Hormonal changes during perimenopause can cause acne, even if you haven’t had breakouts in years.
As estrogen levels decline, other hormones like testosterone may remain steady or rise, leading to increased oil production. That extra oil can clog pores and trigger acne breakouts, particularly around the jawline, chin, and cheeks.
This type of acne is common, and there are straightforward ways to manage it. A consistent skincare routine that includes gentle cleansing, non-acne forming products, and topical treatments like retinoids or benzoyl peroxide can help. In some cases, prescription medications—such as hormonal therapies or oral antibiotics—may be appropriate.
What Is Perimenopause Acne?
Perimenopausal or menopausal acne refers to breakouts that occur during the years leading up to menopause and during menopause
These breakouts are typically driven by hormonal fluctuations—specifically, a drop in estrogen and a relative increase in androgens like testosterone. The result is often inflamed pimples, cystic acne, and oily skin, even for people who haven’t had acne in decades.
Unlike teenage acne, perimenopause-related hormonal acne tends to be more inflammatory and persistent. Cysts or deeper nodules are more common than blackheads or whiteheads, and breakouts often appear along the lower face, especially the jawline, chin, and neck.
Another key difference is skin sensitivity. As estrogen declines, aging skin can become thinner, drier, and more reactive. This means that strong acne treatments used during adolescence may now cause irritation.
Instead, look for gentle formulations that balance acne-fighting ingredients with hydration. Some brands offer products that combine anti-inflammatory ingredients with moisturizers for sensitive or more mature skin.
Signs and Symptoms to Look Out For
Perimenopause acne often shows up in distinct ways. You may notice:
- Deep, painful pimples that don’t come to a head
- Cystic breakouts along the jawline, chin, or neck
- Increased oiliness and more visible pores
- Breakouts that flare up around your menstrual cycle
- Acne that doesn’t respond to products that used to work
These symptoms are linked to hormonal fluctuations, especially shifting levels of estrogen and androgens. While some people go through perimenopause without any skin issues, others experience persistent or new breakouts during this time. Both are common responses to the body’s changing hormonal environment.
Why Does Acne Occur During Perimenopause?
Acne during perimenopause is primarily driven by hormonal changes. As estrogen levels gradually decline, androgens—such as testosterone—can become more dominant. This hormonal imbalance is a common trigger for breakouts during this stage of life.
Estrogen plays an important role in your skin health. It helps regulate oil production, supports hydration, and contributes to collagen formation.
When estrogen drops, mature skin can become drier, thinner, and less elastic, while at the same time, oil production can actually increase due to the relative rise in androgens.
Androgens stimulate the sebaceous glands to produce more sebum. This excess oil, along with dead skin cells and bacteria, can clog pores and trigger acne flare-ups for many women.
While everyone has androgens, higher levels—or heightened sensitivity to them—can significantly affect aging skin. In perimenopause, your sebum production tends to be thicker and more likely to block pores. This makes breakouts deeper, more inflamed, and often harder to treat with over-the-counter products alone.
Hormonal imbalance isn’t the only factor. Other things can also influence how your skin responds during perimenopause, such as:
- Genetics
- Stress
- Dietary factors
- Lifestyle habits
But for many, the shift in estrogen-to-androgen ratio is a key driver behind adult-onset acne.
Natural Ways to Manage Your Skin Health
Hormonal shifts during perimenopause are outside your control—but how you care for your skin isn’t. A consistent, low-irritation routine and a few lifestyle adjustments can go a long way in managing breakouts.
Simple Skin Care
Start with a simple skincare routine. Cleanse twice a day using a gentle, pH-balanced cleanser—something like Cetaphil works well.
Follow with a salicylic acid toner or serum to help keep pores clear and reduce inflammation. Moisturize with a lightweight, non-comedogenic formula, and apply broad-spectrum sunscreen every morning. This helps protect against hyperpigmentation and supports overall skin barrier function.
Look for products designed for sensitive, acne-prone skin. Brands like CeraVe offer formulations with ingredients like niacinamide (which can reduce redness and regulate oil) and retinol (to improve skin texture and prevent clogged pores).
Introduce new products gradually, and avoid over-exfoliating, especially if your skin feels dry or irritated.
