Journal / Menopause

Menopause and Acne: 5 Ways to Achieve Clear Skin

Nancy L. Belcher

Medically reviewed by Nancy L. Belcher Ph.D, MPA

Written by Winona Editorial Team

Last updated November 25, 2021

Menopause and Acne: 5 Ways to Achieve Clear Skin

Mother Nature is acting up again and giving us acne in middle age. As if mood swings, thermostat issues, low libido, and changing metabolism weren’t enough, here we are breaking out like teenagers in combination with wrinkles and facial hair!  Menopause and acne - fabulous.

With menopause, we do have an acne-prone face and can experience facial breakouts more often. At this stage of life, we are worrying about wrinkles, facial blemishes and even scarring on our faces. Gentle facials for acne are a great option but we do not recommend home blackhead extractions. DIY blackhead extractions can lead to infection, scarring, and worsening skin.

Why Are All of These Changes Happening?

As with most things related to life cycles, midlife acne is hormone-driven. Hormones are powerful messengers in your body and when off balance can lead to a world of unpleasant symptoms. The good news is, the imbalance is treatable. Our skin is made up of several layers, and the dermis, or the thickest layer of your skin, is sensitive to the decrease in hormones that occur with aging and menopause. 

Our dance with the hormones estrogen, progesterone, and testosterone is thrown out of balance as women enter perimenopause, which starts in a woman’s late 30s or 40s, and acne skin problems often follow. The average age of menopause (when you haven’t had a period for 1 year or more) is 51. 

These acne breakouts are very different from adolescent acne. Menopausal acne follows a ‘cystic’ pattern along the jawline. The jawline area, along with the upper lip, is where you may also notice new and unwanted hair growth. In addition, you may notice thinning of the hair at the crown (also called female pattern alopecia). These changes are driven by hormonal imbalance.

Menopause and Acne

Whether you haven’t had acne in years, or you’ve always struggled with it - you may notice it starts or gets worse with perimenopause (at about 40). It is even possible to get acne for the first time, “adult-onset acne,” and is most common among women going through menopause. Yes, women get adult acne more often than men.

As adolescents, our acne tended to be the product of hormonally-induced oil excess and sticky skin cells (keratinocytes) plugging up the pores. Because of this abundant oil, we were able to tolerate the drying side effects of those popular topical acne medications. What worked well in our teens included improved diet, hygiene, and OTC topical acne treatments, but that formula isn’t necessarily going to help us today.

In our 30s and early 40s (perimenopause), we may start to notice those early signs of sun damage, manifesting as sunspots and fine lines. Perimenopause can bring more dramatic hormone changes, and hormonal acne is often observed. As estrogen levels fall in perimenopause, other hormones start to jump and can result in adult acne. Adult hormonal acne typically presents as cystic breakouts along the jawline. 

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Estrogen's Critical Role in Your Skin

Each hormone has its own special ‘receptor’ or landing pad throughout the body. Hormones are only effective if they find their correct landing pad. The estrogen receptors in the skin play a role in many factors related to how your skin looks and feels. Here are a few: 

  1. How much oil your skin produces, also called ‘sebum production.’ Sebum is that oily, waxy product produced by your body's sebaceous glands. Sebum is necessary in order to coat, moisturize, and protect your skin.

  2. A decrease in estrogen can lead to the skin becoming thinner, so you may see more sagging and volume loss - especially in your face.

  3. Estrogen hormones are also vital to maintaining skin ‘elastin.’ Elastin is what helps your skin bounce back - like if your watch band is too tight. As estrogen decreases, so does elastin and you may notice skin loses its bounce and begins to sag.

  4. With the one-two punch decline in estrogen and testosterone, the resulting dryness makes wrinkles appear more prominent. 

These changes to your complexion happen slowly over time, but we know that after menopause, our skin and facial structure undergo more rapid changes, including thinner lips, deeper wrinkles, and a sagging jawline.3 It’s important to correct the hormone imbalances before we permanently alter our skin.

5 Effective Ways to PREVENT Adult Acne

Regardless of your acne history, had it as a teen, always had it, or now seeing it for the first time,  there are a number of ways to successfully treat it:

  1. Level out fluctuating hormone levels that occur with age with Hormone Replacement Therapy (HRT). Fluctuations in hormones (especially estrogen and progesterone) can lead to breakouts. Women experience fluctuating hormones with their monthly cycle, pregnancy, and during peri- and menopause.

  2. Lower your stress as much as possible to prevent acne flare-ups. With stress, our bodies’ hormone levels shift and can stimulate the oil glands and hair follicles in the skin, which can lead to acne. 

