Menopausal Acne: Management and Prevention

Most people associate acne breakouts with adolescence. However, many women are discovering that acne is another unpleasant effect of menopause. Both adolescents and menopausal women experience changes in hormonal levels. These hormonal fluctuations are the most common cause of menopausal acne.

Drops in estrogen levels and the resulting higher androgen hormones can cause acne. Menopausal acne may resolve as hormones balance, but if treatment is necessary, what worked as a teenager might not work now.

Why am I getting acne after 40?

In addition to mood swings and hot flashes, menopausal women may also experience skin changes. As women approach menopause, the skin begins to lose elasticity, and collagen levels drop, which can result in larger-looking pores. Various factors may also trigger menopausal acne, such as stress, genetics, and dietary and lifestyle changes, although a hormonal imbalance is usually the main culprit.

Using hormone replacement therapies (HRT) for menopause may cause the skin to break out, or an outbreak may occur from the accompanying physical and hormonal changes. Reducing estrogen levels means less oil production and dry skin, which makes the skin susceptible to various inflammatory conditions, including acne. However, menopausal women often acquire a different type of acne than teenagers and require other care and treatment.

What is hormonal acne?

Hormonal acne differs in appearance and location. During puberty, acne often appears on the forehead, nose, and chin, often referred to as the T-zone. In contrast, hormonal acne occurs on the lower part of the face, such as the chin, jawline, and upper neck. Although having acne on other areas of the face doesn’t always rule out hormonal fluctuations.

The appearance of hormonal acne also varies from usual acne because it’s deeper beneath the skin’s surface and shares similarities to cystic acne. These small, hard bumps may be tender to touch and form deep under the skin and don’t come to a head on the face’s surface.

Even though hormonal changes may result in acne for adolescents and menopausal women, the treatment for sensitive, mature skin isn't the same.

Rule out other causes

Before assuming hormonal changes triggered the acne, consider that sensitive, mature skin can be susceptible to inflammatory conditions such as rashes, rosacea, and various forms of dermatitis. Using acne treatments may make these conditions worse.

The root cause of acne may be as simple as examining the skin and hair products used. Ensure these products are non-comedogenic or state they won’t clog the pores. Visit a dermatologist to rule out other causes or your healthcare physician to ensure that acne isn’t indicating an underlying medical condition.

Endocrine disorders such as polycystic ovarian syndrome, hypothyroidism, insulin resistance, metabolic conditions, and some medications may cause acne. Treatment of the condition may clear the acne.

How do I treat menopausal acne?

The over-the-counter (OTC) acne medications used as a teenager are often ineffective for mature skin. These cystic bumps formed deep under the skin are below the reach of most topical medications.

Often menopausal acne is temporary and clears once hormone levels balance out. If acne persists, it may be time to see a dermatologist about a treatment plan. A dermatologist may recommend oral medication to balance hormones, such as oral contraceptives, anti-androgen medications, or a topical cream for treatment.

There are various types of treatment options for menopausal acne:

• Topical treatments. These could consist of topical retinoids (which may not be suitable for rosacea or sensitive skin), salicylic acid (to prevent build-up and clogging pores), topical antibiotics, benzoyl peroxide, or a combination of benzoyl peroxide and topical antibiotics.
• Hormonal replacement therapy. For some, hormonal replacement therapy (HRT) isn’t the best choice if there are personal risk factors such as a history of breast cancer or heart or liver disease.
• Other treatment options. Other treatment recommendations may include light therapy, topical vitamin C, or chemical peels.

Managing menopausal skin

Skincare is always essential, but even more so during menopause. Although acne prevention may not be possible due to fluctuating hormone levels playing havoc with the menopausal woman's body, some healthy habits can help manage acne or shorten the breakout length.

• Wash your face. Use a small amount of product and avoid over washing, to avoid further drying out the skin. Wash your face morning and evening and after exercising or sweating.
• Use proper cleansers. Choose a fragrance-free, gentle cleanser for daily skin care, and avoid astringents, toners, and exfoliants that may irritate the skin.
• Moisturize. Make moisturizing part of your routine to prevent further moisture loss from low estrogen levels.
• Don’t touch your face. Touching your face can transfer the oil and bacteria on your hands to your face and contribute to breakouts.
• Avoid tanning. Menopausal skin is more vulnerable, so be sure to use sunscreen and avoid tanning.
• Toss old cosmetics. Use clean applicator brushes to reduce the risk of bacteria growth. Replace expired makeup that can contribute to clogged pores or cause breakouts due to bacteria growth or mold.
• Reduce stress. Androgen and cortisol levels increase with stress and may create more oil and make acne worse.
• Diet changes. Overdoing some foods may increase inflammation, so limit sugar, dairy products, white bread, pasta, other refined carbohydrates, and red meats.

​​A single treatment or narrowing down an acne trigger outside hormonal fluctuations may be challenging. Still, practicing healthy habits, ongoing care, and follow-up with a family doctor or dermatologist may help reduce or shorten occurrences.