Diet and Nutrition
Diet may not cause acne on its own, but certain foods can contribute to inflammation or hormonal shifts that make breakouts more likely.
For some people, dairy can be a trigger. High-glycemic foods like white bread, sugary snacks, and sweetened drinks may also lead to flare-ups by spiking insulin and increasing oil production.
A balanced diet can support more stable hormones and healthier skin. Focus on whole, minimally processed foods:
- Fruits and vegetables for antioxidants and fiber
- Healthy fats like olive oil, avocado, nuts, and fatty fish to reduce inflammation
- Whole grains and legumes to support steady blood sugar
- Probiotic-rich foods like yogurt, kefir, and sauerkraut for gut and skin health
There’s no universal "acne diet," but tracking what you eat and how your skin responds can help you spot patterns and make helpful swaps.
Stress Management
Stress has a measurable effect on your skin. It increases cortisol, which can ramp up oil production and trigger inflammation—two key drivers of acne.
Managing stress consistently can help regulate hormones and reduce flare-ups. Evidence-based strategies include:
- Daily movement (like walking, swimming, or yoga)
- Mindfulness practices such as meditation or deep breathing
- Structured mental health support, including journaling or therapy
- Making space for things that bring pleasure—whether that’s reading, art, or connecting with others
Even small changes can shift how your body responds to stress and may help ease skin symptoms over time.
Sleep
Sleep is when your skin does most of its healing. During deep sleep, your body increases blood flow to the skin, repairs damage, and produces new collagen.
Aim for 7 to 9 hours of uninterrupted sleep each night. To support this:
- Stick to a regular sleep schedule, even on weekends
- Create a wind-down routine to signal your body that it’s time to rest
- Keep your bedroom dark, cool, and screen-free
- Avoid caffeine and alcohol in the hours before bed
Prioritizing sleep won’t clear acne overnight, but over time, it supports better skin function and reduces stress, both of which are key during perimenopause.
Over-the-Counter and Home Remedies
Alongside a consistent skincare routine, certain over-the-counter products and at-home treatments can help manage acne during perimenopause.
The goal is to support your skin without overwhelming it, especially when it’s more sensitive or reactive due to hormonal changes.
Cleansers and Moisturizers
Harsh cleansers can strip the skin’s barrier, leading to dryness, irritation, and more breakouts. Likewise, overly rich or occlusive moisturizers can clog pores.
Instead, look for a non-foaming, pH-balanced cleanser that gently removes dirt and excess oil without disrupting your skin’s protective layer. La Roche-Posay, Vanicream, and Paula’s Choice all offer reliable options for sensitive, acne-prone skin.
For hydration, choose a lightweight, oil-free moisturizer that supports the skin barrier without adding to congestion. Ingredients like hyaluronic acid, ceramides, and aloe vera are good options—hydrating, calming, and unlikely to trigger breakouts.
Natural Topical Treatments
Some natural ingredients have antibacterial or anti-inflammatory properties that may help reduce breakouts. These include:
- Tea tree oil: antimicrobial and anti-inflammatory, but must be diluted before use
- Green tea extract: high in antioxidants, which can help regulate oil and calm irritation
- Witch hazel: astringent and soothing, though best used sparingly to avoid dryness
- Aloe vera: supports healing and helps reduce redness
Use these ingredients cautiously. Even “natural” remedies can irritate sensitive skin if applied too often or too directly. Always do a patch test and dilute essential oils like tea tree oil before applying, or talk to your dermatologist or other skincare expert.
Ingredients to Look For and Avoid
When shopping for acne treatments, prioritize ingredients with clinical backing. Dr. Scott Elman recommends:
- Salicylic acid: helps clear pores and reduce inflammation
- Benzoyl peroxide: kills acne-causing bacteria
- Retinol: promotes cell turnover and improves texture
- Niacinamide: reduces oiliness, calms redness, and supports barrier repair
On the other hand, avoid products with known pore-clogging or irritating ingredients such as coconut oil, lanolin, mineral oil, petrolatum, and certain silicones. Not all silicones are problematic, but some can trap oil and bacteria if used in heavy formulations.
Always read product labels and introduce new ingredients one at a time to monitor how your skin reacts. Simplicity and consistency often yield better results than aggressive treatment plans.
