What Is Menopausal Acne?

Menopausal acne refers to breakouts that occur during perimenopause or early postmenopause, usually between ages 40 and 60. Unlike teenage acne, these blemishes are often deep, painful cysts that appear along the jawline, chin, and cheeks. Affecting up to 26% of women, menopausal acne is more than a cosmetic concern—it reflects broader hormonal imbalances happening in the body.

While many women find short-term relief with over-the-counter remedies, these approaches only manage surface-level symptoms. To truly address menopausal acne, it’s important to look at the root cause: hormonal imbalance.

What Causes Acne During Menopause?

The primary trigger for menopausal acne is hormone fluctuation. As estrogen levels decline, androgens like testosterone may become more dominant, leading to increased oil production and clogged pores. Other contributing factors include:

• Hormonal imbalance from declining estrogen and progesterone
• Dietary choices high in sugar or dairy
• Chronic stress that elevates cortisol and fuels inflammation
• Poor sleep that disrupts hormonal regulation
• Harsh or inappropriate skincare products

Hormone Roles in Menopausal Acne

• Estrogen: Lower levels reduce skin elasticity and hydration.
• Androgens (like testosterone): Higher activity increases oil production.
• Cortisol: Stress hormone that worsens inflammation.
• Insulin: Spikes from diet can disrupt hormonal balance and oil production.

For many women, underlying imbalances such as estrogen dominance or insulin resistance can make acne flare-ups more persistent.

Signs and Symptoms of Menopausal Acne

Menopausal acne often presents as:

• Painful, cystic pimples along the lower face
• Redness and inflammation
• Blemishes that heal slowly and may scar

Flare-ups can persist for months or years if untreated and often worsen with stress, poor sleep, or dietary triggers. Beyond physical discomfort, many women experience frustration or emotional distress from these unexpected skin changes.

How to Treat Menopausal Acne

Menopausal acne can be managed in different ways. While treatments may reduce symptoms and improve skin health, they are not always a cure—especially if the underlying hormonal imbalance remains unaddressed.

Over-the-Counter (OTC) Treatments

OTC remedies may provide temporary relief and symptom management but don’t necessarily address the root cause. Common options include:

• Benzoyl peroxide: Reduces acne-causing bacteria
• Salicylic acid: Helps clear clogged pores
• Azelaic acid: Minimizes redness and pigmentation
• Routine skincare: Gentle cleansers and non-comedogenic moisturizers

Prescription Treatments

When OTC remedies aren’t enough, prescription medications may be recommended:

• Retinoids: Encourage faster skin cell turnover
• Antibiotics: Reduce bacteria and inflammation
• Spironolactone: Blocks androgens that trigger oil production

Bioidentical Hormone Replacement Therapy (BHRT)

While topical and oral medications focus on managing symptoms, BHRT addresses hormonal imbalance—the root cause of many menopausal acne cases. Bioidentical hormone therapy uses plant-derived hormones identical to those in the body. By restoring estrogen and progesterone balance, BHRT can help reduce acne, improve skin quality, and support overall well-being.

When to Seek Professional Help

If OTC remedies fail, if acne becomes painful or leads to scarring, or if breakouts significantly affect self-esteem or daily life, it’s time to seek professional support. A provider can help determine whether hormone therapy, prescription treatment, or a root-cause approach is the right solution.