Menopause & Rosacea: Symptoms, Causes, and Treatments

Skin problems are a common concern during menopause, with approximately 64% of menopausal women reporting skin-related symptoms, including rosacea.⁽¹⁾

Rosacea is a chronic inflammatory skin condition that typically affects the central face, causing persistent redness, visible blood vessels, and, in some cases, papules or pustules. Symptoms often appear or worsen between the ages of 45 and 55, a period that overlaps with the menopausal transition.⁽²⁾

The decline in estrogen during this transition can lead to noticeable skin changes. The skin often becomes thinner, less elastic, and more prone to dryness as it loses moisture more easily. Reduced blood flow may dull the skin’s appearance and slow the healing process. These changes can also increase sensitivity and make the skin more reactive to common rosacea triggers.⁽³⁾ 

The impact of rosacea is not limited to the skin, as it may also increase the risk of certain conditions, such as hypertension, inflammatory bowel disease, and mood disorders.⁽²⁾ Given its impact on women’s quality of life and overall health, timely diagnosis and consultation are essential, especially during the menopausal transition.

Understanding Rosacea

Rosacea is a common, chronic inflammatory skin disorder characterized by recurrent episodes of flushing, persistent erythema (redness of the skin), telangiectasia (visible, broken blood vessels near the surface of the skin), and inflammatory lesions such as papules (small, raised bumps) and pustules (pus-filled lesions). These symptoms typically affect the central face, including the nose, chin, cheeks, and forehead.⁽⁴⁾

The following are four primary clinical subtypes of rosacea, classified based on predominant signs and symptoms:⁽⁴⁾

• Erythematotelangiectatic Rosacea: This is characterized by persistent facial redness and visible blood vessels (telangiectasia), often accompanied by frequent flushing.

• Papulopustular Rosacea: This involves inflammatory papules and pustules resembling acne, typically found on the central face.

• Phymatous Rosacea: This causes skin thickening and an irregular surface texture, most commonly affecting the nose (rhinophyma) due to the enlargement of the oil-producing glands.

• Ocular Rosacea: This type affects the eyes and surrounding skin. Symptoms may include dryness, redness, tearing, burning, stinging, a foreign-body sensation, light sensitivity, and blurred vision.

These subtypes are not mutually exclusive. Individuals may exhibit features of more than one subtype, and their clinical presentation may shift over time.

Understanding the Causes and Triggers of Rosacea

The exact cause of rosacea is not fully understood, but research suggests it involves a combination of immune system imbalance, nerve and blood vessel dysfunction, and genetic and environmental factors.⁽⁴⁾

Some common triggers that may initiate or exacerbate rosacea symptoms include the following:

• Ultraviolet (UV) radiation

• Skin microorganisms, especially Demodex mites 

• Extreme temperatures, including heat, cold, wind, and humidity

• Emotional stress

• Spicy foods, alcohol, and hot beverages

• Topical irritants, including certain cosmetics or skincare products

• Hormonal fluctuations, especially during perimenopause and menopause

The Connection Between Rosacea and Menopause

Rosacea often develops or worsens during midlife. Hormonal shifts, especially the decline in estrogen, may be a contributing factor.

Skin Changes Associated with Menopause

During menopause, declining estrogen levels affect skin structure and function. Estrogen plays a crucial role in maintaining skin thickness, hydration, and vascular stability. As levels drop, the skin may become thinner, drier, and more sensitive to environmental and topical triggers.⁽³⁾

These changes can heighten sensitivity and contribute to increased rosacea flare-ups. A disrupted skin barrier also makes the face more vulnerable to redness and inflammation.

Hot Flashes

Hot flashes are a common symptom of menopause, often causing sudden warmth, facial redness, and visible flushing — symptoms that closely resemble rosacea flare-ups. 

Some studies suggest that menopausal flushing can exacerbate rosacea or even contribute to its onset. Repeated flushing can increase blood vessel reactivity, leading to prolonged redness over time.⁽¹⁾

Symptoms of Rosacea During Menopause

The earliest sign of rosacea is often transient facial flushing. Persistent redness may initially appear around the nose and gradually extend to other areas of the face or neck.