Long-Term Skin Care During Perimenopause
Managing acne during perimenopause is an ongoing process. Hormonal shifts can change how your skin behaves, which means your usual routine may need some adjustments.
Why Your Old Routine Might Not Work
What worked well in your 20s or 30s might now leave your skin feeling dry, irritated, or unbalanced. You may find that switching to a gentler cleanser, adding a hydrating serum, or reducing how often you exfoliate helps support your skin’s changing needs.
Key Ingredients to Consider
Some people benefit from incorporating active ingredients like:
- Retinol: supports cell turnover and texture
- Vitamin C: helps with brightness and pigmentation
- Hyaluronic acid: draws moisture into the skin
- Ceramides: reinforce the skin barrier
Introduce these gradually, and adjust based on how your skin responds. The key is to stay consistent while staying flexible. Pay attention to how your skin feels, and make small changes as needed. That’s often more effective than overhauling your routine all at once.
What You Can Do at Home
To minimize long-term marks:
- Don’t pick: it increases the risk of acne scarring
- Use spot treatments: salicylic acid and benzoyl peroxide can help calm inflammation
- Brighten gently: look for ingredients like vitamin C or kojic acid
- Wear sunscreen daily: UV exposure can make discoloration worse and slow fading
When to Consider Professional Treatments
If dark spots or scars persist, a dermatologist may recommend:
- Chemical peels: to exfoliate and fade pigmentation
- Microneedling: to stimulate collagen and smooth texture
- Laser treatments: for more stubborn scarring or discoloration
When to Reach Out to a Professional
Over-the-counter products can often help with mild or occasional breakouts. But if your acne is severe, persistent, or not responding to over-the-counter treatments, it’s worth seeing a dermatologist.
It’s a good idea to make an appointment if:
- You’re dealing with deep, painful cysts
- Breakouts are widespread—across your face, chest, or back
- You’re noticing scarring or dark marks after breakouts
- Acne is starting to affect your quality of life or self-esteem
Dermatologists can offer a range of prescription treatments, including topical creams, oral medications, or in-office procedures that target deeper inflammation or hormonal triggers more effectively than what’s available over the counter.
To make a diagnosis, your dermatologist will examine your skin, assess the type and distribution of your acne, and ask about your health history, skincare habits, and lifestyle. In some cases, they may recommend bloodwork to check hormone levels or rule out other underlying conditions.
From there, they’ll create a treatment plan tailored to your skin and to the hormonal shifts happening during perimenopause.
A Clear Path to Healthier Skin During Perimenopause
Perimenopause acne can be frustrating, but keep in mind that it’s common, normal, and can be managed effectively.
Understanding the hormonal changes behind your breakouts allows for a more targeted approach to treatment. A gentle, consistent skincare routine tailored to your skin’s current needs is usually more effective than trying multiple products at once. What works for someone else may not be the right fit for you, so observe how your skin responds and adjust as needed.
If adult acne persists despite a consistent routine or significantly impacts your quality of life, you may want to consider consulting a dermatologist. Prescription medications or professional procedures can help improve outcomes and help prevent future scarring or pigmentation that you’d rather avoid.
Managing your perimenopause acne is an ongoing process rather than a quick fix. But with the right combination of proven skincare products and reliable information, clearer, healthier skin is achievable.
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Frequently Asked Questions (FAQ):
What is the best treatment for perimenopause acne?
Effective treatments include gentle cleansers with salicylic acid, a consistent skincare routine, and, if needed, consultation with a dermatologist for prescription options. Treatment plans can be tailored based on the severity of acne and individual skin needs.
How long does perimenopausal acne last?
Perimenopausal acne generally persists until hormone levels stabilize. This timeframe varies widely, lasting anywhere from several months to a few years during the menopausal transition.
Why am I suddenly getting acne on my face in my 40s?
Acne in your 40s often results from hormonal changes linked to perimenopause. Declining estrogen and fluctuating androgen levels increase oil production, which can trigger breakouts even if you didn’t have acne before.
What does perimenopausal skin look like?
During perimenopause, skin may become thinner, less elastic, and drier. Hormonal shifts affect oil production and hydration, which can increase sensitivity and susceptibility to acne.