  3. Check your hair and skin care products for specific ingredients. Read labels on your products and try to find products that are the least likely to cause acne -  terms on every container should include at least one of these:

  • Non-comedogenic 

  • Non-acnegenic

  • Oil-free

  • Won’t clog pores

4. Check your current medications for side effects. Acne is a side effect of some medicines.
5. Consider that you may have an undiagnosed medical condition.

Age beautifully. Goodbye getting old.

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Some of the Most Common Adult Acne Question:

It’s important to understand that acne varies in severity based on age, sex, and hormone levels. Treatment will depend on the individual. Thus, there is no singular treatment that will address all types of acne, nor is there one particular treatment that is well-tolerated across the board for all patients. One thing that is a common thread is that treatment goals will include prevention and resolution of acne and the scars that sometimes result.

Common Questions:

  • How do I treat adult acne?

  • Lifestyle changes can be very successful in decreasing adult acne: 

    • The stress hormone ‘cortisol’ is so important for skin health and overall well-being. Daily walks, meditation, yoga, and self-care practice are essential. 

    • An anti-inflammatory diet rich in antioxidants and limiting refined sugars will improve skin appearance and decrease breakouts.

  • Hormone replacement therapy (HRT) available both in a combination with progesterone with estrogen or without is an effective option. Hormone replacement therapy (HRT) can help normalize the levels of hormones to calm down the acne flare-ups. Just like in puberty, the changes of hormones are causing our skin to revolt. We know that teenage girls are often put on hormonal birth control to try to relieve acne. Just like that treatment, HRT (at much lower hormone levels than birth control) can help clear up your skin.

  • Azelaic acid is a naturally occurring acid and is helpful for reducing acne and rosacea, a common skin condition that is often mistaken for acne in midlife.

  • Topical or oral niacinamide (vitamin B3) is anti-inflammatory and can help both acne and hyperpigmentation. While not as potent as retinoids or HRT treatment, niacinamide can be a beneficial addition to acne treatment and can benefit acne, rosacea, hyperpigmentation, and UV-induced skin damage. 

  • Retinoids (the vitamin A family) help with acne, anti-aging, and hyper-pigmentation but can cause irritation and require an adjustment period. Less-potent OTC retinoids (retinol and adapalene) offer better tolerability, but may not be as effective for acne as prescription-strength retinoids. 

  • Spironolactone is another method for helping to clear up hormonal acne if people are intolerant of retinoids or with more pronounced hormonal acne. Oral spironolactone can be used in low doses leading to less oily skin, reversal of scalp hair thinning, less acne, and facial hair. It is available as an oral prescription only but may be compounded by the Winona pharmacy for topical use. It cannot be used in pregnancy. 

  • Topical vitamin C can have some positive effects.

  • Kojic Acid is a popular ingredient in Asia for treating acne and pigmentation... Do not use it if you have a history of allergy to mushrooms or penicillin. In addition to skin lightening properties, it has antimicrobial benefits that may improve acne as well.

  • Spa Facials? While they may advertise “acne facials,” many are left wondering if they really help. Facials certainly can help improve the appearance of the skin temporarily via hydration (steam and topical moisturizers), but there is little proof they prevent future breakouts. 

  • Gentle peels may help with hyperpigmented acne scars.

Factors That Must Be Considered When Treating Acne

While the use of HRT (especially progesterone) may be helpful, when taking too much progesterone, you may experience the opposite effect - worse acne. That’s why it is so important to work with aging specialists that know how to balance your hormones for the best results. 

Another consideration that few talks about are that as we age our skin becomes more and more sensitive to scents added to products, coloring, and cleansers that are just too harsh. These increasing skin sensitivities are due to the loss of estrogen which leads to thinner, drier skin that is more intolerant of topical medications. 

A perfect example of this intolerance is seen when using topical retinoids which are vitamin A derivatives. Retinoids are very effective for acne and anti-aging, but their use must be balanced with their tendency to cause irritation. There are some over-the-counter forms of retinoids but because of the potential to worsen the skin if not used properly, it is more efficacious to use tretinoin that is available only by prescription. 

Custom compounding, like that by the Winona pharmacies, allows for microencapsulation and additional ingredients like hyaluronic acid to minimize dryness and irritation. Microencapsulation is a process where tiny particles of a product are surrounded by a coating to make small capsules that can be readily absorbed.


Menopause and acne; as if the other menopause symptoms weren’t enough, now we have acne-prone faces, and can experience facial breakouts more often. At this stage of life, we are worrying about wrinkles, facial blemishes, and even scarring on our faces. 

Winona encourages women to embrace their new, more mature skin and to treat it well. While acne can be a particularly surprising symptom of aging and decreasing hormones for adults, there are several types of HRT treatments that are appropriate if you’re looking for skincare benefits. Your Winona physician can help determine whether this treatment is right for you. 

“This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.”




  3. August 2019 in the American Journal of Physical Anthropology

  4. June 2018 in the Journal of Cosmetic Dermatology