In individuals with darker skin tones, rosacea may present differently, often appearing as dusty brown discoloration or yellowish-brown, firm bumps, particularly around the mouth and eyes. These variations in presentation can contribute to underdiagnosis or misdiagnosis.⁽⁴⁾

A diagnosis of rosacea typically requires the presence of at least one primary feature:

• Flushing (transient redness)

• Non-transient redness

• Papules 

• Pustules 

• Telangiectasia

In many cases, one or more secondary features are also present:

• Burning or stinging sensations

• Dry or rough skin texture

• Plaque formation

• Facial swelling 

• Central facial distribution of symptoms

• Ocular involvement (redness, dryness, or irritation)

• Skin thickening, typically around the nose

A number of skin conditions may resemble rosacea, including seborrheic dermatitis. A diagnosis by a board-certified dermatologist or primary care provider is essential to identify the underlying cause.⁽⁴⁾

Beyond visible symptoms, rosacea is also associated with anxiety, embarrassment, and depression, which may negatively impact daily life. Research also suggests links between rosacea and systemic conditions, including neurologic diseases, inflammatory bowel disease, and cardiovascular disease.⁽⁴⁾

Managing Rosacea During the Menopausal Transition

The management of rosacea depends on its subtype, severity, and the presence of menopausal symptoms. Most cases require a combination of general skincare measures and targeted therapies.

Hormone Replacement Therapy (HRT)

Systemic estrogen is the most effective treatment for menopausal hot flashes, reducing their frequency by up to 75%.⁽⁵⁾ By lowering the intensity and frequency of hot flashes, HRT may help reduce rosacea flares triggered by hot flashes.

HRT also improves skin hydration, thickness, and elasticity, strengthening the skin barrier and reducing sensitivity to rosacea triggers.

Non-HRT Management

Topical Therapies

Topical agents are selected based on the predominant symptoms.⁽⁶⁾

For erythematotelangiectatic rosacea, metronidazole helps reduce inflammation by targeting reactive oxygen species and calming neutrophil activity. Azelaic acid offers both anti-inflammatory and antimicrobial effects, making it effective for managing redness and irritation. Brimonidine, a topical alpha-agonist, constricts superficial blood vessels to temporarily reduce visible redness. However, it may cause rebound erythema in some individuals if used daily.

In papulopustular rosacea, ivermectin combines anti-inflammatory properties with an effect on Demodex mites, which are thought to contribute to immune activation in rosacea. Dapsone provides anti-inflammatory and antibacterial benefits, helping to reduce pustules and redness. Azelaic acid is also effective in this subtype, helping to calm inflammation, limit bacterial overgrowth, and improve skin texture.

Oral Therapies

• Antibiotics: Doxycycline or minocycline are commonly prescribed for their anti-inflammatory effects. Erythromycin or clarithromycin may be used for individuals who cannot tolerate tetracyclines.

• Vasomodulators: Oral medications like propranolol or clonidine may be considered for persistent flushing, though specialist supervision is recommended.

• Isotretinoin: Reserved for refractory cases, isotretinoin requires specialist referral and careful monitoring due to potential adverse effects.

Laser and Light Therapy

Laser therapy is often used to manage the visible signs of rosacea. Treatments like pulsed dye lasers and intense pulsed light (IPL) can help reduce redness and visible blood vessels on the face. These procedures are usually done by dermatologists trained in laser techniques.⁽⁶⁾

Thick or bumpy skin, often seen around the nose, may require more advanced treatment. In these cases, stronger lasers or minor surgical procedures can help remove excess tissue and restore the skin’s appearance.⁽⁶⁾

Lifestyle Changes to Reduce Rosacea Symptoms

The following lifestyle changes can help manage rosacea symptoms:

• Trigger Avoidance: Common triggers include spicy foods, alcohol, extreme temperatures, hot beverages, and stress. Keeping a symptom diary can help individuals identify and avoid personal aggravating factors.

• Skincare: Ingredients such as alcohol, witch hazel, camphor, fragrance, and glycolic acid may irritate sensitive skin and should be avoided. Fragrance-free, hypoallergenic products are recommended. 

• Sun Protection: Daily use of a broad-spectrum sunscreen with SPF 30 or higher is essential. Sunscreen should be applied to all exposed areas, including the face, neck, ears, and chest, and reapplied regularly when outdoors.

Struggling with rosacea during perimenopause? Discover if HRT is right for you.

If you’ve entered menopause and are struggling with rosacea, take our brief menopause quiz to see if HRT is right for you. Start with Winona to feel better.