Acne from menopause: Causes, symptoms and treatment

Some symptoms of menopause are well known. You may expect to develop hot flashes or night sweats, and you might not be surprised if you experience changes in mood. However, breakouts during menopause may take you by surprise. While it's true that acne blemishes typically decrease with age, some women see a resurgence or develop pimples for the first time before and during menopause. Fortunately, you can take steps to address menopause-related blemishes when they occur.

During menopause, acne typically happens due to fluctuations in hormone levels. As estrogen levels decrease, the effects of male sex hormones called androgens increase. Androgens increase the production of sebum, the skin's natural oil.

Excess oil on the skin can mix with bacteria, dead skin and debris to clog pores. This can result in dark blemishes called blackheads. If the immune system responds to the presence of clogs, inflammation can occur, leading to the formation of whiteheads.

Genetics may also play a role in adult acne. If a close family member experienced acne during menopause or experienced blemishes throughout their life, you may be more likely to develop the problem.

One thing that scientists have ruled out as a cause of acne during menopause is diet. Consuming large amounts of chocolate and greasy foods may not be the best fit for a healthy diet, but it’s unlikely to contribute to blemishes.

Blemishes that develop during menopause resemble acne that occurs at other times in life. They can appear as black dots on the surface of the skin or raised bumps with a white head. Pimples are often red at the base, and the surrounding skin may become red if you have several breakouts side by side.

Menopausal acne often develops in the T-zone, which consists of the forehead, nose and chin. However, you can get breakouts anywhere on your face, as well as on your chest, back, shoulders and scalp.

Many women may begin to see acne in perimenopause, the period of time leading up to menopause. Perimenopause lasts an average of four years. However, this phase can take place over a period of eight to 10 years prior to menopause, or it can be as short as a few months prior to menopause in some people.

Perimenopausal acne may persist even after you haven’t had a menstrual period for a full year. Typically, breakouts will gradually subside in the years following menopause, which is called postmenopause.

 For mild acne, a daily skin care routine and self-care may be enough to support clearer skin. Follow these tips to address blemishes:

Use a daily facial cleanser for acne

Wash your face twice per day with a  facial cleanser designed for acne. These products often contain benzoyl peroxide or salicylic acid. Benzoyl peroxide helps regulate oil levels on the skin while also fighting bacteria that contribute to acne. Salicylic acid supports clearer skin by lifting away dead cells that can clog pores.

When washing your face, use a gentle touch. Avoid using abrasive scrubs for cleansing, as these may irritate your skin.

Apply topical treatments

If you don't see results from using an acne face wash alone, try over-the-counter spot treatments. Typically, you apply these ointments, gels and creams directly to blemishes and the surrounding skin once or twice daily.

Benzoyl peroxide and salicylic acid are common active ingredients in over-the-counter acne treatments. Adapalene is another popular over-the-counter acne spot treatment. This medication is a retinoid. It aids in the natural turnover of skin cells. Over time, its actions may reduce pore blockages to help existing blemishes heal and reduce the risk of future breakouts.

Avoid the urge to pop and pick

Resist the temptation to pop and pick blemishes. Doing so will slow down the healing process and could result in scarring. Keep your hands away from your face as much as possible while acne heals.

Monitor your skin’s condition

When trying new face washes and spot treatments, watch out for signs of dryness, like dullness, roughness, flaking and itching. Some over-the-counter acne skin care products may dehydrate skin and actually make acne worse. If you notice symptoms of dry skin, discontinue use of your acne care products and consult your medical provider.

Choose cosmetics and sunscreen carefully

Makeup can contribute to clogs and make postmenopausal and perimenopausal acne worse. Look for cosmetics that are noncomedogenic, meaning they don't clog the pores.

Protecting your skin from the sun is important at any age, so don't stop applying your daily sunscreen due to blemishes. Instead, switch to an oil-free facial sunscreen to shield your skin from UV rays.

If perimenopausal acne doesn't clear up with at-home care, see your medical provider. They can recommend acne medication, such as additional over-the-counter products or prescription topical medications, to address breakouts. Your medical provider can also discuss other menopause symptoms that you're experiencing and suggest interventions that can help you feel and look your best through each stage of menopause.

Published January 2023.