic resistance, these medications are now generally prescribed only when other treatments are ineffective and for the shortest possible duration. Oral antibiotics (such as doxycycline, minocycline, azithromycin, and erythromycin) circulate through your entire system, eventually reaching the skin where they can fight acne-causing bacteria.

The Bottom Line

The menopause transition significantly changes your hormone balance, which can lead to several bothersome symptoms, including acne. But don’t worry! There are many safe, effective treatment options available—-from lifestyle changes and OTC remedies to prescription medications. Talk to your healthcare provider about your skin health and find the solution that’s right for you.